CMS Formulary

Displaying 168731-168740 of 1611142 results.
ID: 168731
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 151226
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168732
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199889
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168733
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 311486
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 168734
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 904396
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 168735
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199672
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168736
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 252559
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 168737
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 239238
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168738
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 602393
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168739
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 432402
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168740
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 477560
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0