CMS Formulary

Displaying 136351-136360 of 1611142 results.
ID: 136351
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2370174
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136352
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2170613
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 30
ID: 136353
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2395785
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 136354
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2370170
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136355
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1946836
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136356
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1946840
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136357
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1946844
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136358
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2180671
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136359
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1946848
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136360
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 865098
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0