CMS Formulary

Displaying 142421-142430 of 1611142 results.
ID: 142421
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 315059
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142422
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 103457
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 28
ID: 142423
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197407
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142424
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 310364
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 28
ID: 142425
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 238920
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142426
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349351
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142427
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 204135
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142428
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1370754
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142429
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1370750
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142430
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 861487
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0