CMS Formulary

Displaying 137651-137660 of 1611142 results.
ID: 137651
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197550
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137652
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2102717
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137653
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2102713
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137654
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2102715
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137655
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1314768
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 137656
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 211777
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137657
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 348506
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137658
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1719862
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137659
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1719803
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137660
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866103
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30