CMS Formulary

Displaying 143381-143390 of 1611142 results.
ID: 143381
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1116758
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 25
Qty Limit Days: 30
ID: 143382
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 730834
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143383
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 543492
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143384
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1440936
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143385
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 309077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143386
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 313428
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143387
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 242680
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143388
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205292
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143389
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 205290
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143390
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 315134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0