CMS Formulary

Displaying 140761-140770 of 1611142 results.
ID: 140761
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197978
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140762
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1246306
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 140763
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1246290
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 140764
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1666334
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140765
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1116639
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140766
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1872261
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 140767
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 793872
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140768
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 859192
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 140769
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2166094
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 200
Qty Limit Days: 28
ID: 140770
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 830876
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0