CMS Formulary

Displaying 136741-136750 of 1611142 results.
ID: 136741
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 420
Qty Limit Days: 30
ID: 136742
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136743
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2123314
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136744
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2121096
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 136745
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2121100
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136746
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1298099
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136747
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 545293
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136748
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 207029
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136749
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 665022
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 136750
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2196592
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 30