CMS Formulary

Displaying 138931-138940 of 1611142 results.
ID: 138931
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197626
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138932
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197627
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138933
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197628
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138934
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199390
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138935
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197553
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138936
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 328160
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138937
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310490
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 138938
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310488
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138939
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993687
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138940
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 993691
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0