CMS Formulary

Displaying 79451-79460 of 1611142 results.
ID: 79451
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2467575
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 79452
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2286261
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79453
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2472789
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79454
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2478450
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 79455
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 2369403
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 79456
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1594673
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79457
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 905059
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 79458
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 905064
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 84
ID: 79459
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 905057
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 168
ID: 79460
Formulary ID: 00021028
Formulary Version: 14
Contract Year: 2021
RXCUI: 1251334
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0