CMS Formulary

Displaying 78111-78120 of 1611142 results.
ID: 78111
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1870968
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 28
ID: 78112
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1304985
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 78113
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1811182
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 78114
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649405
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78115
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 852920
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78116
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313096
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78117
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 198224
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78118
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 318179
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78119
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 283535
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78120
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 858778
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30