CMS Formulary

Displaying 138131-138140 of 1611142 results.
ID: 138131
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1649996
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 138132
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1650004
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 138133
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 582984
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138134
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2477272
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138135
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 795749
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 138136
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1809520
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138137
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 239189
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138138
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665107
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138139
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309072
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138140
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 863538
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0