CMS Formulary

Displaying 75581-75590 of 1611142 results.
ID: 75581
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 897659
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75582
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 897640
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75583
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 855480
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75584
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 855474
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75585
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 749860
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75586
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 198373
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 75587
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1094543
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75588
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 859033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75589
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 859040
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75590
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 859052
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0