CMS Formulary

Displaying 137991-138000 of 1611142 results.
ID: 137991
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283639
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137992
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200284
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137993
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312076
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137994
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351108
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137995
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349251
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137996
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905041
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 137997
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905092
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137998
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905100
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 137999
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 153822
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138000
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 153823
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30