CMS Formulary

Displaying 85381-85390 of 1611142 results.
ID: 85381
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 311277
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 85382
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1099563
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85383
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 904932
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 1
Qty Limit Days: 28
ID: 85384
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 313758
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85385
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 199655
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85386
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 349208
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85387
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 360110
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85388
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 799055
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85389
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 799056
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85390
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 799054
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0