CMS Formulary

Displaying 78581-78590 of 1611142 results.
ID: 78581
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 854868
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 78582
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001564
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 78583
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738803
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78584
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78585
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738807
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78586
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 897584
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78587
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 897590
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78588
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 897596
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78589
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 317769
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78590
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 314208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0