CMS Formulary

Displaying 142241-142250 of 1611142 results.
ID: 142241
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197797
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142242
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197726
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142243
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1653217
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142244
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 860225
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142245
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1111018
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142246
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 798061
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142247
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 212381
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142248
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2174818
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 310
Qty Limit Days: 31
ID: 142249
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1430383
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142250
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2104192
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0