CMS Formulary

Displaying 76241-76250 of 1611142 results.
ID: 76241
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 665022
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76242
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1720881
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76243
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251596
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76244
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 207035
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76245
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 261101
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76246
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 847232
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 76247
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 285018
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 40
Qty Limit Days: 28
ID: 76248
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 855178
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76249
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 866094
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76250
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 866083
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0