CMS Formulary

Displaying 138621-138630 of 1611142 results.
ID: 138621
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313413
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138622
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314286
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138623
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313776
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138624
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313777
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138625
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313778
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138626
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313995
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138627
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314214
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138628
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312835
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138629
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314215
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138630
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312836
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30