CMS Formulary

Displaying 142751-142760 of 1611142 results.
ID: 142751
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 311759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 142752
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 866511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142753
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 866514
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142754
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 476809
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142755
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197499
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142756
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197500
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142757
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 198105
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142758
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 198104
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142759
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 860510
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142760
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 860516
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0