CMS Formulary

Displaying 84041-84050 of 1611142 results.
ID: 84041
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 833139
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84042
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 833143
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84043
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 833149
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84044
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 833146
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84045
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433250
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84046
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433223
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 84047
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433229
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 84048
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433235
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 84049
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1433241
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 84050
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307309
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30