CMS Formulary

Displaying 139831-139840 of 1611142 results.
ID: 139831
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310005
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139832
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1099681
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139833
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197682
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139834
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 866910
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139835
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 308867
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139836
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198037
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139837
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1092357
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139838
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1798370
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139839
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1798375
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139840
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 200132
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30