CMS Formulary

Displaying 138341-138350 of 1611142 results.
ID: 138341
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 616749
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138342
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 728231
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138343
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 477367
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138344
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 477372
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138345
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1657212
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138346
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1147228
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 138347
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2197873
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 138348
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2197877
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 138349
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205532
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 138350
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1592285
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30