CMS Formulary

Displaying 149191-149200 of 1611142 results.
ID: 149191
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 856364
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149192
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 863636
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149193
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 863619
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 149194
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 863628
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 149195
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 314080
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149196
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1190655
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149197
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 545236
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149198
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1724340
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149199
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 312075
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149200
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 308345
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0