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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62107004113 COMPLETE TAB 12/31/9999 2<strong>01</strong>2362107004506 COMPLETE TAB SENIOR 12/31/9999 2<strong>01</strong>23138110<strong>01</strong>030 COMPLETE NAT PAK DHA 12/31/9999 2<strong>01</strong>23138110<strong>01</strong>490 COMPLETENATE CHW 12/31/9999 2<strong>01</strong>2300574722612 COMPRO SUP 25MG 12/31/9999 2<strong>01</strong>2300078032705 COMTAN TAB 200MG 12/31/9999 2<strong>01</strong>2300067208220 COMTREX CLD/ PAK CGH D/NT 12/31/9999 2<strong>01</strong>2300067208224 COMTREX CLD/ PAK CGH D/NT 12/31/9999 2<strong>01</strong>2300067207720 COMTREX COLD TAB /CGH MAX 12/31/9999 2<strong>01</strong>2300067207724 COMTREX COLD TAB /CGH MAX 12/31/9999 2<strong>01</strong>2300067208120 COMTREX COLD TAB /CGH NT 12/31/9999 2<strong>01</strong>2300067208124 COMTREX COLD TAB /CGH NT 12/31/9999 2<strong>01</strong>2300067622724 COMTREX DEEP TAB CHST CLD 12/31/9999 2<strong>01</strong>2300067208420 COMTREX FLU PAK THERAPY 12/31/9999 2<strong>01</strong>2300067208424 COMTREX FLU PAK THERAPY 12/31/9999 2<strong>01</strong>2300067208320 COMTREX SEV PAK CLD/SINU 12/31/9999 2<strong>01</strong>2300067208324 COMTREX SEV PAK CLD/SINU 12/31/9999 2<strong>01</strong>2352747062130 CONCEPT DHA CAP 12/31/9999 2<strong>01</strong>2352747062030 CONCEPT OB CAP 12/31/9999 2<strong>01</strong>23504580585<strong>01</strong> CONCERTA TAB 18MG 12/31/9999 2<strong>01</strong>23504580588<strong>01</strong> CONCERTA TAB 27MG 12/31/9999 2<strong>01</strong>23504580586<strong>01</strong> CONCERTA TAB 36MG 12/31/9999 2<strong>01</strong>23504580587<strong>01</strong> CONCERTA TAB 54MG 12/31/9999 2<strong>01</strong>2352544004513 CONDYLOX GEL 0.5% 12/31/9999 2<strong>01</strong>2352544004613 CONDYLOX SOL 0.5% 12/31/9999 2<strong>01</strong>2354859080204 CONEX SOL CLD/ALRG 12/31/9999 2<strong>01</strong>2354859070260 CONEX TAB 2-60MG 12/31/9999 2<strong>01</strong>2300225058006 CONGESTAC TAB 60-400MG 12/31/9999 2<strong>01</strong>2300225058008 CONGESTAC TAB 60-400MG 12/31/9999 2<strong>01</strong>2345963043963 CONSTULOSE SOL 10GM/15 12/31/9999 2<strong>01</strong>2345963043965 CONSTULOSE SOL 10GM/15 12/31/9999 2<strong>01</strong>230<strong>01</strong>35043602 CONTAC TAB COLD+FLU 12/31/9999 2<strong>01</strong>230<strong>01</strong>350438<strong>01</strong> CONTAC-D TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35043802 CONTAC-D TAB 10MG 12/31/9999 2<strong>01</strong>2368025005330 CONZIP CAP 100MG 12/31/9999 2<strong>01</strong>2368025005530 CONZIP CAP 200MG 12/31/9999 2<strong>01</strong>2368025005630 CONZIP CAP 300MG 12/31/9999 2<strong>01</strong>2368546031730 COPAXONE KIT 20MG/ML 12/31/9999 2<strong>01</strong>2315370002110 COPD TAB 200-200 12/31/9999 2<strong>01</strong>2300004008694 COPEGUS TAB 200MG 12/31/9999 2<strong>01</strong>2351552049704 COPPER POW GLUCONAT 12/31/9999 2<strong>01</strong>2300517621025 COPPER SULF INJ 0.4MG/ML 12/31/9999 2<strong>01</strong>2351552037703 COPPER SULF POW PENTAHYD 12/31/9999 2<strong>01</strong>2300008418804 CORDARONE TAB 200MG 12/31/9999 2<strong>01</strong>2352544004424 CORDRAN 24X3 TAP 4MCG/CM 12/31/9999 2<strong>01</strong>2352544004480 CORDRAN 80X3 TAP 4MCG/CM 12/31/9999 2<strong>01</strong>2300007414120 COREG TAB 12.5MG 12/31/9999 2<strong>01</strong>2300007414220 COREG TAB 25MG 12/31/9999 2<strong>01</strong>2300007413920 COREG TAB 3.125MG 12/31/9999 2<strong>01</strong>2300007414020 COREG TAB 6.25MG 12/31/9999 2<strong>01</strong>2300007337<strong>01</strong>3 COREG CR CAP 10MG 12/31/9999 2<strong>01</strong>2300007337113 COREG CR CAP 20MG 12/31/9999 2<strong>01</strong>2300007337213 COREG CR CAP 40MG 12/31/9999 2<strong>01</strong>2300007337313 COREG CR CAP 80MG 12/31/9999 2<strong>01</strong>2360258052<strong>01</strong>6 CORFEN-DM LIQ 12/31/9999 2<strong>01</strong>23607930800<strong>01</strong> CORGARD TAB 20MG 12/31/9999 2<strong>01</strong>236079308<strong>01</strong><strong>01</strong> CORGARD TAB 40MG 12/31/9999 2<strong>01</strong>23607930802<strong>01</strong> CORGARD TAB 80MG 12/31/9999 2<strong>01</strong>2363833051802 CORIFACT KIT 12/31/9999 2<strong>01</strong>23004092304<strong>01</strong> CORLOPAM INJ 10MG/ML 12/31/9999 2<strong>01</strong>23

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