CMS Formulary

Displaying 174371-174380 of 1611142 results.
ID: 174371
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 199369
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174372
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 861164
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174373
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 861171
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174374
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 645037
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174375
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 1000064
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174376
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 577154
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174377
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 403969
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174378
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 403972
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174379
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 403970
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 174380
Formulary ID: 00021075
Formulary Version: 23
Contract Year: 2021
RXCUI: 403971
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0