CMS Formulary

Displaying 138111-138120 of 1611142 results.
ID: 138111
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597987
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138112
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597977
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138113
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597971
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138114
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403908
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138115
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198038
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138116
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198039
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138117
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138118
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1010600
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 138119
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307056
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138120
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1010604
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30