CMS Formulary

Displaying 137301-137310 of 1611142 results.
ID: 137301
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 727575
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137302
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1653470
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137303
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1086776
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137304
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1086780
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137305
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1086786
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137306
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307415
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137307
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307421
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137308
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1869699
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137309
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1805427
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137310
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1602588
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30