CMS Formulary

Displaying 167461-167470 of 1611142 results.
ID: 167461
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 904447
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1286
Qty Limit Days: 30
ID: 167462
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 904158
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167463
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861495
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 28
ID: 167464
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861448
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 28
ID: 167465
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 309370
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 167466
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 103457
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 167467
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197407
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167468
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 310364
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 167469
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 238920
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167470
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 349351
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0