CMS Formulary

Displaying 142121-142130 of 1611142 results.
ID: 142121
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 476515
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142122
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 805464
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 142123
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1659927
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142124
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2046585
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 124
Qty Limit Days: 31
ID: 142125
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 403878
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 142126
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1098143
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142127
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2200174
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 142128
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2200177
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 142129
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2200180
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 142130
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2200183
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31