CMS Formulary

Displaying 137381-137390 of 1611142 results.
ID: 137381
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197863
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137382
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197556
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137383
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197554
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137384
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197555
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137385
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137386
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1009145
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137387
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 687043
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137388
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 577957
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137389
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000114
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137390
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199159
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0