CMS Formulary

Displaying 167841-167850 of 1611142 results.
ID: 167841
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 260376
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 167842
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 857706
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167843
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1359105
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167844
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 328161
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167845
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197971
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167846
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167847
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197787
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167848
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197782
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167849
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197783
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167850
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 313142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0