CMS Formulary

Displaying 136481-136490 of 1611142 results.
ID: 136481
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402092
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136482
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861637
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136483
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861206
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136484
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136485
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854859
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136486
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 136487
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136488
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136489
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797880
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136490
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1113046
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0