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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 3294S PREPRATION H MULTI-SYMPTOM 0.25% | 1% CR (GSK/COL) PHENYLEPHRINE | PRAMOXINE 26G A 12.69 0.25|1% 1 2022-04-01 2024-03-31 0