CMS Formulary

Displaying 137941-137950 of 1611142 results.
ID: 137941
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884189
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137942
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099625
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137943
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 996571
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 137944
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 996561
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137945
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854916
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137946
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854919
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137947
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854908
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137948
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 201708
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137949
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 248420
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137950
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351172
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30