CMS Formulary

Displaying 138631-138640 of 1611142 results.
ID: 138631
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311277
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138632
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099563
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138633
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904932
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 138634
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313758
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138635
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199655
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138636
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349208
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138637
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 360110
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138638
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 206913
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138639
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 206917
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138640
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1657151
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30