CMS Formulary

Displaying 138941-138950 of 1611142 results.
ID: 138941
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 903887
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138942
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 903891
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138943
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 903884
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138944
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 242446
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138945
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213291
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138946
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1111339
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138947
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860805
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138948
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1111343
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138949
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 284008
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138950
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313919
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28