CMS Formulary

Displaying 139011-139020 of 1611142 results.
ID: 139011
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 966241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139012
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 966243
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139013
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049223
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 139014
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049227
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 139015
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1049216
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 139016
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854801
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139017
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313477
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139018
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861200
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139019
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861208
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139020
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000647
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0