CMS Formulary

Displaying 137071-137080 of 1611142 results.
ID: 137071
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1942485
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137072
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1942489
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137073
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2047639
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137074
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2053927
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137075
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1721571
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137076
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1721583
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137077
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1989109
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137078
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2205634
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137079
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1790644
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 137080
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2387331
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30