CMS Formulary

Displaying 136521-136530 of 1611142 results.
ID: 136521
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351266
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136522
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351267
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136523
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905172
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136524
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905168
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136525
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 892589
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3000
Qty Limit Days: 30
ID: 136526
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 894780
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1500
Qty Limit Days: 30
ID: 136527
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 997170
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136528
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 997287
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136529
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 997296
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136530
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310792
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30