CMS Formulary

Displaying 138241-138250 of 1611142 results.
ID: 138241
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1658241
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 1
ID: 138242
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1939299
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138243
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1939348
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138244
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 577324
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138245
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 727316
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 138246
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1870207
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 138247
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1374574
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 138248
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2001430
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138249
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2003255
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138250
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2043464
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30