CMS Formulary

Displaying 139701-139710 of 1611142 results.
ID: 139701
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855480
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139702
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855474
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139703
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 749860
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139704
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198373
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139705
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1094543
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139706
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859033
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139707
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859040
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139708
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139709
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855642
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139710
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312504
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0