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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00409486202 D10W/NACL INJ 0.225% 12/31/9999 2<strong>01</strong>2300264762200 D10W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300264760500 D2.5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300264760510 D2.5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300338007304 D2.5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300264775100 D5W/LR INJ 12/31/9999 2<strong>01</strong>2300264775110 D5W/LR INJ 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>2503 D5W/LR INJ 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>2504 D5W/LR INJ 12/31/9999 2<strong>01</strong>2300409792903 D5W/LR INJ 12/31/9999 2<strong>01</strong>2300409792909 D5W/LR INJ 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>4303 D5W/LYTES INJ #48 12/31/9999 2<strong>01</strong>2300264761600 D5W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>2300264761610 D5W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>2300264761620 D5W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>2300338007702 D5W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>2300338007703 D5W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>2300338007704 D5W/NACL INJ 0.2% 12/31/9999 2<strong>01</strong>2300409792402 D5W/NACL INJ 0.225% 12/31/9999 2<strong>01</strong>2300409792403 D5W/NACL INJ 0.225% 12/31/9999 2<strong>01</strong>2300409792409 D5W/NACL INJ 0.225% 12/31/9999 2<strong>01</strong>2300409792503 D5W/NACL INJ 0.3% 12/31/9999 2<strong>01</strong>2300409792509 D5W/NACL INJ 0.3% 12/31/9999 2<strong>01</strong>2300264761400 D5W/NACL INJ 0.33% 12/31/9999 2<strong>01</strong>2300264761410 D5W/NACL INJ 0.33% 12/31/9999 2<strong>01</strong>2300338008103 D5W/NACL INJ 0.33% 12/31/9999 2<strong>01</strong>2300264761200 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300264761210 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300264761220 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300338008502 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300338008503 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300338008504 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300338630803 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300409792602 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300409792603 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300409792609 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300409792630 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300409792648 D5W/NACL INJ 0.45% 12/31/9999 2<strong>01</strong>2300264761000 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300264761<strong>01</strong>0 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300264761020 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300338008903 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300338008904 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300409794103 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300409794109 D5W/NACL INJ 0.9% 12/31/9999 2<strong>01</strong>2300264778100 D5W/RINGERS INJ 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>2710 DACARBAZINE INJ 100MG 12/31/9999 2<strong>01</strong>23007035075<strong>01</strong> DACARBAZINE INJ 200MG 12/31/9999 2<strong>01</strong>2300703507503 DACARBAZINE INJ 200MG 12/31/9999 2<strong>01</strong>2355390009<strong>01</strong>0 DACARBAZINE INJ 200MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2361703032722 DACARBAZINE INJ 200MG 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>2820 DACARBAZINE INJ 200MG 12/31/9999 2<strong>01</strong>23628560600<strong>01</strong> DACOGEN INJ 50MG 12/31/9999 2<strong>01</strong>23553900337<strong>01</strong> DACTINOMYCIN INJ 0.5MG 12/31/9999 2<strong>01</strong>23638680624<strong>01</strong> DAILY MULTI TAB VIT/IRON 12/31/9999 2<strong>01</strong>2363868062160 DAILY MULTI TAB VIT/MENS 12/31/9999 2<strong>01</strong>23638680613<strong>01</strong> DAILY MULTI TAB VIT/MIN 12/31/9999 2<strong>01</strong>23516450741<strong>01</strong> DAILY VIT TAB +IRON 12/31/9999 2<strong>01</strong>23516450742<strong>01</strong> DAILY VIT TAB +MINERAL 12/31/9999 2<strong>01</strong>23516450740<strong>01</strong> DAILY VITAMI TAB FORMULA 12/31/9999 2<strong>01</strong>23

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