CMS Formulary

Displaying 139211-139220 of 1611142 results.
ID: 139211
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1117522
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139212
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1664981
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139213
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 859871
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139214
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 204416
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139215
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1722934
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139216
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 730781
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139217
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1807632
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139218
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1795609
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139219
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 1807552
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 139220
Formulary ID: 00021057
Formulary Version: 16
Contract Year: 2021
RXCUI: 861379
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0