CMS Formulary

Displaying 138421-138430 of 1611142 results.
ID: 138421
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 724142
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138422
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 724156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138423
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1251922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138424
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1739788
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 138425
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1149617
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138426
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213197
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138427
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 997010
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138428
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866427
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138429
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866412
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138430
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866419
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0