CMS Formulary

Displaying 72961-72970 of 1611142 results.
ID: 72961
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 351174
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72962
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 351175
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72963
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 794639
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72964
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 616578
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 72965
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 801417
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72966
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 204520
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72967
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1799890
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72968
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 800928
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72969
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 800812
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 72970
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1189640
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0