CMS Formulary

Displaying 139731-139740 of 1611142 results.
ID: 139731
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1989507
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139732
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1876920
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139733
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1876924
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139734
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1876916
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139735
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308725
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139736
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855657
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139737
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1812011
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139738
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1812013
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139739
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 562806
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 139740
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 825130
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30