CMS Formulary

Displaying 84311-84320 of 1611142 results.
ID: 84311
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 545835
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84312
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 645884
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84313
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 757968
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84314
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 754508
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 28
ID: 84315
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 197411
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84316
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 310600
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84317
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 403850
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84318
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 810090
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84319
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 403851
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84320
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 810083
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0