CMS Formulary

Displaying 139191-139200 of 1611142 results.
ID: 139191
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197518
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139192
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 284215
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139193
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1658221
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139194
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 544840
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139195
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313165
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 139196
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 865129
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139197
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1807513
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139198
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312447
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139199
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313416
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139200
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 597823
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0