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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 3791J ALLEGRA -D 120MG F/60MG P TAB (SFA/COL) FEXOF 10'S C 1.12 120MG|60MG 0 2022-04-01 2024-03-31 0