CMS Formulary

Displaying 139581-139590 of 1611142 results.
ID: 139581
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1650030
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139582
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198201
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139583
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 728109
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139584
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312122
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139585
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 833709
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139586
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 833711
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139587
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 833713
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139588
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200346
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139589
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139590
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309054
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0