CMS Formulary

Displaying 137821-137830 of 1611142 results.
ID: 137821
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 863619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137822
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137823
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137824
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1190655
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137825
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 545236
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137826
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1724340
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137827
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137828
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308345
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137829
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197636
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137830
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 260243
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0