CMS Formulary

Displaying 142221-142230 of 1611142 results.
ID: 142221
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 198056
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142222
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 351276
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142223
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 728207
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142224
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349194
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 142225
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349195
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 142226
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349198
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 142227
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 403825
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 142228
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 312439
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142229
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 198103
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142230
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 250820
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0