CMS Formulary

Displaying 139371-139380 of 1611142 results.
ID: 139371
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198335
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139372
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979468
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139373
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979464
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139374
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 979471
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139375
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198188
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139376
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313134
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139377
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 562508
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139378
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861783
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139379
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 617430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139380
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199884
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0