CMS Formulary

Displaying 78001-78010 of 1611142 results.
ID: 78001
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197853
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78002
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858813
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78003
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858817
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78004
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858810
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78005
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 308973
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78006
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858824
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78007
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858828
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78008
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 308976
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78009
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 834348
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78010
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1370767
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30