CMS Formulary

Displaying 136161-136170 of 1611142 results.
ID: 136161
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744001
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136162
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744005
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136163
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1744009
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136164
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1243585
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136165
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 313988
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136166
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 309307
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136167
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790684
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136168
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 197854
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136169
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 201912
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136170
Formulary ID: 00021056
Formulary Version: 15
Contract Year: 2021
RXCUI: 310003
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0