CMS Formulary

Displaying 78121-78130 of 1611142 results.
ID: 78121
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 198222
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78122
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 198150
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78123
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 96304
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78124
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 998689
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78125
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 998685
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78126
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099686
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 78127
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099691
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 78128
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099697
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 78129
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1313785
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78130
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 207588
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0