CMS Formulary

Displaying 79221-79230 of 1611142 results.
ID: 79221
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251336
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79222
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 749157
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79223
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 748798
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79224
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1989507
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79225
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1053697
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79226
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 197849
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79227
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876920
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 79228
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876924
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 79229
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876916
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 79230
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1111642
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30