CMS Formulary

Displaying 139121-139130 of 1611142 results.
ID: 139121
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859975
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139122
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283316
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139123
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283317
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139124
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 477130
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139125
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 849389
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139126
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313407
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139127
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313408
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139128
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1536490
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139129
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310878
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139130
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311982
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0