CMS Formulary

Displaying 143281-143290 of 1611142 results.
ID: 143281
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1658221
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143282
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 544840
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143283
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 313165
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 143284
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 865129
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143285
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1807513
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143286
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 312447
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143287
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 313416
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143288
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 597823
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143289
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1726214
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143290
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1721458
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0