CMS Formulary

Displaying 139111-139120 of 1611142 results.
ID: 139111
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866482
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139112
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866479
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139113
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349401
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139114
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349405
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139115
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205322
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139116
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205323
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139117
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403853
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139118
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403854
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139119
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403855
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139120
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859981
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30