CMS Formulary

Displaying 138081-138090 of 1611142 results.
ID: 138081
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312846
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138082
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283858
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138083
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 562704
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138084
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312849
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138085
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 997229
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138086
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 997223
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138087
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993503
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138088
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993518
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138089
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898723
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138090
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898687
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30