CMS Formulary

Displaying 136511-136520 of 1611142 results.
ID: 136511
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 352228
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136512
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1653579
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 136513
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991722
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136514
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198148
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136515
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797833
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136516
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797844
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136517
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 393245
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136518
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 885857
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136519
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860901
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 200
Qty Limit Days: 30
ID: 136520
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351265
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30