CMS Formulary

Displaying 77091-77100 of 1611142 results.
ID: 77091
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197411
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77092
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 310600
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77093
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 403850
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77094
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 810090
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77095
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 403851
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77096
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 810083
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77097
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 403852
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77098
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 730988
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77099
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 349556
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 77100
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 240741
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0