CMS Formulary

Displaying 139821-139830 of 1611142 results.
ID: 139821
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1744005
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139822
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1744009
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139823
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1243585
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139824
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313988
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139825
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309307
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139826
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1790684
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139827
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197854
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139828
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 201912
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139829
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310003
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139830
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310004
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0