CMS Formulary

Displaying 138371-138380 of 1611142 results.
ID: 138371
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 477391
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138372
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197877
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138373
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1010739
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138374
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 391937
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138375
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197305
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138376
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313786
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138377
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 212787
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138378
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1312408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138379
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1439894
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138380
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1439896
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0