CMS Formulary

Displaying 136841-136850 of 1611142 results.
ID: 136841
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1652084
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136842
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1006801
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 136843
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 996921
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136844
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136845
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136846
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 136847
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136848
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 485440
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136849
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 899511
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136850
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 899439
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0