CMS Formulary

Displaying 136861-136870 of 1611142 results.
ID: 136861
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904467
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136862
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904475
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136863
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490065
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136864
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199058
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136865
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 596843
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 136866
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308868
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136867
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403879
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 136868
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476556
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 136869
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197535
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136870
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310295
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30