CMS Formulary

Displaying 75241-75250 of 1611142 results.
ID: 75241
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310796
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75242
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310797
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75243
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310809
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75244
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 198052
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75245
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 312086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75246
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310384
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75247
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310385
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75248
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 313989
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75249
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 979485
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75250
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 979492
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0