CMS Formulary

Displaying 138211-138220 of 1611142 results.
ID: 138211
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2200180
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 138212
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2200183
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138213
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1648755
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138214
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 725021
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138215
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 725023
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138216
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138217
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138218
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138219
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138220
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 780
Qty Limit Days: 30