CMS Formulary

Displaying 135291-135300 of 1611142 results.
ID: 135291
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313919
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 135292
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797865
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135293
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797867
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135294
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135295
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 860107
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135296
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 904481
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135297
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 260218
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135298
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 205324
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135299
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135300
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30