CMS Formulary

Displaying 84071-84080 of 1611142 results.
ID: 84071
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 857677
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84072
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245443
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84073
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245373
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84074
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 309329
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84075
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 314078
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84076
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 197635
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84077
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 197634
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84078
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 238154
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 84079
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 309844
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1200
Qty Limit Days: 30
ID: 84080
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 865117
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0