CMS Formulary

Displaying 137601-137610 of 1611142 results.
ID: 137601
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476576
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137602
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617423
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137603
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617993
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137604
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 745302
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137605
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314227
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 137606
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 142046
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137607
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 244374
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137608
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 238004
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137609
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313921
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137610
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28