CMS Formulary

Displaying 136821-136830 of 1611142 results.
ID: 136821
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136822
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110455
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136823
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918209
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 136824
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918194
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 136825
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1918203
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 136826
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 136827
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904876
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 136828
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1314763
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 136829
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312594
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136830
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198141
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0