CMS Formulary

Displaying 142891-142900 of 1611142 results.
ID: 142891
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1550720
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142892
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 727816
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142893
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650901
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 142894
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054995
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142895
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 809477
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142896
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123137
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142897
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123141
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142898
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2123145
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142899
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1102277
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 142900
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205918
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0