CMS Formulary

Displaying 139521-139530 of 1611142 results.
ID: 139521
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490026
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139522
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490034
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139523
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1490038
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139524
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1597620
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139525
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313580
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139526
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1996246
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139527
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859081
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139528
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1486691
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139529
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1111020
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139530
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1653221
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0