CMS Formulary

Displaying 75411-75420 of 1611142 results.
ID: 75411
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2044732
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75412
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2046376
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75413
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2046380
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75414
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2046370
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75415
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 311288
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75416
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 311289
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75417
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 387003
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75418
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 807832
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75419
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 846378
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75420
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 309112
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0