CMS Formulary

Displaying 137701-137710 of 1611142 results.
ID: 137701
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311725
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137702
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311726
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137703
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884386
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 137704
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884385
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 137705
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993770
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 390
Qty Limit Days: 30
ID: 137706
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993890
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 390
Qty Limit Days: 30
ID: 137707
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 864718
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 137708
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197593
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137709
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199168
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137710
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312357
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0