CMS Formulary

Displaying 139471-139480 of 1611142 results.
ID: 139471
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 647239
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139472
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198313
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139473
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198312
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139474
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 352210
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139475
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198175
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139476
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490032
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139477
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490036
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139478
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490040
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139479
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139480
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1361615
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0