CMS Formulary

Displaying 85801-85810 of 1611142 results.
ID: 85801
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1044591
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 85802
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 311192
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85803
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 311197
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85804
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 311196
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85805
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854868
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 85806
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2001564
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 85807
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738803
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85808
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738805
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85809
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1738807
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 85810
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 897584
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0