CMS Formulary

Displaying 139381-139390 of 1611142 results.
ID: 139381
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311296
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139382
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200285
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139383
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349353
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139384
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 636042
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139385
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 636045
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139386
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 251872
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139387
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314200
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139388
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349483
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139389
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349199
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139390
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349200
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30