CMS Formulary

Displaying 137641-137650 of 1611142 results.
ID: 137641
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 137642
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 137643
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137644
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 137645
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137646
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137647
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858262
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137648
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310023
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137649
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137650
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197549
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0