CMS Formulary

Displaying 139961-139970 of 1611142 results.
ID: 139961
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1659161
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 139962
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2472789
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 139963
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2478450
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 139964
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 2369403
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 139965
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1594673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139966
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905059
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139967
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905064
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139968
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 905057
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139969
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198050
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139970
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198049
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0