CMS Formulary

Displaying 136541-136550 of 1611142 results.
ID: 136541
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1874553
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136542
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 900575
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 136543
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 977427
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136544
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 977434
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136545
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 977438
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136546
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1304979
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136547
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 892625
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 136548
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311355
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136549
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197893
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136550
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313932
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0