CMS Formulary

Displaying 143011-143020 of 1611142 results.
ID: 143011
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 313919
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143012
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797865
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 34
Qty Limit Days: 30
ID: 143013
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797867
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 25
ID: 143014
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1797847
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143015
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 860107
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143016
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1992299
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143017
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 904481
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143018
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 260218
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143019
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205324
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143020
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 617312
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0