CMS Formulary

Displaying 139791-139800 of 1611142 results.
ID: 139791
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1373497
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139792
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403875
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139793
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310430
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139794
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310459
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139795
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 828320
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139796
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 314285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139797
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198006
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139798
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198007
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139799
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198008
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139800
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0