CMS Formulary

Displaying 143911-143920 of 1611142 results.
ID: 143911
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1053697
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143912
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 197849
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143913
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1111642
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 31
Qty Limit Days: 31
ID: 143914
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1487363
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 143915
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 308725
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143916
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 855657
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143917
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1812011
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143918
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 1812013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143919
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 562806
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 143920
Formulary ID: 00021058
Formulary Version: 15
Contract Year: 2021
RXCUI: 825130
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0