CMS Formulary

Displaying 143021-143030 of 1611142 results.
ID: 143021
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 617310
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143022
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143023
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 485486
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143024
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 485485
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143025
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 485484
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143026
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143027
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143028
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143029
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143030
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0