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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 7912E ORPHENADRINE 30MG/ML INJ (AKI/AHI) 10X2ML C 69.01 30MG/ML 0 2022-04-01 2022-09-30 0