CMS Formulary

Displaying 138161-138170 of 1611142 results.
ID: 138161
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 977978
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138162
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309289
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138163
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309291
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138164
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 705129
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138165
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 895487
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138166
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 895987
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138167
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 797274
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138168
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1597120
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138169
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1597126
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138170
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310982
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30