CMS Formulary

Displaying 168111-168120 of 1611142 results.
ID: 168111
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 476351
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168112
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 835829
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168113
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 860975
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 168114
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 860981
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168115
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312136
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168116
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312137
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168117
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1299911
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168118
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168119
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197890
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168120
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 855873
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0