CMS Formulary

Displaying 135301-135310 of 1611142 results.
ID: 135301
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135302
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135303
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135304
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 135305
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 135306
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 135307
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135308
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135309
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 351107
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135310
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 859193
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0