CMS Formulary

Displaying 167281-167290 of 1611142 results.
ID: 167281
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 845515
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 167282
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1119400
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 167283
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199369
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167284
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861164
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167285
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861171
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167286
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 645037
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 167287
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1000064
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167288
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 577154
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167289
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198140
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167290
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 403969
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0