CMS Formulary

Displaying 136621-136630 of 1611142 results.
ID: 136621
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2102456
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136622
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2099956
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136623
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2058926
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136624
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2102460
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136625
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2047602
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136626
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2047608
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136627
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2047614
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136628
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2047596
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136629
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2047623
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136630
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2463737
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0