CMS Formulary

Displaying 138891-138900 of 1611142 results.
ID: 138891
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1048450
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138892
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1048445
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138893
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855626
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138894
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1607617
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138895
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311345
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138896
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198200
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138897
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349514
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138898
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351256
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138899
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351257
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138900
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310261
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0