CMS Formulary

Displaying 171381-171390 of 1611142 results.
ID: 171381
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 617311
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 171382
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 485486
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171383
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 485485
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171384
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 485484
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171385
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 310818
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171386
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 259255
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 171387
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 905028
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 171388
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 905024
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 171389
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 577208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 171390
Formulary ID: 00021071
Formulary Version: 14
Contract Year: 2021
RXCUI: 205328
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0