CMS Formulary

Displaying 168381-168390 of 1611142 results.
ID: 168381
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 724863
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168382
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 724859
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168383
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 724861
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168384
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 403818
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168385
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 730869
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168386
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 897021
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168387
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2052064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168388
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861375
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168389
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 861370
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168390
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1373745
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0