What are the implications of having main plugin file name different to plugin slug?

It’s only a good pratice to adopt this naming convention. As long as you have in the header of your main file the meta (at last Plugin name: Name of Your Plugin, WordPress will automatically recognize this file for being the main one.

Be aware that at the top of this file you should write at least :

/*
 * Plugin Name: YOUR PLUGIN NAME
 */

In the plugin handbook, WordPress it is written :

Create a new PHP file (it’s also good to name this file after your
plugin, e.g. plugin-name.php).

[…] Only one file in the plugin’s folder should have the header comment —
if the plugin has multiple PHP files, only one of those files should
have the header comment.

As you can see, it’s only a naming convention. It is not mandatory.

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