CMS Formulary

Displaying 165551-165560 of 1611142 results.
ID: 165551
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861771
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 165552
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1729311
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165553
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165554
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1988671
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 165555
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1988675
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 165556
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165557
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1486841
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165558
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 798300
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165559
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830253
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165560
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830245
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0