CMS Formulary

Displaying 75301-75310 of 1611142 results.
ID: 75301
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 722137
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75302
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 722126
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75303
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 722131
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75304
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 860715
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75305
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 860695
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75306
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 860707
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75307
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 309058
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75308
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 419849
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75309
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1800499
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75310
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1800500
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0