CMS Formulary

Displaying 75481-75490 of 1611142 results.
ID: 75481
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 477347
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75482
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 642452
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75483
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 602635
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75484
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1736654
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75485
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1736656
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75486
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806683
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75487
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806684
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75488
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356074
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75489
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 748832
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75490
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1722680
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0