CMS Formulary

Displaying 165791-165800 of 1611142 results.
ID: 165791
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1923054
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165792
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1801840
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 165793
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1923056
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165794
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1923058
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165795
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2002719
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 165796
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2058981
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165797
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1298099
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165798
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 545293
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165799
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 207029
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165800
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 665022
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0