CMS Formulary

Displaying 143681-143690 of 1611142 results.
ID: 143681
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 409823
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143682
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 849833
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143683
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 858372
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143684
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 892582
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 186
Qty Limit Days: 31
ID: 143685
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 892672
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 186
Qty Limit Days: 31
ID: 143686
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490026
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143687
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490034
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143688
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1490038
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143689
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1597620
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143690
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1540890
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0