CMS Formulary

Displaying 139101-139110 of 1611142 results.
ID: 139101
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897584
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139102
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897590
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139103
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897596
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139104
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 317769
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139105
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139106
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139107
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205284
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139108
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139109
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 643019
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139110
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 643022
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30