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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
42 4061H ANTAZOLINE|NAPHAZOLINE 0.5%|0.05% EYE DR (FSB) 10ML A 6.14 0.5%|0.05% 1 2026-04-01 No No Add to Contract as Cat A 6