CMS Formulary

Displaying 168441-168450 of 1611142 results.
ID: 168441
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1737581
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168442
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 540617
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168443
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 404419
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168444
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 213337
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168445
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 106351
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168446
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 308136
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168447
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197361
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168448
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 310432
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 168449
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 311880
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168450
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 317174
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30