CMS Formulary

Displaying 137961-137970 of 1611142 results.
ID: 137961
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855172
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137962
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 242679
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137963
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309313
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137964
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137965
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2123194
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137966
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313565
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 137967
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313564
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137968
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199885
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137969
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 242438
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137970
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200094
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30