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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 B2241 LEVEMIR PEN 100U/ML INJ (NOV/COL) DETEMIR 5X3ML A 25.88 100U/ML 1 2022-04-01 2024-03-31 6