CMS Formulary

Displaying 168591-168600 of 1611142 results.
ID: 168591
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1738495
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168592
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1738503
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168593
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1099596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168594
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 197412
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168595
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312828
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168596
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312829
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168597
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312830
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168598
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312831
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168599
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 312832
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168600
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 314211
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30