CMS Formulary

Displaying 86381-86390 of 1611142 results.
ID: 86381
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 686429
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86382
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 284201
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 86383
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 351134
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 6
Qty Limit Days: 30
ID: 86384
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 314142
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 86385
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 311919
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 86386
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988308
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86387
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988311
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86388
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988316
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86389
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988319
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86390
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1988324
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0