CMS Formulary

Displaying 166911-166920 of 1611142 results.
ID: 166911
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1043031
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166912
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1373016
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166913
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855858
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166914
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 313306
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166915
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 884522
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166916
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 856980
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 390
Qty Limit Days: 30
ID: 166917
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 348472
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166918
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 282401
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166919
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198427
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 166920
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198428
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0