CMS Formulary

Displaying 141491-141500 of 1611142 results.
ID: 141491
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 211777
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141492
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2107621
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 141493
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 348506
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141494
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1719862
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141495
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1719803
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 141496
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 866103
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 141497
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 672567
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 141498
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 672569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 141499
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 672571
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 141500
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1370748
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0