CMS Formulary

Displaying 168741-168750 of 1611142 results.
ID: 168741
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 477562
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168742
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1373497
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 180
ID: 168743
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 403875
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168744
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 310430
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 168745
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 310459
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168746
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 828320
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168747
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 314285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168748
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198006
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168749
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198007
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168750
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 198008
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0