CMS Formulary

Displaying 135201-135210 of 1611142 results.
ID: 135201
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1052660
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135202
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1250723
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 135203
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1600710
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135204
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1999587
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 135205
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1364515
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135206
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2373941
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135207
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049677
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135208
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 762675
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135209
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 259966
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135210
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197973
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0