CMS Formulary

Displaying 171361-171370 of 1611142 results.
ID: 171361
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 903891
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 171362
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 903884
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 171363
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 242446
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171364
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 857700
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 28
ID: 171365
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 213291
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171366
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1111339
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171367
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 860805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171368
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 308739
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171369
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 1111343
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171370
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 284008
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0