CMS Formulary

Displaying 134701-134710 of 1611142 results.
ID: 134701
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2100099
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 134702
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2100100
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 134703
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054310
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134704
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054313
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134705
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054316
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134706
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054318
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 134707
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312614
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134708
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 283077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134709
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 134710
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0