CMS Formulary

Displaying 169221-169230 of 1611142 results.
ID: 169221
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1603369
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 21
ID: 169222
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1656346
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169223
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425110
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 169224
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425118
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 169225
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 867506
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 169226
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 672152
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 169227
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 169228
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1425228
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 169229
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245003
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 169230
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 825425
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0