CMS Formulary

Displaying 138471-138480 of 1611142 results.
ID: 138471
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 203088
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 138472
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313227
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138473
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 857366
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 138474
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313226
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138475
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308715
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138476
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 848208
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138477
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 848176
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138478
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 848178
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138479
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 896110
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138480
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1191310
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0