CMS Formulary

Displaying 138291-138300 of 1611142 results.
ID: 138291
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860215
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138292
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860221
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138293
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198056
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138294
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351276
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138295
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349194
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138296
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138297
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349198
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138298
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403825
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138299
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312439
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138300
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198103
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0