CMS Formulary

Displaying 84481-84490 of 1611142 results.
ID: 84481
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 995281
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84482
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1095227
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84483
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1304988
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84484
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1661092
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 91
Qty Limit Days: 84
ID: 84485
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 309079
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84486
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1438778
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84487
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1440937
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84488
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1440183
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84489
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1537209
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84490
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1487086
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0