CMS Formulary

Displaying 168711-168720 of 1611142 results.
ID: 168711
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830897
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168712
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 245723
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168713
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198363
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168714
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 200220
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168715
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830861
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168716
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830845
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168717
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830837
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168718
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 830801
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168719
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 352257
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 30
ID: 168720
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1364477
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0