CMS Formulary

Displaying 134121-134130 of 1611142 results.
ID: 134121
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 317573
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 134122
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312440
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134123
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312441
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134124
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134125
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197956
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134126
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197958
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134127
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 200064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134128
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199224
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134129
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313190
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134130
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198377
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0