CMS Formulary

Displaying 86721-86730 of 1611142 results.
ID: 86721
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2395785
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 2
Qty Limit Days: 28
ID: 86722
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2370170
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 86723
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2047247
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86724
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2256947
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 86725
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946836
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 86726
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2256943
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 8
Qty Limit Days: 30
ID: 86727
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2205474
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86728
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946840
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 86729
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946844
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28
ID: 86730
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1946848
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 56
Qty Limit Days: 28