CMS Formulary

Displaying 142801-142810 of 1611142 results.
ID: 142801
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 798479
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142802
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1300378
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142803
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1300370
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142804
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 805579
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142805
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 901518
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142806
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 830463
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142807
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1601407
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142808
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 809159
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142809
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 802652
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 7
Qty Limit Days: 28
ID: 142810
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1653225
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 7
Qty Limit Days: 28