CMS Formulary

Displaying 139401-139410 of 1611142 results.
ID: 139401
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139402
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139403
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 664741
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139404
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 833528
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139405
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 722134
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139406
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139407
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 722126
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139408
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 722131
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139409
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860715
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139410
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 860695
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30