CMS Formulary

Displaying 87001-87010 of 1611142 results.
ID: 87001
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1873087
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87002
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1940709
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 84
Qty Limit Days: 28
ID: 87003
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1597388
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87004
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 835896
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87005
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 835835
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87006
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115468
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87007
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1926069
NDC:
Tier Level: 4
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87008
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115259
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87009
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115459
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87010
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1115464
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0