CMS Formulary

Displaying 86561-86570 of 1611142 results.
ID: 86561
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 197944
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86562
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1659929
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86563
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2102705
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86564
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058906
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86565
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1872458
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 86566
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049133
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 86567
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 2049121
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 86568
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1855072
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 86569
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1986331
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 86570
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 1918230
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30