CMS Formulary

Displaying 166771-166780 of 1611142 results.
ID: 166771
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 904419
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166772
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 866436
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166773
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855633
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1000
Qty Limit Days: 28
ID: 166774
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1607784
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166775
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199245
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 166776
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199246
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 166777
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199247
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 166778
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 314231
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166779
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312961
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 166780
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198211
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30