CMS Formulary

Displaying 138451-138460 of 1611142 results.
ID: 138451
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1655934
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 112
Qty Limit Days: 28
ID: 138452
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2053512
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 138453
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904447
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138454
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 284592
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138455
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 284594
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138456
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 284593
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138457
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 284595
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138458
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904158
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138459
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861495
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138460
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861448
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0