CMS Formulary

Displaying 136461-136470 of 1611142 results.
ID: 136461
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 762859
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136462
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 762868
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136463
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 762897
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136464
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 260285
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136465
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205826
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136466
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1011987
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136467
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856935
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136468
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1009341
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136469
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000089
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136470
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1190955
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30