CMS Formulary

Displaying 74871-74880 of 1611142 results.
ID: 74871
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 855812
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 74872
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665050
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74873
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665093
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74874
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665088
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74875
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665046
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74876
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091650
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74877
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1091654
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74878
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1235150
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74879
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1235157
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 74880
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310467
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0