CMS Formulary

Displaying 142581-142590 of 1611142 results.
ID: 142581
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870952
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142582
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870960
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142583
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1870968
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142584
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1811182
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142585
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1716215
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142586
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1716219
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142587
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1716223
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 142588
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1101339
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 142589
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1482821
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 142590
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649405
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0