CMS Formulary

Displaying 77801-77810 of 1611142 results.
ID: 77801
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 861171
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77802
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 645037
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 77803
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000064
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77804
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197987
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77805
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197986
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77806
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 860215
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77807
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 860221
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77808
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 198056
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77809
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 351276
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 77810
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 728207
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0