CMS Formulary

Displaying 135761-135770 of 1611142 results.
ID: 135761
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 403818
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135762
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 730869
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135763
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 897021
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135764
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049264
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135765
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1856424
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135766
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2052064
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135767
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 861375
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135768
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 861370
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135769
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1373745
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 135770
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1922783
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0