CMS Formulary

Displaying 147141-147150 of 1611142 results.
ID: 147141
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 898346
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147142
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 562266
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147143
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 863669
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147144
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 313581
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 147145
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 402246
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147146
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 402247
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147147
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 664741
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147148
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 833528
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147149
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 722134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 147150
Formulary ID: 00021060
Formulary Version: 14
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0