CMS Formulary

Displaying 76311-76320 of 1611142 results.
ID: 76311
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1148141
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 76312
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 861960
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 76313
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 905032
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 76314
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1090996
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76315
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197595
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76316
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76317
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 309958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76318
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 309960
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76319
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 884707
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 76320
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 753543
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0