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 PoliciesPage67DateAugust 1, 2013Drug ProductQuantityDays’SupplyDexilant 30 mg (dexlansoprazole) 30 30Dexilant 60 mg (dexlansoprazole) 30 30Diastat (diazepem) 6 30Diazepam syringes 15 30syringesDiazepam intensol 5 mg/ml240 ml 30(diazepam)Diazepam oral solution 1 mg/ml 1200 ml 30(diazepam)Differin 0.1% cream (adapalene) 45 30Differin 0.1% gel (adapalene) 45 30Diovan 40 mg (valsartan) 30 30Diovan 80 mg (valsartan) 30 30Diovan 160 mg (valsartan) 30 30Diovan 320 mg (valsartan) 30 30Diovan HCT 80-12.5 mg30 30(valsartan/HCTZ)Diovan HCT 160-12.5 mg30 30(valsartan/HCTZ)Diovan HCT 160-25 mg30 30(valsartan/HCTZ)Diovan HCT 320-12.5 mg30 30(valsartan/HCTZ)Diovan HCT 320-25 mg30 30(valsartan/HCTZ)Ditropan XL 5 mg (oxybutynin ER) 30 30Ditropan XL 10 mg (oxybutynin ER) 60 30Ditropan XL 15 mg (oxybutynin ER) 60 30Doral 7.5 mg (quazepam) 30 30Doral 15 mg (quazepam) 30 30Duoneb 3 ml vial620 ml 30(albuterol/ipratropium)Edurant 25 mg (rilpivirine) 30 30Effexor XR 37.5 mg (venlafaxine) 30 30Effexor XR 75 mg (venlafaxine) 30 30Effexor XR 150 mg (venlafaxine) 90 30EMLA (lidocaine-prilocaine) 30 grams 30Emsam 6 mg/24-hour patch30 30(selegiline)Emsam 9 mg/24-hour patch30 30(selegiline)Emsam 12 mg/24-hour patch(selegiline)30 30Comments
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