CMS Formulary

Displaying 136751-136760 of 1611142 results.
ID: 136751
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1720881
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136752
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251596
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136753
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 207035
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136754
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1246313
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 30
ID: 136755
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1246310
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 30
ID: 136756
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 261101
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136757
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 847232
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136758
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 285018
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136759
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866094
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136760
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866083
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0