CMS Formulary

Displaying 75471-75480 of 1611142 results.
ID: 75471
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 308135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75472
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 309054
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75473
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 848140
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75474
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 848131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75475
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 848145
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75476
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 848151
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75477
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 848135
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75478
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 854894
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75479
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 854880
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75480
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 672149
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0