CMS Formulary

Displaying 79121-79130 of 1611142 results.
ID: 79121
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 205316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79122
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 205315
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79123
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313583
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 79124
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 313585
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 79125
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 992438
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79126
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 992447
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79127
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 310672
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79128
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 314035
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79129
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197754
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79130
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 686924
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0