CMS Formulary

Displaying 142491-142500 of 1611142 results.
ID: 142491
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197654
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142492
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 748879
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142493
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 238153
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 372
Qty Limit Days: 31
ID: 142494
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 359385
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142495
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 834768
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142496
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 835956
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142497
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 748859
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142498
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1359032
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142499
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1359027
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142500
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 751875
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0