CMS Formulary

Displaying 139511-139520 of 1611142 results.
ID: 139511
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 898715
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 900
Qty Limit Days: 30
ID: 139512
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 282755
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139513
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205304
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139514
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 205305
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139515
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 409823
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139516
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 892582
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 139517
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 892672
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139518
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923822
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139519
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923828
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139520
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1923826
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0