CMS Formulary

Displaying 137021-137030 of 1611142 results.
ID: 137021
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197444
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137022
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197445
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137023
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197816
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137024
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197815
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137025
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1001004
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137026
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351264
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137027
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 848951
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137028
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 834346
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137029
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993466
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137030
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993470
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0