CMS Formulary

Displaying 138141-138150 of 1611142 results.
ID: 138141
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1665507
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138142
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1608276
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138143
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1608274
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138144
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1191299
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138145
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 240209
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138146
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1797883
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138147
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 318202
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138148
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 238600
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138149
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310465
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138150
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1085640
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0