CMS Formulary

Displaying 135811-135820 of 1611142 results.
ID: 135811
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 647237
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135812
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 647239
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 135813
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198313
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135814
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198312
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135815
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 352210
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135816
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 198175
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 135817
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490032
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 135818
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490036
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 135819
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490040
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 135820
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 351156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0