CMS Formulary

Displaying 167061-167070 of 1611142 results.
ID: 167061
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1091389
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167062
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1091322
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167063
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1091152
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167064
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 608623
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167065
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 608624
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167066
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197702
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167067
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1049615
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 167068
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1736047
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167069
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1736050
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167070
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1736053
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0