CMS Formulary

Displaying 143841-143850 of 1611142 results.
ID: 143841
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 143842
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 311919
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 93
Qty Limit Days: 31
ID: 143843
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988308
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143844
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143845
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143846
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988319
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143847
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988324
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143848
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1988330
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143849
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1649401
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143850
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 2054979
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 341
Qty Limit Days: 31