CMS Formulary

Displaying 80801-80810 of 1611142 results.
ID: 80801
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055676
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 80802
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 2055672
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 30
ID: 80803
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 314111
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80804
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 858798
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 150
Qty Limit Days: 30
ID: 80805
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 197738
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80806
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 311725
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80807
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 311726
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 80808
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 884386
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 80809
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 884385
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 80810
Formulary ID: 00021029
Formulary Version: 14
Contract Year: 2021
RXCUI: 993770
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30