CMS Formulary

Displaying 78651-78660 of 1611142 results.
ID: 78651
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1356588
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 78652
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1790126
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 720
Qty Limit Days: 30
ID: 78653
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 824299
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78654
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 824303
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78655
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054157
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78656
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1796665
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78657
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604384
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78658
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2054159
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78659
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604350
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 78660
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1792393
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0