CMS Formulary

Displaying 138101-138110 of 1611142 results.
ID: 138101
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 208185
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138102
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 577127
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138103
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 404013
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138104
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 404011
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138105
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597990
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138106
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597984
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138107
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597993
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138108
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597967
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138109
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597980
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138110
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597974
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30