CMS Formulary

Displaying 84871-84880 of 1611142 results.
ID: 84871
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1809520
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84872
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 239189
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84873
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665107
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84874
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 309072
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84875
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 863538
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84876
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1665507
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84877
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1191299
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84878
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 240209
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 84879
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797883
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 25
ID: 84880
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 318202
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30