CMS Formulary

Displaying 136381-136390 of 1611142 results.
ID: 136381
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 847199
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136382
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136383
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136384
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136385
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136386
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 799830
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136387
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1045408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136388
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1045404
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136389
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1364441
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136390
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1364447
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30