CMS Formulary

Displaying 139491-139500 of 1611142 results.
ID: 139491
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 106351
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139492
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198241
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139493
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198242
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139494
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308136
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139495
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197361
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139496
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310432
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139497
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311880
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139498
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 317174
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139499
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312745
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139500
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 616483
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30