CMS Formulary

Displaying 136581-136590 of 1611142 results.
ID: 136581
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213272
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136582
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 206792
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136583
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 207850
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136584
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 207100
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136585
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 208821
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136586
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1011080
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136587
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213307
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136588
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 213320
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136589
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 351875
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 136590
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1307630
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30