CMS Formulary

Displaying 148101-148110 of 1611142 results.
ID: 148101
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 2169320
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 148102
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 2362244
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 148103
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1365866
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 148104
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1656351
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 148105
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1873991
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 148106
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1873993
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 148107
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1873995
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 148108
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1421456
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 148109
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1923054
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 28
ID: 148110
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1801840
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30