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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 4253U BANEOCIN 250IU | 5MG OINT (BCH/COL) BACITRACIN | NEOMYCIN 20G A 5.25 250IU/G|5MG/G 2 2022-04-01 2022-05-24 Delete from contract 0