CMS Formulary

Displaying 85241-85250 of 1611142 results.
ID: 85241
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 105583
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85242
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 199378
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85243
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 402505
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85244
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 402506
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85245
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1313885
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85246
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 577237
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85247
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 310285
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85248
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198359
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85249
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 389242
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85250
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 204119
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0