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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 A0814 PNEUMOVAX 23 25MCG INJ (MSD/STO) PNEUMOCOCCAL 10X0.5ML B 23.98 25MCG 0 2022-04-01 2024-03-31 0