Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

60575021216 CODAR AR LIQ 12/31/9999 2012360575051516 CODAR D LIQ 12/31/9999 2012360575061616 CODAR GF LIQ 12/31/9999 2012351224030010 CODEINE SULF SOL 30MG/5ML 12/31/9999 2012300054024324 CODEINE SULF TAB 15MG 12/31/9999 2012300054024424 CODEINE SULF TAB 30MG 12/31/9999 2012300054024425 CODEINE SULF TAB 30MG 12/31/9999 2012368462019301 CODEINE SULF TAB 30MG 12/31/9999 2012300054024525 CODEINE SULF TAB 60MG 12/31/9999 2012368462019401 CODEINE SULF TAB 60MG 12/31/9999 2012352152017202 CODEINE/GG TAB 10-300 12/31/9999 2012300131503864 CODIMAL PH SYP 12/31/9999 2012300131503870 CODIMAL PH SYP 12/31/9999 2012300603072854 CODITUSS DM SYP 12/31/9999 2012300536193807 COENZYME Q10 CAP 100MG 12/31/9999 2012367386061152 COGENTIN INJ 1MG/ML 11/30/2013 2012300131210437 CO-GESIC TAB 5-500MG 12/31/9999 2012367618010110 COLACE CAP 100MG 12/31/9999 2012367618010130 COLACE CAP 100MG 12/31/9999 2012367618010152 COLACE CAP 100MG 12/31/9999 2012367618010160 COLACE CAP 100MG 12/31/9999 2012367618010030 COLACE CAP 50MG 12/31/9999 2012367618010060 COLACE CAP 50MG 12/31/9999 2012367618010424 COLACE SUP 2.1GM 12/31/9999 2012367618010316 COLACE SYP 60/15ML 12/31/9999 2012367618010512 COLACE PED SUP 1.2GM 12/31/9999 2012365649010102 COLAZAL CAP 750MG 12/31/9999 2012313310011901 COLCRYS TAB 0.6MG 12/31/9999 2012313310011907 COLCRYS TAB 0.6MG 12/31/9999 2012338779093508 COLD CRE 12/31/9999 2012362011007001 COLD & SINUS TAB RELIEF 12/31/9999 2012324385096360 COLD HEAD PAK DAY/NGHT 12/31/9999 2012300113023462 COLD HEAD TAB CONG DT 12/31/9999 2012336800023462 COLD HEAD TAB CONG DT 12/31/9999 2012324385054262 COLD HEAD TAB CONGEST 12/31/9999 2012336800040262 COLD HEAD TAB CONGESTI 12/31/9999 2012324385096260 COLD MULTI PAK DAY/NGHT 12/31/9999 2012324385096262 COLD MULTI PAK DAY/NGHT 12/31/9999 2012336800001462 COLD MULTI-S TAB NIGHTTIM 12/31/9999 2012324385005262 COLD MULT-SY TAB DAYTIME 12/31/9999 2012336800037162 COLD MULT-SY TAB DAYTIME 12/31/9999 2012300113030862 COLD MULT-SY TAB SEVR DAY 12/31/9999 2012336800030862 COLD MULT-SY TAB SEVR DAY 12/31/9999 2012346122007362 COLD RELIEF TAB MULTI-S 12/31/9999 2012346122007262 COLD RELIEF TAB MULTI-SY 12/31/9999 2012346122006360 COLD RELIEF TAB PLUS 12/31/9999 2012363868022820 COLD RELIEF TAB PLUS 12/31/9999 2012300113080701 COLD REMEDY TAB 07/01/2013 2012336800080701 COLD REMEDY TAB CHERRY 12/31/9999 2012324385098041 COLD SORE LIQ TREATMEN 12/31/9999 2012300904365024 COLD SYMPTOM TAB RELIEF 12/31/9999 2012300113090626 COLD/ALLERGY ELX CHILDREN 12/31/9999 2012336800090626 COLD/ALLERGY ELX CHILDREN 12/31/9999 2012336800090634 COLD/ALLERGY ELX CHILDREN 12/31/9999 2012337205093126 COLD/ALLERGY ELX CHILDREN 12/31/9999 2012362011006201 COLD/ALLERGY ELX CHILDREN 12/31/9999 2012324385092462 COLD/ALLERGY TAB 4-10MG 12/31/9999 2012336800013962 COLD/ALLERGY TAB 4-10MG 12/31/9999 2012300113098726 COLD/COUGH ELX CHILD 12/31/9999 2012336800098726 COLD/COUGH ELX CHILD 12/31/9999 20123