CMS Formulary

Displaying 142161-142170 of 1611142 results.
ID: 142161
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 763106
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142162
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1658241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142163
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1939299
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142164
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1939348
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142165
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 577324
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142166
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 727316
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142167
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870207
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142168
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1374574
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 224
Qty Limit Days: 56
ID: 142169
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2001430
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 142170
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2003255
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31