CMS Formulary

Displaying 149371-149380 of 1611142 results.
ID: 149371
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 153822
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149372
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 153823
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 149373
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 639537
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149374
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 578325
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149375
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 578330
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149376
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 802749
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149377
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 861822
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 149378
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1095712
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 149379
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1665515
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 149380
Formulary ID: 00021061
Formulary Version: 15
Contract Year: 2021
RXCUI: 1719286
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0