CMS Formulary

Displaying 861-870 of 1611142 results.
ID: 861
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 311683
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 862
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 727575
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 863
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1040012
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 864
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1040016
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 865
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1653470
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 866
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1086776
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 867
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1086780
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 868
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1086786
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 869
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307415
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 870
Formulary ID: 00021000
Formulary Version: 14
Contract Year: 2021
RXCUI: 1307421
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30