CMS Formulary

Displaying 138001-138010 of 1611142 results.
ID: 138001
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 639537
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138002
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 578325
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138003
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 578330
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138004
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 802749
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138005
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861822
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 138006
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1095712
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138007
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665515
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138008
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1719286
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138009
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2045201
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138010
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313115
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0