CMS Formulary

Displaying 138711-138720 of 1611142 results.
ID: 138711
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 104894
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138712
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861132
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138713
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310352
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138714
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310353
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138715
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200257
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 960
Qty Limit Days: 30
ID: 138716
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200256
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 480
Qty Limit Days: 30
ID: 138717
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200258
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 138718
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313582
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138719
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313584
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138720
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314277
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0