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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
42 02429 PENICILLIN V 250MG TAB (ROL) 10X10 A 0.16 250MG 56 2026-04-01 No No 0