CMS Formulary

Displaying 142651-142660 of 1611142 results.
ID: 142651
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 577080
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 142652
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 904932
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142653
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 313758
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142654
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 199655
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142655
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142656
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 360110
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142657
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 799055
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142658
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 799056
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142659
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 799054
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142660
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 206913
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0