CMS Formulary

Displaying 86761-86770 of 1611142 results.
ID: 86761
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 404460
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86762
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1593140
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86763
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1547575
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 86764
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1547110
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 86765
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243848
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 86766
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243843
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 86767
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1243833
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 86768
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 665044
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 86769
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 665040
NDC:
Tier Level: 3
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 86770
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 744846
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0