CMS Formulary

Displaying 134531-134540 of 1611142 results.
ID: 134531
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 798133
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134532
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 884520
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 134533
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 755470
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134534
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 544452
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134535
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597768
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134536
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597770
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134537
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 597772
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134538
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 403975
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134539
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 259306
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134540
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1799654
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0