CMS Formulary

Displaying 138951-138960 of 1611142 results.
ID: 138951
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797865
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138952
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797867
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138953
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138954
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860107
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138955
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 904481
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138956
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 260218
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138957
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205324
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 138958
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138959
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138960
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30