CMS Formulary

Displaying 138541-138550 of 1611142 results.
ID: 138541
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312138
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138542
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312839
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 138543
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312837
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 138544
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091341
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1800
Qty Limit Days: 30
ID: 138545
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138546
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310599
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138547
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856535
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138548
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856569
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138549
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856460
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138550
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856481
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0