CMS Formulary

Displaying 130161-130170 of 1611142 results.
ID: 130161
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 351175
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130162
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 999965
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130163
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 801417
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130164
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 204520
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130165
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1601982
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130166
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1799890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130167
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 1795252
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130168
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 244098
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130169
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 245220
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 130170
Formulary ID: 00021054
Formulary Version: 15
Contract Year: 2021
RXCUI: 800928
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0