CMS Formulary

Displaying 139771-139780 of 1611142 results.
ID: 139771
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2265735
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139772
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 877417
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139773
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1809643
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139774
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1809499
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139775
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1664463
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139776
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1664440
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139777
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1664458
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139778
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1495070
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139779
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199888
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139780
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 151226
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0