CMS Formulary

Displaying 142821-142830 of 1611142 results.
ID: 142821
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 208094
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142822
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1114470
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142823
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1294621
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142824
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 904882
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142825
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 904874
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142826
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 904878
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142827
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1542999
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142828
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1432971
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142829
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1544404
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142830
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1544383
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0