CMS Formulary

Displaying 79321-79330 of 1611142 results.
ID: 79321
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 311915
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79322
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1725064
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 30
ID: 79323
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001439
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 79324
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1437713
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79325
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918242
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 79326
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1862595
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 79327
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921589
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 79328
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1862590
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 79329
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1666545
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79330
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1666542
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0