CMS Formulary

Displaying 139741-139750 of 1611142 results.
ID: 139741
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 260260
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139742
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1370758
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139743
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311382
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139744
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1366550
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139745
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861668
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 139746
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830795
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139747
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 831359
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139748
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313453
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139749
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 359050
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139750
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 801957
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 30