CMS Formulary

Displaying 76481-76490 of 1611142 results.
ID: 76481
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 597850
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76482
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 310273
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76483
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 284245
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76484
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 835886
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76485
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 866049
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 76486
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 896019
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 76487
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 896027
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 76488
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 896023
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 76489
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 213484
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 76490
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 759473
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 180