CMS Formulary

Displaying 139341-139350 of 1611142 results.
ID: 139341
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309078
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139342
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198352
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139343
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200031
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139344
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139345
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 315223
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 139346
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313161
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 139347
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313160
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 30
ID: 139348
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854873
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139349
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310796
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139350
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310797
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30