CMS Formulary

Displaying 143001-143010 of 1611142 results.
ID: 143001
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 903891
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143002
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 903884
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143003
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 242446
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143004
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 857700
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 450
Qty Limit Days: 28
ID: 143005
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 213291
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143006
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1111339
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143007
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 860805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143008
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 308739
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143009
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1111343
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143010
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 284008
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0