CMS Formulary

Displaying 139451-139460 of 1611142 results.
ID: 139451
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861654
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139452
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349591
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139453
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349592
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139454
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 349593
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139455
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1011736
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139456
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1011739
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139457
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 388311
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139458
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200133
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139459
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200131
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139460
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 896184
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30