CMS Formulary

Displaying 86861-86870 of 1611142 results.
ID: 86861
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000497
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86862
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000499
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86863
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000500
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86864
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1000487
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86865
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653579
NDC:
Tier Level: 3
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86866
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 198148
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86867
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797833
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 28
ID: 86868
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1797844
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 15
Qty Limit Days: 10
ID: 86869
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 885857
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 86870
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 860901
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 200
Qty Limit Days: 30