CMS Formulary

Displaying 139261-139270 of 1611142 results.
ID: 139261
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 902624
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139262
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 902626
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139263
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139264
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139265
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139266
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139267
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2384465
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28
ID: 139268
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1670324
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 139269
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1670322
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 139270
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1600774
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0