CMS Formulary

Displaying 134301-134310 of 1611142 results.
ID: 134301
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197889
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134302
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 855172
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134303
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 242679
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134304
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 309313
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134305
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 351285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134306
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123194
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134307
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313565
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134308
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313564
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 134309
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199885
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134310
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 242438
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30