CMS Formulary

Displaying 166661-166670 of 1611142 results.
ID: 166661
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1719862
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166662
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1719803
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166663
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 866103
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166664
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 672567
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166665
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 672569
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 166666
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 672571
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166667
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 993541
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 166668
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 993557
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166669
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 996097
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166670
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 996615
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0