CMS Formulary

Displaying 86421-86430 of 1611142 results.
ID: 86421
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 749860
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86422
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 198373
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 86423
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1094543
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86424
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 859033
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86425
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 859040
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86426
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 859052
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86427
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 855642
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 100
Qty Limit Days: 28
ID: 86428
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 312504
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86429
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 313291
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86430
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1245919
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0