CMS Formulary

Displaying 143751-143760 of 1611142 results.
ID: 143751
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 853201
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 62
Qty Limit Days: 31
ID: 143752
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649990
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143753
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649425
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143754
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650446
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143755
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1650030
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143756
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 198201
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143757
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 728109
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 170
Qty Limit Days: 365
ID: 143758
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 312122
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 365
ID: 143759
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 200346
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143760
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 308135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0