CMS Formulary

Displaying 142171-142180 of 1611142 results.
ID: 142171
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2043464
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 142172
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1246321
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142173
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2102784
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142174
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 865208
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142175
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 865212
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142176
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 865216
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142177
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 723827
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142178
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 729201
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142179
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 729203
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142180
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1796079
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0