CMS Formulary

Displaying 137011-137020 of 1611142 results.
ID: 137011
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1246290
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 137012
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1666334
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137013
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1116639
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137014
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859192
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137015
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1539762
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137016
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991233
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137017
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308047
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137018
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308048
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137019
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197321
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137020
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197322
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30