CMS Formulary

Displaying 168751-168760 of 1611142 results.
ID: 168751
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 200311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168752
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 310431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 168753
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 702306
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168754
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1731020
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168755
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 751563
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168756
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 753451
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168757
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 751139
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168758
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 728113
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168759
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 483442
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 168760
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 483448
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30