CMS Formulary

Displaying 139131-139140 of 1611142 results.
ID: 139131
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 104884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139132
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139133
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197939
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139134
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197940
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139135
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 886662
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139136
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 886666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139137
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 886671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139138
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 686400
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139139
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1190572
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139140
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476345
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30