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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 22719 VISTA-METHASONE 0.1% EYE (MTP/COL) BETAMETHAS 10ML A 5.30 0.1% 1 2022-04-01 2024-03-31 6
41 22719 VISTA-METHASONE 0.1% EYE DR (MTP) BETAMETHASONE 10ML A 7.421 0.1% 1 2024-04-01 2026-03-31 6