CMS Formulary

Displaying 84821-84830 of 1611142 results.
ID: 84821
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 312079
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 84822
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 208185
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84823
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 577127
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 84824
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 404013
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84825
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 404011
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84826
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 597990
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84827
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 597984
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84828
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 597993
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84829
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 597967
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84830
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 597980
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0