CMS Formulary

Displaying 138501-138510 of 1611142 results.
ID: 138501
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 855671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138502
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 311679
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138503
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 105583
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138504
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 199378
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138505
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402505
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138506
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 402506
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138507
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1313885
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138508
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 577237
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138509
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 310285
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138510
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 967017
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0