CMS Formulary

Displaying 137731-137740 of 1611142 results.
ID: 137731
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349545
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137732
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349490
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137733
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349553
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137734
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349547
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137735
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 730866
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137736
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 730861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137737
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 730872
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137738
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856373
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137739
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310288
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137740
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197985
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0