CMS Formulary

Displaying 137771-137780 of 1611142 results.
ID: 137771
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855633
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137772
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1607784
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137773
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199245
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 137774
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199246
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137775
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199247
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137776
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314231
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137777
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312961
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137778
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198211
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137779
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200060
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137780
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 317573
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30