CMS Formulary

Displaying 173121-173130 of 1611142 results.
ID: 173121
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 351174
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173122
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 351175
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173123
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 794639
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173124
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 616578
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173125
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 204520
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173126
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 1601982
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173127
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 1799890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173128
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 1795252
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173129
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 1598073
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 173130
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 2001321
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0