CMS Formulary

Displaying 165811-165820 of 1611142 results.
ID: 165811
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 207035
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165812
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1246313
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 30
ID: 165813
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1246310
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 30
ID: 165814
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 261101
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165815
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 847232
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165816
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 285018
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165817
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855178
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165818
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 866094
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165819
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 866083
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 165820
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 211817
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0