CMS Formulary

Displaying 137471-137480 of 1611142 results.
ID: 137471
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 828299
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137472
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1745091
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137473
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1801289
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137474
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311892
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137475
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311893
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137476
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199521
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 137477
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 996572
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137478
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198076
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137479
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198077
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137480
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198078
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0