CMS Formulary

Displaying 79611-79620 of 1611142 results.
ID: 79611
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 904170
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79612
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 854859
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79613
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1859000
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 79614
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1604544
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 13
Qty Limit Days: 28
ID: 79615
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2002420
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 28
ID: 79616
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923338
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79617
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1923347
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79618
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1876406
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79619
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2375329
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 79620
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2099302
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0