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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 05616 CHLORAMBUCIL 2MG TAB (KWA/ATB) 3X10 A 5.89 2MG 240 2022-05-27 2024-03-31 Package Size Change 6