CMS Formulary

Displaying 39641-39650 of 1611142 results.
ID: 39641
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 207840
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39642
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178081
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39643
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178077
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39644
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 311671
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39645
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 995278
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39646
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 995253
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39647
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 198228
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39648
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 852913
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39649
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 993536
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 39650
Formulary ID: 00021014
Formulary Version: 14
Contract Year: 2021
RXCUI: 852877
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0