CMS Formulary

Displaying 138601-138610 of 1611142 results.
ID: 138601
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 580286
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 138602
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1313785
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138603
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 207588
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138604
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213510
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138605
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1433736
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138606
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310386
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138607
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199148
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 960
Qty Limit Days: 30
ID: 138608
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311787
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138609
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1605088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138610
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199370
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0