CMS Formulary

Displaying 168791-168800 of 1611142 results.
ID: 168791
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 200132
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 168792
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199149
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 168793
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 199150
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 168794
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 311915
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168795
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1867544
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168796
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1725064
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168797
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 2107518
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168798
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1437713
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 168799
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1918242
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 168800
Formulary ID: 00021067
Formulary Version: 13
Contract Year: 2021
RXCUI: 1862595
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30