CMS Formulary

Displaying 142721-142730 of 1611142 results.
ID: 142721
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2120195
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 142722
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123191
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 142723
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 727537
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142724
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1648162
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142725
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1648160
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142726
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1991509
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142727
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 858125
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142728
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 858127
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142729
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197699
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142730
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197700
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0