CMS Formulary

Displaying 138261-138270 of 1611142 results.
ID: 138261
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1546894
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138262
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1857913
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138263
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1857917
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138264
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1857925
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1840
Qty Limit Days: 30
ID: 138265
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1989506
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138266
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2122526
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138267
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2380551
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138268
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2374566
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 138269
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197839
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138270
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313447
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0