CMS Formulary

Displaying 143361-143370 of 1611142 results.
ID: 143361
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 617768
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 143362
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1368012
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143363
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1368430
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143364
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1368437
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143365
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1368444
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143366
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1368020
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143367
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790892
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143368
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790886
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143369
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1790890
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143370
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2384465
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 28