CMS Formulary

Displaying 138411-138420 of 1611142 results.
ID: 138411
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739774
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138412
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2173500
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 138413
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739778
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138414
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739782
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138415
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 795085
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138416
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 849599
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138417
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739770
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138418
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251914
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138419
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 722256
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138420
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251918
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0