CMS Formulary

Displaying 143821-143830 of 1611142 results.
ID: 143821
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 845488
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143822
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 861736
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143823
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 861740
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143824
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 312817
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143825
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 310245
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143826
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 359500
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143827
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 577315
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143828
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 577317
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143829
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 836395
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 372
Qty Limit Days: 31
ID: 143830
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 198116
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0