CMS Formulary

Displaying 79501-79510 of 1611142 results.
ID: 79501
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946836
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 79502
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2256943
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 79503
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2205474
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79504
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946840
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 79505
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946844
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 79506
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946848
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 79507
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 207834
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79508
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1718936
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 79509
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1745114
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79510
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 729234
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0