CMS Formulary

Displaying 136871-136880 of 1611142 results.
ID: 136871
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310297
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136872
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313992
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136873
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313993
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136874
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310293
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136875
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310294
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 136876
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1299903
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136877
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2000695
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136878
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1299909
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136879
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197507
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136880
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1362706
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0