CMS Formulary

Displaying 84361-84370 of 1611142 results.
ID: 84361
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1809667
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84362
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854228
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 18
Qty Limit Days: 30
ID: 84363
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854235
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 24
Qty Limit Days: 30
ID: 84364
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854238
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 36
Qty Limit Days: 30
ID: 84365
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854241
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 84366
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854248
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84367
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854245
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 48
Qty Limit Days: 30
ID: 84368
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854252
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 84369
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 406503
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84370
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 858262
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0