CMS Formulary

Displaying 84721-84730 of 1611142 results.
ID: 84721
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 905092
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 84722
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 905100
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 84723
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 153822
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84724
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 153823
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84725
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 639537
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84726
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 578325
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84727
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 578330
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84728
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 802749
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84729
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1095712
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84730
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665515
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0