CMS Formulary

Displaying 86301-86310 of 1611142 results.
ID: 86301
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1649990
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86302
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1650030
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86303
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198201
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86304
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 728109
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 180
ID: 86305
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 312122
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 42
Qty Limit Days: 180
ID: 86306
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 200346
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86307
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 308135
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86308
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 309054
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86309
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 848140
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86310
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 848131
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0