CMS Formulary

Displaying 137271-137280 of 1611142 results.
ID: 137271
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884535
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137272
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884532
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137273
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 245136
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 137274
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 245134
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 137275
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 245135
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 137276
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197696
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30
ID: 137277
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1870650
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137278
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 829762
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137279
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1191234
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137280
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1724338
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0