CMS Formulary

Displaying 138331-138340 of 1611142 results.
ID: 138331
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 749783
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138332
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 248656
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138333
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 749780
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138334
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 204844
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138335
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198372
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138336
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198369
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138337
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138338
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1659803
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138339
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1242819
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 30
ID: 138340
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1242815
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30