CMS Formulary

Displaying 138191-138200 of 1611142 results.
ID: 138191
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 884520
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 138192
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 755470
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138193
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 544452
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138194
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597768
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138195
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597770
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138196
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597772
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138197
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403975
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138198
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 259306
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138199
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1799654
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138200
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 105292
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0