CMS Formulary

Displaying 77671-77680 of 1611142 results.
ID: 77671
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 977990
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77672
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 977978
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77673
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 309289
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 77674
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 309291
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 19
Qty Limit Days: 30
ID: 77675
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 895487
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77676
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 895987
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77677
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 797274
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77678
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 310982
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30
ID: 77679
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313189
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 30
ID: 77680
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 309290
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30