CMS Formulary

Displaying 134471-134480 of 1611142 results.
ID: 134471
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650282
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 134472
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649996
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 134473
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650004
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 134474
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 582984
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134475
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2477272
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134476
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 795749
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 134477
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1809520
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134478
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 239189
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134479
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1665107
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134480
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 309072
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0