CMS Formulary

Displaying 86711-86720 of 1611142 results.
ID: 86711
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 861663
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86712
Formulary ID: 00021030
Formulary Version: 14
Contract Year: 2021
RXCUI: 545278
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86713
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1551300
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 86714
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1551306
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 86715
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058877
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 86716
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1745108
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86717
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2395779
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 86718
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2058887
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 30
ID: 86719
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2370174
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 86720
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2170613
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 3
Qty Limit Days: 30