CMS Formulary

Displaying 137091-137100 of 1611142 results.
ID: 137091
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861045
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137092
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861043
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137093
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 206347
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137094
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1729511
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137095
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1085773
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137096
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1648999
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137097
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 486515
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137098
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 730782
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137099
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1795470
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 137100
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1794886
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0