CMS Formulary

Displaying 75171-75180 of 1611142 results.
ID: 75171
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797113
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 75172
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2399904
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 28
ID: 75173
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098141
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75174
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1098134
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75175
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 577033
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 75176
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 995624
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75177
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2266506
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 75178
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75179
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857321
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75180
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857328
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0