CMS Formulary

Displaying 139311-139320 of 1611142 results.
ID: 139311
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197312
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139312
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 485496
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 750
Qty Limit Days: 30
ID: 139313
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 348719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 139314
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2183131
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139315
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 825134
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139316
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1801519
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139317
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 539789
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139318
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 856666
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139319
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213439
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139320
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979115
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0