CMS Formulary

Displaying 167931-167940 of 1611142 results.
ID: 167931
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 167932
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 167933
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 167934
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167935
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167936
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 314155
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 167937
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 351107
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 167938
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 859193
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167939
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 686379
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 167940
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0