CMS Formulary

Displaying 143551-143560 of 1611142 results.
ID: 143551
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 897021
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 143552
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049264
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143553
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1856424
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143554
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2052064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143555
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 849450
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 9
Qty Limit Days: 28
ID: 143556
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 861375
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143557
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 861370
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143558
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1373745
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143559
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 485442
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143560
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 485465
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0