CMS Formulary

Displaying 139281-139290 of 1611142 results.
ID: 139281
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 242680
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 960
Qty Limit Days: 30
ID: 139282
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205292
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139283
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205290
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139284
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 315134
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139285
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866021
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139286
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1992303
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139287
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 427163
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139288
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313123
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139289
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139290
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198012
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0