CMS Formulary

Displaying 138491-138500 of 1611142 results.
ID: 138491
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858817
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138492
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858810
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138493
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308973
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138494
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858824
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138495
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858828
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138496
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308976
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138497
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310247
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138498
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310379
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138499
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310380
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138500
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1313112
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0