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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00002327004 CYMBALTA CAP 60MG 12/31/9999 2<strong>01</strong>2300002327030 CYMBALTA CAP 60MG 12/31/9999 2<strong>01</strong>2300002327033 CYMBALTA CAP 60MG 12/31/9999 2<strong>01</strong>2300472075528 CYPROHEPTAD SYP 2MG/5ML 12/31/9999 2<strong>01</strong>2300472140<strong>01</strong>6 CYPROHEPTAD SYP 2MG/5ML 12/31/9999 2<strong>01</strong>2364980050448 CYPROHEPTAD SYP 2MG/5ML 12/31/9999 2<strong>01</strong>23000932929<strong>01</strong> CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2300093292910 CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2300093292993 CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2300904114561 CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2349884004305 CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>23602580850<strong>01</strong> CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2360258085<strong>01</strong>0 CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>23<strong>01</strong> CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>2310 CYPROHEPTAD TAB 4MG 12/31/9999 2<strong>01</strong>2351552087104 CYPROHEPTADI POW USP 12/31/9999 2<strong>01</strong>2351552087105 CYPROHEPTADI POW USP 12/31/9999 2<strong>01</strong>2351552087106 CYPROHEPTADI POW USP 12/31/9999 2<strong>01</strong>23666214000<strong>01</strong> CYSTADANE POW 12/31/9999 2<strong>01</strong>23003789045<strong>01</strong> CYSTAGON CAP 150MG 12/31/9999 2<strong>01</strong>2300378904505 CYSTAGON CAP 150MG 12/31/9999 2<strong>01</strong>23003789040<strong>01</strong> CYSTAGON CAP 50MG 12/31/9999 2<strong>01</strong>2300378904005 CYSTAGON CAP 50MG 12/31/9999 2<strong>01</strong>2300517206425 CYSTEINE HCL INJ 50MG/ML 12/31/9999 2<strong>01</strong>23004074086<strong>01</strong> CYSVIEW INJ 100MG 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>3110 CYTARABINE INJ 100MG 12/31/9999 2<strong>01</strong>2355390080610 CYTARABINE INJ 100MG 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>55<strong>01</strong> CYTARABINE INJ 100MG/ML 12/31/9999 2<strong>01</strong>2361703031922 CYTARABINE INJ 100MG/ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>2020 CYTARABINE INJ 100MG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>33<strong>01</strong> CYTARABINE INJ 1GM 12/31/9999 2<strong>01</strong>23553900808<strong>01</strong> CYTARABINE INJ 1GM 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>52<strong>01</strong> CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>5202 CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>53<strong>01</strong> CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>5302 CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>54<strong>01</strong> CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2361703030346 CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2361703030436 CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2361703030538 CYTARABINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>3210 CYTARABINE INJ 500MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2355390080710 CYTARABINE INJ 500MG 12/31/9999 2<strong>01</strong>2344206053211 CYTOGAM INJ 12/31/9999 2<strong>01</strong>234420631<strong>01</strong>10 CYTOGAM INJ 06/28/2<strong>01</strong>3 2<strong>01</strong>2360793<strong>01</strong>16<strong>01</strong> CYTOMEL TAB 25MCG 12/31/9999 2<strong>01</strong>2360793<strong>01</strong>17<strong>01</strong> CYTOMEL TAB 50MCG 12/31/9999 2<strong>01</strong>2360793<strong>01</strong>15<strong>01</strong> CYTOMEL TAB 5MCG 12/31/9999 2<strong>01</strong>2300025145120 CYTOTEC TAB 100MCG 12/31/9999 2<strong>01</strong>2300025145134 CYTOTEC TAB 100MCG 12/31/9999 2<strong>01</strong>2300025145160 CYTOTEC TAB 100MCG 12/31/9999 2<strong>01</strong>2300025146131 CYTOTEC TAB 200MCG 12/31/9999 2<strong>01</strong>2300025146134 CYTOTEC TAB 200MCG 12/31/9999 2<strong>01</strong>2300025146160 CYTOTEC TAB 200MCG 12/31/9999 2<strong>01</strong>2300004694003 CYTOVENE INJ 500MG 12/31/9999 2<strong>01</strong>23602580005<strong>01</strong> CYTRA K GRA CRYSTALS 12/31/9999 2<strong>01</strong>236025800<strong>01</strong>16 CYTRA-2 SOL 12/31/9999 2<strong>01</strong>2360258000216 CYTRA-3 SYP 12/31/9999 2<strong>01</strong>2360258000316 CYTRA-K SOL 12/31/9999 2<strong>01</strong>23664900041<strong>01</strong> D.H.E. 45 INJ 1MG/ML 12/31/9999 2<strong>01</strong>2300264762320 D10W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>23

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