CMS Formulary

Displaying 138851-138860 of 1611142 results.
ID: 138851
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1721690
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138852
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 212219
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138853
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213475
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138854
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 794610
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138855
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 831870
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138856
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 850457
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 138857
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1236632
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 400
Qty Limit Days: 30
ID: 138858
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1359271
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138859
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 758555
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138860
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1052660
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30