CMS Formulary

Displaying 138251-138260 of 1611142 results.
ID: 138251
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1246321
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138252
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 865208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138253
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 865212
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138254
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 865216
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138255
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 723827
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1800
Qty Limit Days: 30
ID: 138256
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 729201
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138257
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 729203
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138258
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1796079
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138259
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1796083
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138260
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1433879
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30