CMS Formulary

Displaying 142361-142370 of 1611142 results.
ID: 142361
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1739782
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142362
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 795085
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 142363
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 849599
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 142364
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1739770
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142365
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1251914
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142366
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 722256
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142367
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1251918
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142368
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 724142
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142369
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 724156
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142370
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1251922
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0