CMS Formulary

Displaying 134071-134080 of 1611142 results.
ID: 134071
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 402131
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134072
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 349545
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134073
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 349490
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134074
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 349553
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134075
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 349547
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134076
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 730866
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134077
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 730861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134078
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 730872
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134079
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856373
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134080
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310288
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0