CMS Formulary

Displaying 80341-80350 of 1611142 results.
ID: 80341
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 748961
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80342
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 751901
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 80343
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 810096
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 80344
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 749761
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 80345
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 748868
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80346
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 759743
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80347
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 748806
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80348
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 748804
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80349
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 310404
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80350
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 310405
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0