CMS Formulary

Displaying 183441-183450 of 1611142 results.
ID: 183441
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 1235591
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 183442
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 668606
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 183443
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 861821
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 183444
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 861771
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 183445
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 904495
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 183446
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 1729311
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 183447
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 2055766
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 183448
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 1988671
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 183449
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 1988675
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 183450
Formulary ID: 00021080
Formulary Version: 13
Contract Year: 2021
RXCUI: 1924315
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0