CMS Formulary

Displaying 137261-137270 of 1611142 results.
ID: 137261
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091497
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137262
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091392
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137263
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091145
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137264
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091225
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137265
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897696
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 137266
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897702
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 137267
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897710
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 137268
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 864706
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 137269
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049611
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 137270
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049618
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30