CMS Formulary

Displaying 136811-136820 of 1611142 results.
ID: 136811
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617296
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136812
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 636664
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136813
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 608328
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136814
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1148141
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 136815
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861960
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136816
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905032
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136817
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1090996
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136818
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197595
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136819
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136820
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884707
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30