CMS Formulary

Displaying 169501-169510 of 1611142 results.
ID: 169501
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 903879
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169502
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 892342
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169503
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 892349
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169504
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 892355
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169505
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 892297
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169506
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 894942
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169507
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 894970
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 169508
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 351264
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 169509
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 904605
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 169510
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 904571
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0