CMS Formulary

Displaying 137221-137230 of 1611142 results.
ID: 137221
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137222
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1855389
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137223
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199689
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137224
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 603208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137225
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 603203
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137226
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 603206
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137227
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 748961
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137228
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 751901
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137229
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 810096
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137230
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 749761
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0