CMS Formulary

Displaying 143171-143180 of 1611142 results.
ID: 143171
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 311196
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143172
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 854868
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 143173
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2001564
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143174
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1738803
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143175
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1738805
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143176
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1738807
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143177
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 897584
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143178
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 897590
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143179
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 897596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143180
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 317769
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0