CMS Formulary

Displaying 86091-86100 of 1611142 results.
ID: 86091
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854984
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86092
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854988
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86093
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 854925
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86094
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 857166
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86095
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 857174
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86096
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 904431
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 4
Qty Limit Days: 28
ID: 86097
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 312087
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86098
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198334
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86099
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198335
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86100
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 433798
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30