CMS Formulary

Displaying 139421-139430 of 1611142 results.
ID: 139421
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 730869
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139422
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 897021
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139423
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2049264
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139424
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1856424
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139425
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2052064
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139426
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861375
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139427
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861370
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139428
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373745
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139429
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1922783
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139430
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 485442
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30