CMS Formulary

Displaying 136411-136420 of 1611142 results.
ID: 136411
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 665040
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136412
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 744846
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136413
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 665036
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136414
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1547114
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136415
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1547118
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136416
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1235595
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136417
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1235591
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136418
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 668606
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136419
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861821
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136420
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861771
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30