CMS Formulary

Displaying 75901-75910 of 1611142 results.
ID: 75901
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1435117
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 75902
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 351859
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 75903
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1731317
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 28
ID: 75904
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 643177
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75905
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 643173
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 75906
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 643175
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75907
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 799830
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75908
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1045408
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75909
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1045404
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 75910
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1364441
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30