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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 7421D LIDOCAINE|PRILOCAINE 2.5%|2.5% CR (AKI) (BQ) 30G BQ 116.453 2.5%|2.5% 1 2024-04-01 2026-03-31 0