CMS Formulary

Displaying 134961-134970 of 1611142 results.
ID: 134961
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313412
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134962
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313413
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134963
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314286
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134964
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313776
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134965
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313777
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134966
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313778
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134967
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313995
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 134968
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314214
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134969
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 134970
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314215
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30