CMS Formulary

Displaying 138361-138370 of 1611142 results.
ID: 138361
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2100100
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 138362
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2054310
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138363
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2054313
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138364
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2054316
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138365
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2054318
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138366
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312614
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138367
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138368
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4500
Qty Limit Days: 30
ID: 138369
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197448
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138370
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0