CMS Formulary

Displaying 73461-73470 of 1611142 results.
ID: 73461
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 864110
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73462
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 854302
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73463
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1793916
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 73464
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1657160
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 73465
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1654630
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 73466
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2000007
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 12
Qty Limit Days: 28
ID: 73467
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 309339
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73468
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 309335
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73469
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 309336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73470
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 308207
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0