CMS Formulary

Displaying 143181-143190 of 1611142 results.
ID: 143181
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 314208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143182
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 312847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143183
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205284
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143184
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143185
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 643019
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143186
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 643022
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143187
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 866482
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143188
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 866479
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143189
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349401
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143190
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 349405
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31