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

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37205096926 COLD/COUGH ELX DM CHILD 12/31/9999 2<strong>01</strong>230<strong>01</strong>13065630 COLD/FLU LIQ DAYTIME 10/19/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>13065638 COLD/FLU LIQ DAYTIME 08/11/2<strong>01</strong>3 2<strong>01</strong>2300009026002 COLESTID GRA 5GM 12/31/9999 2<strong>01</strong>2300009026<strong>01</strong>7 COLESTID GRA 5GM 12/31/9999 2<strong>01</strong>23000090260<strong>01</strong> COLESTID POW 5GM 12/31/9999 2<strong>01</strong>2300009026004 COLESTID POW 5GM 12/31/9999 2<strong>01</strong>2300009045003 COLESTID TAB 1GM 12/31/9999 2<strong>01</strong>2300009037003 COLESTID FLA GRA 5/7.5GM 12/31/9999 2<strong>01</strong>2300009037005 COLESTID FLA GRA 5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>15521218 COLESTIPOL GRA 5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>15521229 COLESTIPOL GRA 5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>15521302 COLESTIPOL GRA 5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>15521116 COLESTIPOL TAB 1GM 12/31/9999 2<strong>01</strong>23597620450<strong>01</strong> COLESTIPOL TAB 1GM 12/31/9999 2<strong>01</strong>23005740858<strong>01</strong> COLISTIMETH INJ 150MG 12/31/9999 2<strong>01</strong>23398220615<strong>01</strong> COLISTIMETH INJ 150MG 12/31/9999 2<strong>01</strong>2339822061502 COLISTIMETH INJ 150MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>31<strong>01</strong> COLISTIMETH INJ 150MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>3106 COLISTIMETH INJ 150MG 12/31/9999 2<strong>01</strong>2363323039306 COLISTIMETH INJ 150MG 12/31/9999 2<strong>01</strong>2351552074305 COLLAGEN POW HYDROLYS 12/31/9999 2<strong>01</strong>2351552020305 COLLODION LIQ 12/31/9999 2<strong>01</strong>2351552020306 COLLODION LIQ 12/31/9999 2<strong>01</strong>23005742020<strong>01</strong> COLOCORT ENE 100MG 12/31/9999 2<strong>01</strong>2300574202007 COLOCORT ENE 100MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>07<strong>01</strong> COLY-MYCIN M INJ 150MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>0706 COLY-MYCIN M INJ 150MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>08<strong>01</strong> COLY-MYCIN S SUS OTIC 12/31/9999 2<strong>01</strong>2368220<strong>01</strong>3004 COLYTE/FLAVR SOL PACKS 12/31/9999 2<strong>01</strong>2368220<strong>01</strong>33<strong>01</strong> COLYTE/FLAVR SOL PACKS 12/31/9999 2<strong>01</strong>2300023921105 COMBIGAN SOL 0.2/0.5% 12/31/9999 2<strong>01</strong>2300023921110 COMBIGAN SOL 0.2/0.5% 12/31/9999 2<strong>01</strong>2300078037742 COMBIPATCH DIS .05/.14 12/31/9999 2<strong>01</strong>2300078037762 COMBIPATCH DIS .05/.14 12/31/9999 2<strong>01</strong>2300078037842 COMBIPATCH DIS .05/.25 12/31/9999 2<strong>01</strong>2300078037862 COMBIPATCH DIS .05/.25 12/31/9999 2<strong>01</strong>23005970<strong>01</strong>314 COMBIVENT AER 12/31/9999 2<strong>01</strong>2300597002402 COMBIVENT AER RESPIMAT 12/31/9999 2<strong>01</strong>230<strong>01</strong>73059500 COMBIVIR TAB 150-300 07/31/2<strong>01</strong>4 2<strong>01</strong>2349702020218 COMBIVIR TAB 150-300 12/31/9999 2<strong>01</strong>2349702020229 COMBIVIR TAB 150-300 12/31/9999 2<strong>01</strong>230<strong>01</strong>35020803 COMMIT LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350452<strong>01</strong> COMMIT LOZ 2MG CHRY 12/31/9999 2<strong>01</strong>230<strong>01</strong>35045203 COMMIT LOZ 2MG CHRY 12/31/9999 2<strong>01</strong>230<strong>01</strong>35020903 COMMIT LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350453<strong>01</strong> COMMIT LOZ 4MG CHRY 12/31/9999 2<strong>01</strong>230<strong>01</strong>35045303 COMMIT LOZ 4MG CHRY 12/31/9999 2<strong>01</strong>2337205027762 COMP ALLERGY CAP 25MG 12/31/9999 2<strong>01</strong>2337205027778 COMP ALLERGY CAP 25MG 12/31/9999 2<strong>01</strong>23638680087<strong>01</strong> COMP ALLERGY CAP 25MG 12/31/9999 2<strong>01</strong>2363868008724 COMP ALLERGY CAP 25MG 12/31/9999 2<strong>01</strong>2337205056526 COMP ALLERGY ELX 12.5/5ML 12/31/9999 2<strong>01</strong>2337205056534 COMP ALLERGY ELX 12.5/5ML 12/31/9999 2<strong>01</strong>2337205027062 COMP ALLERGY TAB 25MG 12/31/9999 2<strong>01</strong>2337205027078 COMP ALLERGY TAB 25MG 12/31/9999 2<strong>01</strong>23638680500<strong>01</strong> COMP ALLERGY TAB 25MG 12/31/9999 2<strong>01</strong>2363868050024 COMP ALLERGY TAB 25MG 12/31/9999 2<strong>01</strong>236195811<strong>01</strong><strong>01</strong> COMPLERA TAB 12/31/9999 2<strong>01</strong>230<strong>01</strong>13<strong>01</strong>7324 COMPLETE KIT LICE 12/31/9999 2<strong>01</strong>23

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