CMS Formulary

Displaying 72871-72880 of 1611142 results.
ID: 72871
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 284245
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72872
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 835886
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72873
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 866049
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72874
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 896019
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72875
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 896027
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 72876
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 896023
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72877
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 213484
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72878
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 759473
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 180
ID: 72879
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 896185
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72880
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 896212
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30