CMS Formulary

Displaying 78381-78390 of 1611142 results.
ID: 78381
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 616698
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 78382
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 616705
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 78383
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 312635
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78384
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 198365
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78385
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 995666
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78386
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 198145
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78387
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313215
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78388
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313217
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78389
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313219
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78390
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 260376
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0