CMS Formulary

Displaying 137611-137620 of 1611142 results.
ID: 137611
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137612
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198322
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137613
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308962
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137614
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 849395
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137615
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991039
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137616
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991194
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137617
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991336
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137618
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991044
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137619
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 991188
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137620
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 584414
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30