CMS Formulary

Displaying 134141-134150 of 1611142 results.
ID: 134141
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197528
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 134142
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197529
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 134143
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312744
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 134144
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 616487
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 134145
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312962
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134146
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 349332
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134147
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 351250
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134148
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856834
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134149
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856845
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134150
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 856853
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0