CMS Formulary

Displaying 135621-135630 of 1611142 results.
ID: 135621
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313428
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135622
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 242680
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 960
Qty Limit Days: 30
ID: 135623
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 205292
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 135624
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 205290
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 135625
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 315134
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135626
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 866021
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135627
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1992303
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135628
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 427163
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135629
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313123
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135630
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0