CMS Formulary

Displaying 77381-77390 of 1611142 results.
ID: 77381
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 850309
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77382
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 310015
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77383
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988399
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 5
Qty Limit Days: 30
ID: 77384
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1150836
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77385
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2118539
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77386
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 864650
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77387
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 308511
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77388
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1375922
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77389
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 863042
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77390
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 204423
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0