CMS Formulary

Displaying 166481-166490 of 1611142 results.
ID: 166481
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 863559
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166482
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 897612
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166483
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 897618
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166484
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 897624
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166485
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 897630
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166486
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312025
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166487
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198041
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166488
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 582926
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166489
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1597123
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30
ID: 166490
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1597129
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30