CMS Formulary

Displaying 166531-166540 of 1611142 results.
ID: 166531
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 859315
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 50
Qty Limit Days: 30
ID: 166532
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1049635
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 166533
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166534
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199167
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166535
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199164
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166536
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 763181
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166537
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 763179
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166538
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 763185
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166539
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 763183
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166540
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861424
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0