CMS Formulary

Displaying 138771-138780 of 1611142 results.
ID: 138771
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1601407
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 1
ID: 138772
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 809159
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138773
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 802652
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138774
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1653225
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138775
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2182340
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138776
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2392142
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138777
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 261105
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138778
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1310531
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138779
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1310535
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138780
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2110618
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30