CMS Formulary

Displaying 165581-165590 of 1611142 results.
ID: 165581
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1549454
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165582
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 205562
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165583
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1011987
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165584
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861206
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165585
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165586
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165587
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165588
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1876406
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 165589
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2375329
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 165590
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2099302
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28