CMS Formulary

Displaying 137241-137250 of 1611142 results.
ID: 137241
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310169
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137242
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 209789
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137243
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 209788
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137244
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861657
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137245
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 486148
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137246
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 486152
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137247
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 486146
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137248
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 577057
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 137249
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110510
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137250
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110513
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30