CMS Formulary

Displaying 167301-167310 of 1611142 results.
ID: 167301
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 351276
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167302
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 349194
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 167303
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 349195
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 167304
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 349198
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 167305
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 403825
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 167306
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312439
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167307
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198103
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167308
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 250820
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167309
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 858751
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167310
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 858733
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0