CMS Formulary

Displaying 166641-166650 of 1611142 results.
ID: 166641
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855300
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166642
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1233711
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166643
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854228
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 166644
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854235
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 11
Qty Limit Days: 28
ID: 166645
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 16
Qty Limit Days: 28
ID: 166646
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 22
Qty Limit Days: 28
ID: 166647
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 166648
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 22
Qty Limit Days: 28
ID: 166649
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 28
Qty Limit Days: 28
ID: 166650
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0