CMS Formulary

Displaying 75661-75670 of 1611142 results.
ID: 75661
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 252559
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75662
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 239238
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75663
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 602393
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75664
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 432402
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 75665
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 477560
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75666
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 477562
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75667
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 1373497
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75668
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 403875
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75669
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310430
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 75670
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 310459
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0