CMS Formulary

Displaying 138461-138470 of 1611142 results.
ID: 138461
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309370
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138462
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 103457
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138463
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 197407
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138464
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310364
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138465
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 238920
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138466
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 204135
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138467
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1370754
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138468
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1370750
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138469
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861487
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138470
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1992281
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0