CMS Formulary

Displaying 77351-77360 of 1611142 results.
ID: 77351
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 861004
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 75
Qty Limit Days: 30
ID: 77352
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 861731
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 77353
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 562524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77354
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1652673
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77355
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649429
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77356
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650142
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77357
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650444
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77358
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 406524
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77359
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 434018
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77360
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 799048
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0