CMS Formulary

Displaying 139331-139340 of 1611142 results.
ID: 139331
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308194
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139332
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308182
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139333
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283406
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139334
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283407
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139335
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 283485
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139336
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 756209
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1920
Qty Limit Days: 30
ID: 139337
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311943
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 139338
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313850
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139339
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313222
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139340
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309076
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0