CMS Formulary

Displaying 72251-72260 of 1611142 results.
ID: 72251
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 105590
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72252
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364498
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 45
Qty Limit Days: 30
ID: 72253
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364490
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 72254
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364494
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 72255
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648772
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 72256
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 884077
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72257
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 2046597
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 228
Qty Limit Days: 14
ID: 72258
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 1989117
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 72259
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 2178792
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 72260
Formulary ID: 00021025
Formulary Version: 14
Contract Year: 2021
RXCUI: 644304
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0