CMS Formulary

Displaying 134451-134460 of 1611142 results.
ID: 134451
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597974
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134452
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597987
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134453
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597977
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134454
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597971
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134455
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 403908
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134456
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198038
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134457
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198039
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134458
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134459
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1010600
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 134460
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307056
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30