CMS Formulary

Displaying 139221-139230 of 1611142 results.
ID: 139221
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861383
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139222
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1743549
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139223
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1795477
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139224
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 581531
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139225
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2371050
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 139226
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2371054
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 139227
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2371058
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 139228
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2371062
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 139229
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2371066
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 139230
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1482513
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30