CMS Formulary

Displaying 84421-84430 of 1611142 results.
ID: 84421
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 884385
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 84422
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 993770
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 360
Qty Limit Days: 30
ID: 84423
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 993890
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 84424
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 864718
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 84425
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 977939
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 84426
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 977942
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 84427
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 197593
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84428
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 199168
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84429
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 312357
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84430
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 312362
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0