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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51645074<strong>01</strong>0 DAILY VITAMI TAB FORMULA 12/31/9999 2<strong>01</strong>23005363547<strong>01</strong> DAILY VITE TAB 12/31/9999 2<strong>01</strong>2300536354710 DAILY VITE TAB 12/31/9999 2<strong>01</strong>23005363546<strong>01</strong> DAILY-VITE/ TAB IRON 12/31/9999 2<strong>01</strong>2300536354610 DAILY-VITE/ TAB IRON 12/31/9999 2<strong>01</strong>2336800064164 DAIRY AID TAB 9000UNIT 12/31/9999 2<strong>01</strong>2368<strong>01</strong>6068196 DAIRY DIGEST CHW ULTRA 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>4976 DAIRY-RELIEF CHW 3000UNIT 12/31/9999 2<strong>01</strong>2300456009530 DALIRESP TAB 500MCG 12/31/9999 2<strong>01</strong>2300456009563 DALIRESP TAB 500MCG 12/31/9999 2<strong>01</strong>2300456009590 DALIRESP TAB 500MCG 12/31/9999 2<strong>01</strong>2316477<strong>01</strong>52<strong>01</strong> DALLERGY CHW 12.5-5MG 12/31/9999 2<strong>01</strong>2316477<strong>01</strong>2030 DALLERGY DRO 1-2MG/ML 12/31/9999 2<strong>01</strong>23164770820<strong>01</strong> DALLERGY SYP 12/31/9999 2<strong>01</strong>2316477<strong>01</strong>60<strong>01</strong> DALLERGY TAB 25-10MG 12/31/9999 2<strong>01</strong>2316477<strong>01</strong>40<strong>01</strong> DALLERGY DM SYP 12/31/9999 2<strong>01</strong>2300277<strong>01</strong>8641 DALLERGY-JR SUS 03/31/2<strong>01</strong>3 2<strong>01</strong>2350383062316 DALYVITE/FE LIQ 12/31/9999 2<strong>01</strong>23005271368<strong>01</strong> DANAZOL CAP 100MG 12/31/9999 2<strong>01</strong>2300555063402 DANAZOL CAP 100MG 12/31/9999 2<strong>01</strong>23005271369<strong>01</strong> DANAZOL CAP 200MG 12/31/9999 2<strong>01</strong>2300527136906 DANAZOL CAP 200MG 12/31/9999 2<strong>01</strong>2300555063502 DANAZOL CAP 200MG 12/31/9999 2<strong>01</strong>2300555063509 DANAZOL CAP 200MG 12/31/9999 2<strong>01</strong>2368084007421 DANAZOL CAP 200MG 12/31/9999 2<strong>01</strong>23005271392<strong>01</strong> DANAZOL CAP 50MG 12/31/9999 2<strong>01</strong>2300555063302 DANAZOL CAP 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>49003305 DANTRIUM CAP 100MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2342023<strong>01</strong>26<strong>01</strong> DANTRIUM CAP 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>49003005 DANTRIUM CAP 25MG 07/31/2<strong>01</strong>3 2<strong>01</strong>2342023<strong>01</strong>24<strong>01</strong> DANTRIUM CAP 25MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>25<strong>01</strong> DANTRIUM CAP 50MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>2306 DANTRIUM IV INJ 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>154433<strong>01</strong> DANTROLENE CAP 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>154411<strong>01</strong> DANTROLENE CAP 25MG 12/31/9999 2<strong>01</strong>2368084030021 DANTROLENE CAP 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>154422<strong>01</strong> DANTROLENE CAP 50MG 12/31/9999 2<strong>01</strong>2349938<strong>01</strong><strong>01</strong>30 DAPSONE TAB 100MG 12/31/9999 2<strong>01</strong>2349938<strong>01</strong>0230 DAPSONE TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>7302<strong>01</strong>55 DARAPRIM TAB 25MG 03/31/2<strong>01</strong>3 2<strong>01</strong>2352054033<strong>01</strong>0 DARAPRIM TAB 25MG 12/31/9999 2<strong>01</strong>2355390080510 DAUNORUBICIN INJ 20MG 12/31/9999 2<strong>01</strong>2300703523313 DAUNORUBICIN INJ 5MG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>08<strong>01</strong> DAUNORUBICIN INJ 5MG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>0810 DAUNORUBICIN INJ 5MG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>4210 DAUNORUBICIN INJ 5MG/ML 12/31/9999 2<strong>01</strong>2300904576312 DAY TIME CAP COLD/FLU 12/31/9999 2<strong>01</strong>2336800065630 DAY TIME LIQ COLD/FLU 12/31/9999 2<strong>01</strong>2336800065638 DAY TIME LIQ COLD/FLU 12/31/9999 2<strong>01</strong>2336800047338 DAY TIME LIQ COUGH 12/31/9999 2<strong>01</strong>230<strong>01</strong>13028273 DAYHIST ALRG TAB 12 HOUR 12/31/9999 2<strong>01</strong>2336800028251 DAYHIST ALRG TAB 12 HOUR 12/31/9999 2<strong>01</strong>2300025138131 DAYPRO TAB 600MG 12/31/9999 2<strong>01</strong>2337205071930 DAY-TIME LIQ COLD/FLU 12/31/9999 2<strong>01</strong>230<strong>01</strong>13021553 DAYTIME PE CAP COLD/FLU 08/09/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>13021560 DAYTIME PE CAP COLD/FLU 08/09/2<strong>01</strong>3 2<strong>01</strong>2336800021553 DAYTIME PE CAP COLD/FLU 12/31/9999 2<strong>01</strong>2336800021560 DAYTIME PE CAP COLD/FLU 12/31/9999 2<strong>01</strong>2337205070553 DAY-TIME PE CAP 12/31/9999 2<strong>01</strong>2368968555203 DAYTRANA DIS 10MG/9HR 12/31/9999 2<strong>01</strong>23

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