CMS Formulary

Displaying 138961-138970 of 1611142 results.
ID: 138961
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138962
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138963
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 138964
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 138965
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 138966
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138967
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138968
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351107
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138969
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859193
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138970
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 686379
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30