CMS Formulary

Displaying 139531-139540 of 1611142 results.
ID: 139531
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311288
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139532
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311289
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139533
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 387003
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139534
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 807832
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139535
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 846378
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139536
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309112
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139537
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309114
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139538
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 828373
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139539
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310274
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139540
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313570
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30