CMS Formulary

Displaying 138171-138180 of 1611142 results.
ID: 138171
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313189
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138172
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309290
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138173
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138174
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313852
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138175
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 106336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138176
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1191307
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138177
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 543460
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138178
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197574
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 138179
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 358917
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138180
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309333
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0