CMS Formulary

Displaying 137691-137700 of 1611142 results.
ID: 137691
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 209002
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137692
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 208420
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137693
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2055676
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137694
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2055672
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137695
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1010603
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137696
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137697
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1010606
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137698
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307063
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137699
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137700
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858798
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30