CMS Formulary

Displaying 75461-75470 of 1611142 results.
ID: 75461
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 261962
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75462
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 199147
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75463
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 349491
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75464
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 853201
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75465
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649990
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75466
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650030
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75467
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 198201
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75468
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 728109
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 180
ID: 75469
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 312122
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 42
Qty Limit Days: 180
ID: 75470
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 200346
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0