CMS Formulary

Displaying 76341-76350 of 1611142 results.
ID: 76341
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 721773
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 76342
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 476179
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 76343
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 476177
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 76344
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 199703
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76345
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1359129
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76346
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 485440
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 76347
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860157
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 76348
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860129
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 76349
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860137
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 76350
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1860148
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30