CMS Formulary

Displaying 139151-139160 of 1611142 results.
ID: 139151
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139152
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855873
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139153
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308989
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139154
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308988
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139155
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197443
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139156
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099678
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139157
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099870
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139158
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1356563
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139159
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1356572
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139160
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1356576
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30