CMS Formulary

Displaying 136231-136240 of 1611142 results.
ID: 136231
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136232
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313364
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136233
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313361
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136234
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197558
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136235
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197557
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136236
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 903843
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136237
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1599841
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136238
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049884
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136239
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2265701
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136240
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 2283505
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30