CMS Formulary

Displaying 139351-139360 of 1611142 results.
ID: 139351
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310809
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139352
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139353
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139354
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310384
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139355
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310385
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139356
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313989
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139357
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979485
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139358
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979492
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139359
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979480
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139360
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 248109
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0