CMS Formulary

Displaying 138971-138980 of 1611142 results.
ID: 138971
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855818
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138972
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855812
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138973
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665050
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138974
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665093
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138975
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665088
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138976
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665046
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138977
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091650
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138978
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1091654
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138979
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1235150
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 138980
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1235157
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30