CMS Formulary

Displaying 138871-138880 of 1611142 results.
ID: 138871
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 401954
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138872
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 616698
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138873
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 616705
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138874
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 312635
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138875
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198365
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138876
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 995666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138877
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 198145
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138878
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313215
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138879
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313217
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 138880
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 313219
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0