CMS Formulary

Displaying 77731-77740 of 1611142 results.
ID: 77731
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2167563
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 77732
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2167567
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 77733
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2167571
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 77734
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648755
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 77735
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 725021
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 77736
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 725023
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 77737
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 311994
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 77738
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 311995
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 77739
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1648759
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 77740
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 903847
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0