CMS Formulary

Displaying 139431-139440 of 1611142 results.
ID: 139431
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 485465
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139432
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1989085
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 28
ID: 139433
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 582595
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 210
Qty Limit Days: 30
ID: 139434
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861966
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139435
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1442143
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139436
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1488667
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139437
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1488671
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139438
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1488675
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139439
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1488679
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139440
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1858833
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0