CMS Formulary

Displaying 87701-87710 of 1611142 results.
ID: 87701
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1482908
NDC:
Tier Level: 5
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87702
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806187
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 87703
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806189
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 60
Qty Limit Days: 30
ID: 87704
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806191
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 87705
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 1806193
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 30
Qty Limit Days: 30
ID: 87706
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 905369
NDC:
Tier Level: 1
Qty Limit?: 0
Qty Limit Amt: 120
Qty Limit Days: 30
ID: 87707
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 311166
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87708
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 197832
NDC:
Tier Level: 1
Qty Limit?: 1
Qty Limit Amt: 0
Qty Limit Days: 0
ID: 87709
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 349196
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 90
Qty Limit Days: 30
ID: 87710
Formulary ID: 00021031
Formulary Version: 14
Contract Year: 2021
RXCUI: 349197
NDC:
Tier Level: 2
Qty Limit?: 0
Qty Limit Amt: 300
Qty Limit Days: 30