CMS Formulary

Displaying 139391-139400 of 1611142 results.
ID: 139391
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200224
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139392
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898350
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139393
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898353
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139394
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898356
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139395
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898359
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139396
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898342
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139397
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898346
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139398
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 562266
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139399
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139400
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0