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Contract Number Brand Code Brand Name Package Size Formulary Category Unit Price Strength Max. Reimbursable / Month Drug Contract Start Date Drug Contract End Date Restrict To Ophthalmologist Restrict To Pulmonologist Status Description Max Repeats
40 52614 ONE-ALPHA 0.25MCG CAP (LEO/COL) ALFACALCIDOL 100'S A 0.42 0.25MCG 120 2022-04-01 2024-03-31 6