CMS Formulary

Displaying 137781-137790 of 1611142 results.
ID: 137781
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312440
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137782
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312441
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137783
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199123
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137784
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197956
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137785
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197958
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137786
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137787
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199224
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137788
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313190
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137789
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198377
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137790
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198378
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0