CMS Formulary

Displaying 139551-139560 of 1611142 results.
ID: 139551
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 835591
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139552
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 835577
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139553
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312940
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139554
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139555
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309081
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139556
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197452
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139557
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197453
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139558
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309110
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139559
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309113
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139560
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200345
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30