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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
41 6432D FOLINIC ACID 50MG INJ (ZUV) CALCIUM FOLI (BQ) 50MG VIAL BQ 5.5726 50MG 0 2024-04-01 2026-03-31 0