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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 4211BE BETAZOLE 0.25% | 1% CR (LDP/AHI) BECLOMETHASONE | CLOTRIMAZOLE 10G A 3.18 0.25%|1% 2 2022-04-01 2024-03-31 6