CMS Formulary

Displaying 79351-79360 of 1611142 results.
ID: 79351
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940654
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 79352
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944382
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 79353
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1944376
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 79354
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1921081
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 79355
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1866047
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79356
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099026
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79357
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099269
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79358
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1006065
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79359
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1020155
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 79360
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1720616
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0