CMS Formulary

Displaying 75251-75260 of 1611142 results.
ID: 75251
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 979480
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75252
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 248109
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75253
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 314108
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75254
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 311290
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75255
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 854984
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75256
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 854988
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75257
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 854925
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75258
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857166
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75259
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857174
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75260
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 904431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28