CMS Formulary

Displaying 74121-74130 of 1611142 results.
ID: 74121
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2167571
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 74122
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 74123
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 725021
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 74124
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 725023
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 74125
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 311994
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 74126
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 74127
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 74128
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74129
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307061
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 74130
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115698
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 540
Qty Limit Days: 180