CMS Formulary

Displaying 138721-138730 of 1611142 results.
ID: 138721
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313586
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138722
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138723
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138724
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866514
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138725
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476809
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138726
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197499
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138727
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197500
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138728
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198105
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138729
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198104
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138730
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1662285
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0