CMS Formulary

Displaying 137751-137760 of 1611142 results.
ID: 137751
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 643070
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137752
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 797697
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137753
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855926
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137754
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855906
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137755
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855664
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137756
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 995281
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137757
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1095227
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137758
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1304988
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137759
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1661092
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137760
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309079
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0