CMS Formulary

Displaying 137361-137370 of 1611142 results.
ID: 137361
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860918
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137362
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859841
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137363
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313159
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 137364
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197516
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137365
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197517
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137366
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 996740
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 137367
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311369
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 320
Qty Limit Days: 30
ID: 137368
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1482908
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 137369
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310497
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137370
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0