CMS Formulary

Displaying 136081-136090 of 1611142 results.
ID: 136081
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 825130
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136082
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 260260
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136083
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1370758
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136084
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 311382
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136085
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1366550
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136086
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 861668
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 136087
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 830795
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136088
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 831359
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136089
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313453
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136090
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 359050
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0