CMS Formulary

Displaying 75791-75800 of 1611142 results.
ID: 75791
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058520
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 75792
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058525
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 75793
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 966607
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 75794
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 208083
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 75795
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054275
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 14
Qty Limit Days: 28
ID: 75796
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2275613
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75797
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272118
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75798
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272122
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75799
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2272126
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75800
Formulary ID: 00021026
Formulary Version: 14
Contract Year: 2021
RXCUI: 2394947
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30