Prescribed Drugs Provider Manual - Iowa Department of Human ...
Prescribed Drugs Provider Manual - Iowa Department of Human ...
Prescribed Drugs Provider Manual - Iowa Department of Human ...
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<strong>Iowa</strong><strong>Department</strong><strong>of</strong> <strong>Human</strong>Services<strong>Provider</strong> and Chapter<strong>Prescribed</strong> <strong>Drugs</strong>Chapter III. <strong>Provider</strong>-Specific PoliciesPage66DateAugust 1, 2013Drug ProductConcerta SA 18 mg(methylphenidate ER)Concerta SA 27 mg(methylphenidate ER)Concerta SA 36 mg(methylphenidate ER)Concerta SA 54 mg(methylphenidate ER)Cosopt (dorzolamide hydrochloride/timolol maleate)Days’Quantity Supply60 3060 3060 3060 3010 ml 30Cozaar 25 mg (losartan) 60 30Cozaar 50 mg (losartan) 60 30Cozaar 100 mg (losartan) 30 30Crestor 5 mg (rosuvastatin) 30 30Crestor 10 mg (rosuvastatin) 30 30Crestor 20 mg (rosuvastatin) 30 30Crestor 40 mg (rosuvastatin) 30 30Cymbalta 20 mg (duloxetine) 60 30Cymbalta 30 mg (duloxetine) 60 30Cymbalta 60 mg (duloxetine) 60 30Dalmane 15 mg (flurazepam) 30 30Dalmane 30 mg (flurazepam) 30 30Darvocet-N 50 (propoxyphene-n/ 180 30acetaminophen)Darvocet-N 100 (propoxyphenen/acetaminophen)180 30Daytrana 10 mg/9-hour patch30 30(methylphenidate)Daytrana 15 mg/9-hour patch30 30(methylphenidate)Daytrana 20 mg/9-hour patch30 30(methylphenidate)Daytrana 30 mg/9-hour patch30 30(methylphenidate)Detrol LA 2 mg (tolterodine) 30 30Detrol LA 4 mg (tolterodine) 30 30Dexedrine 5 mg SR60 30(dextroamphetamine SR)Dexedrine 10 mg SR60 30(dextroamphetamine SR)Dexedrine 15 mg SR(dextroamphetamine SR)120 30Comments
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