CMS Formulary

Displaying 77141-77150 of 1611142 results.
ID: 77141
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 77142
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 77143
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 77144
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 77145
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77146
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858262
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77147
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 310023
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77148
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 403890
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77149
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197549
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77150
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197550
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0