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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 A531W SAFLUTAN 0.015MG/ML EYE DR (MSD/STO) TAFLUPROST 30X0.3ML B 36.43 0.015MG/ML 0 2022-04-01 2024-03-31 6