CMS Formulary

Displaying 138801-138810 of 1611142 results.
ID: 138801
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1602604
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138802
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1602607
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138803
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 104206
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138804
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309888
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138805
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 309889
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138806
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 745752
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138807
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1649961
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138808
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1593858
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138809
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854832
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138810
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 854836
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0