CMS Formulary

Displaying 72001-72010 of 1611142 results.
ID: 72001
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1053697
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72002
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 197849
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72003
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876920
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72004
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876924
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 72005
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876916
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 72006
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1111642
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 72007
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1487363
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 72008
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 308725
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 420
Qty Limit Days: 30
ID: 72009
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 855657
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72010
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1812011
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0