CMS Formulary

Displaying 218141-218150 of 1611142 results.
ID: 218141
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 200258
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 218142
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 313582
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 218143
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 313584
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 218144
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 314277
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 218145
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 313586
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 218146
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 311759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 218147
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 866511
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218148
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 866514
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 218149
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 476809
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 218150
Formulary ID: 00021095
Formulary Version: 13
Contract Year: 2021
RXCUI: 197499
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0