CMS Formulary

Displaying 164391-164400 of 1611142 results.
ID: 164391
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 1359271
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 164392
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 758555
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 164393
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 1052660
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 164394
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 1250723
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 164395
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 1600710
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 164396
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 1999587
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 164397
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 1364515
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 164398
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 2373941
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 164399
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 2049677
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 164400
Formulary ID: 00021065
Formulary Version: 15
Contract Year: 2021
RXCUI: 762675
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0