CMS Formulary

Displaying 138691-138700 of 1611142 results.
ID: 138691
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1649491
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138692
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1649495
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138693
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2168596
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 450
Qty Limit Days: 30
ID: 138694
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2045638
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 138695
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2120195
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 138696
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 727537
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138697
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1991509
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138698
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858125
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138699
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858127
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138700
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197699
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0