CMS Formulary

Displaying 138381-138390 of 1611142 results.
ID: 138381
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1439899
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138382
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1439901
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138383
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1439903
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138384
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2105657
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 138385
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2105645
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138386
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2105653
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 138387
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2180336
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138388
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 615979
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138389
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402252
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138390
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 207059
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 30