CMS Formulary

Displaying 134391-134400 of 1611142 results.
ID: 134391
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 904880
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 134392
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 891881
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 134393
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 891888
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 134394
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 891893
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 134395
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 891874
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 134396
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 892646
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134397
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 848726
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134398
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 848738
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134399
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 848742
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134400
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 848746
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30