CMS Formulary

Displaying 75601-75610 of 1611142 results.
ID: 75601
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 349373
NDC:
Tier Level: 6
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75602
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857216
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75603
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 857224
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75604
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 197572
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75605
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 314266
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 75606
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 749784
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75607
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 644088
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 75608
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1603861
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 75609
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75610
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 749157
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0