CMS Formulary

Displaying 135701-135710 of 1611142 results.
ID: 135701
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 248109
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135702
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314108
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135703
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 311290
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135704
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 854984
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135705
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 854988
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135706
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 854925
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135707
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 857166
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 135708
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 857174
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 135709
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 904431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 135710
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312087
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0