CMS Formulary

Displaying 85141-85150 of 1611142 results.
ID: 85141
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1114202
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 85142
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1549683
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85143
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650968
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 0
Qty Limit Days: 84
ID: 85144
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650972
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 84
ID: 85145
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650974
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 84
ID: 85146
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650976
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 84
ID: 85147
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739766
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 85148
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739774
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 85149
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2173500
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 10
Qty Limit Days: 30
ID: 85150
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739778
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30