CMS Formulary

Displaying 136001-136010 of 1611142 results.
ID: 136001
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 656659
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136002
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 905158
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136003
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199376
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136004
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 199381
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136005
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 898490
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136006
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 686429
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136007
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136008
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 311919
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136009
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988308
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136010
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0