CMS Formulary

Displaying 139021-139030 of 1611142 results.
ID: 139021
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000862
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139022
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1000897
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139023
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923428
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139024
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 831109
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139025
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 978573
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139026
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308720
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139027
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1605071
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139028
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1605075
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139029
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314072
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139030
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 244967
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0