CMS Formulary

Displaying 138741-138750 of 1611142 results.
ID: 138741
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 853354
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138742
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 853356
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138743
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 848164
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138744
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1653144
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138745
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1482814
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138746
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1653166
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138747
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1100075
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138748
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2000019
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138749
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1994362
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138750
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1442992
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30