CMS Formulary

Displaying 85161-85170 of 1611142 results.
ID: 85161
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1739788
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 600
Qty Limit Days: 30
ID: 85162
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1149617
NDC:
Tier Level: 4
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 85163
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 213197
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 85164
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 997010
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 42
Qty Limit Days: 7
ID: 85165
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 861353
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85166
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 866427
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85167
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 866412
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85168
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 866419
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85169
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198034
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85170
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198035
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0