CMS Formulary

Displaying 87391-87400 of 1611142 results.
ID: 87391
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 835958
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87392
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 834346
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87393
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 993466
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87394
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 993470
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87395
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 993462
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87396
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 2047868
NDC:
Tier Level: 5
Qty Limit?: 0
Qty Limit Amt: 180
Qty Limit Days: 30
ID: 87397
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 834350
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87398
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801299
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87399
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 832731
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87400
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1801295
NDC:
Tier Level: 2
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0