CMS Formulary

Displaying 138221-138230 of 1611142 results.
ID: 138221
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138222
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138223
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310362
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138224
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138225
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1435115
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 138226
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099808
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138227
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1484296
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138228
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1190919
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 138229
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1244205
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 138230
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830470
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1