CMS Formulary

Displaying 141431-141440 of 1611142 results.
ID: 141431
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 745302
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141432
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 314227
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 141433
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 142046
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141434
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 244374
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141435
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 238004
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141436
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 313921
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 28
ID: 141437
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 238003
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141438
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 403923
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141439
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 241946
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141440
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 388525
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0