CMS Formulary

Displaying 84761-84770 of 1611142 results.
ID: 84761
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650143
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84762
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1298910
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 84763
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1298816
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 240
Qty Limit Days: 30
ID: 84764
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1298906
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 270
Qty Limit Days: 30
ID: 84765
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 858613
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84766
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 858616
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84767
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 858747
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84768
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1542997
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 84769
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1432969
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 84770
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 904880
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28