CMS Formulary

Displaying 139301-139310 of 1611142 results.
ID: 139301
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 259081
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139302
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 835603
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 139303
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283536
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139304
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199387
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139305
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312085
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139306
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308429
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139307
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283523
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139308
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198358
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139309
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099569
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139310
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1244214
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0