CMS Formulary

Displaying 74131-74140 of 1611142 results.
ID: 74131
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1308569
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 74132
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 351209
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74133
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310362
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74134
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 197623
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74135
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055650
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 74136
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099808
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74137
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1484296
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74138
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1190919
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74139
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244205
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74140
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 830470
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0