CMS Formulary

Displaying 77441-77450 of 1611142 results.
ID: 77441
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 884189
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77442
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099625
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77443
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 996571
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 77444
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 996561
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 77445
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854916
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77446
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854919
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77447
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854908
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77448
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 201708
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77449
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 248420
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77450
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 351172
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0