CMS Formulary

Displaying 139751-139760 of 1611142 results.
ID: 139751
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 801961
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 30
ID: 139752
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 801966
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 30
ID: 139753
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830877
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139754
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830879
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139755
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830882
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139756
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830897
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139757
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198363
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139758
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200220
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 139759
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139760
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 830845
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0