CMS Formulary

Displaying 139801-139810 of 1611142 results.
ID: 139801
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310431
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139802
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1731020
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139803
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 403930
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139804
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1944656
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139805
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197843
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139806
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197844
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139807
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197845
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139808
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 728113
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 139809
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 483442
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139810
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 483448
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30