CMS Formulary

Displaying 139141-139150 of 1611142 results.
ID: 139141
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476349
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139142
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476350
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139143
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 476351
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139144
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139145
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139146
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139147
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139148
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139149
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139150
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0