CMS Formulary

Displaying 139251-139260 of 1611142 results.
ID: 139251
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1876674
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139252
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1812434
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139253
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139254
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198252
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139255
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373489
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139256
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373493
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139257
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373498
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139258
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1040058
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139259
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 858804
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139260
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 794641
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30