CMS Formulary

Displaying 75501-75510 of 1611142 results.
ID: 75501
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2123072
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 17
Qty Limit Days: 30
ID: 75502
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 314076
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75503
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 314077
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75504
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 205326
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75505
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 646456
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 75506
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1487251
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 75507
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 848768
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 75508
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738511
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75509
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 205316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75510
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 205315
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0