CMS Formulary

Displaying 140141-140150 of 1611142 results.
ID: 140141
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 762852
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140142
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 762859
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140143
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 762868
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140144
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 762897
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140145
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 260285
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140146
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205826
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140147
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1011987
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140148
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1009341
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 31
ID: 140149
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 858366
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140150
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1000089
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0