CMS Formulary

Displaying 137971-137980 of 1611142 results.
ID: 137971
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200095
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137972
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200096
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137973
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197311
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137974
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197313
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137975
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313566
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 137976
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 485434
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137977
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 485436
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137978
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859424
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137979
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859747
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137980
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859751
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30