CMS Formulary

Displaying 136151-136160 of 1611142 results.
ID: 136151
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 483448
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136152
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 483446
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136153
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 312515
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136154
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310155
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136155
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 315090
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136156
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310157
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136157
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1795598
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136158
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1366192
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 136159
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1796922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136160
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 311913
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0