CMS Formulary

Displaying 73571-73580 of 1611142 results.
ID: 73571
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 899518
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 73572
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 899548
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 73573
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091133
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 900
Qty Limit Days: 30
ID: 73574
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 863664
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73575
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1483329
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 73576
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006122
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73577
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055676
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 73578
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055672
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 73579
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 314111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 73580
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 858798
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30