CMS Formulary

Displaying 80301-80310 of 1611142 results.
ID: 80301
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 198325
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80302
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 198323
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80303
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 855942
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 80304
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 313366
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80305
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000070
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80306
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 1536586
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 28
ID: 80307
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 242333
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 80308
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 241527
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 80309
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 403922
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 80310
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 402109
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0