CMS Formulary

Displaying 135561-135570 of 1611142 results.
ID: 135561
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 861379
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135562
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 861383
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135563
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1743549
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135564
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1795477
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135565
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 581531
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135566
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371050
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 135567
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371054
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 135568
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371058
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 135569
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371062
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 135570
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2371066
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30