CMS Formulary

Displaying 138901-138910 of 1611142 results.
ID: 138901
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308459
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138902
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 141963
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138903
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309332
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 138904
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197519
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138905
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000126
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138906
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000153
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138907
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198232
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138908
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311727
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138909
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 317128
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138910
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309337
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0