CMS Formulary

Displaying 137191-137200 of 1611142 results.
ID: 137191
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855863
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137192
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313366
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137193
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000070
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137194
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1536586
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137195
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 242333
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137196
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 241527
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137197
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403922
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137198
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402109
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137199
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855875
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137200
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 834235
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0