CMS Formulary

Displaying 138011-138020 of 1611142 results.
ID: 138011
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 239240
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138012
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1596108
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 138013
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 809871
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138014
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197873
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 138015
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2058845
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 138016
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 864661
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138017
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2001424
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138018
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1363408
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138019
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1363410
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138020
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1364581
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0