CMS Formulary

Displaying 142131-142140 of 1611142 results.
ID: 142131
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1648755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 365
ID: 142132
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 725021
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142133
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 725023
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142134
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 311994
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 365
ID: 142135
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 365
ID: 142136
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 365
ID: 142137
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142138
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 142139
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1080
Qty Limit Days: 365
ID: 142140
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30