CMS Formulary

Displaying 130081-130090 of 1611142 results.
ID: 130081
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 106258
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130082
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 203105
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130083
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197409
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130084
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197408
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130085
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 197405
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130086
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 103401
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130087
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 706546
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130088
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 616238
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130089
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 847241
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130090
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 153095
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0