CMS Formulary

Displaying 138481-138490 of 1611142 results.
ID: 138481
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1246096
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138482
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138483
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 103456
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138484
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310891
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138485
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308979
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138486
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197686
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138487
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197303
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138488
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197304
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138489
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197853
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138490
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858813
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30