CMS Formulary

Displaying 75211-75220 of 1611142 results.
ID: 75211
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1244064
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 11
Qty Limit Days: 28
ID: 75212
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1596778
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75213
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673274
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 75214
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673278
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 75215
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1673280
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 75216
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1925264
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 56
ID: 75217
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049343
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 365
ID: 75218
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 312941
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75219
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 312938
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75220
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 308194
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0