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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68968555303 DAYTRANA DIS 15MG/9HR 12/31/9999 2<strong>01</strong>2368968555403 DAYTRANA DIS 20MG/9HR 12/31/9999 2<strong>01</strong>2354092055530 DAYTRANA DIS 30MG/9HR 12/<strong>01</strong>/2<strong>01</strong>2 2<strong>01</strong>2368968555503 DAYTRANA DIS 30MG/9HR 12/31/9999 2<strong>01</strong>23000752451<strong>01</strong> DDAVP INJ 4MCG/ML 12/31/9999 2<strong>01</strong>2300075245153 DDAVP INJ 4MCG/ML 12/31/9999 2<strong>01</strong>23000752450<strong>01</strong> DDAVP SOL 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>23000752452<strong>01</strong> DDAVP SPR 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>23000750<strong>01</strong>600 DDAVP TAB 0.1MG 12/31/9999 2<strong>01</strong>2300075002600 DDAVP TAB 0.2MG 12/31/9999 2<strong>01</strong>2351552084107 DEANOL POW BITARTRA 12/31/9999 2<strong>01</strong>230<strong>01</strong>35009159 DEBROX SOL 6.5% OT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35009163 DEBROX SOL 6.5% OT 12/31/9999 2<strong>01</strong>2360258052116 DE-CHLOR DM LIQ LIQUID 12/31/9999 2<strong>01</strong>2300472151704 DECOFED SYP 30MG/5ML 12/31/9999 2<strong>01</strong>2300472151716 DECOFED SYP 30MG/5ML 12/31/9999 2<strong>01</strong>2300472151794 DECOFED SYP 30MG/5ML 12/31/9999 2<strong>01</strong>2350991058260 DECONEX CAP 10-390MG 12/31/9999 2<strong>01</strong>2350991058360 DECONEX DM CAP 12/31/9999 2<strong>01</strong>2350991073060 DECONEX DMX TAB 12/31/9999 2<strong>01</strong>2350991071660 DECONEX IR TAB 10-380MG 12/31/9999 2<strong>01</strong>2337205044652 DECONGESTANT CAP 120MG CR 12/31/9999 2<strong>01</strong>2337205048310 DECONGESTANT SOL 1% 12/31/9999 2<strong>01</strong>2336800005452 DECONGESTANT TAB 120MG CR 12/31/9999 2<strong>01</strong>2336800005460 DECONGESTANT TAB 120MG CR 12/31/9999 2<strong>01</strong>23493480361<strong>01</strong> DECONGESTANT TAB 120MG CR 12/31/9999 2<strong>01</strong>230<strong>01</strong>13005452 DECONGESTANT TAB 120MG ER 12/31/9999 2<strong>01</strong>2300904386575 DEEP SEA SPR 0.65% 12/31/9999 2<strong>01</strong>2300409233725 DEFEROXAMINE INJ 2GM 12/31/9999 2<strong>01</strong>2300555113111 DEFEROXAMINE INJ 2GM 12/31/9999 2<strong>01</strong>2363323059930 DEFEROXAMINE INJ 2GM 12/31/9999 2<strong>01</strong>2300409233610 DEFEROXAMINE INJ 500MG 12/31/9999 2<strong>01</strong>2300555113212 DEFEROXAMINE INJ 500MG 12/31/9999 2<strong>01</strong>2355390026310 DEFEROXAMINE INJ 500MG 12/31/9999 2<strong>01</strong>2363323059710 DEFEROXAMINE INJ 500MG 12/31/9999 2<strong>01</strong>23119940<strong>01</strong>104 DEFINITY SUS 1.1MG/ML 12/31/9999 2<strong>01</strong>236797905<strong>01</strong>40 DELATESTRYL INJ 200MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>10<strong>01</strong> DELESTROGEN INJ 10MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>11<strong>01</strong> DELESTROGEN INJ 20MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>12<strong>01</strong> DELESTROGEN INJ 40MG/ML 12/31/9999 2<strong>01</strong>2349908<strong>01</strong>2380 DELOS LIQ 3.5% 12/31/9999 2<strong>01</strong>2349908<strong>01</strong>2145 DELOS LOT 3.5% 12/31/9999 2<strong>01</strong>2353<strong>01</strong>4046343 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2353<strong>01</strong>4046348 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2353<strong>01</strong>4046356 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2353<strong>01</strong>4046361 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>7163 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>7165 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>7265 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>7563 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>7565 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>7663 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824027263 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824027663 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824027665 DELSYM LIQ 30MG/5ML 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>8464 DELSYM CHILD LIQ CGH/COLD 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>8264 DELSYM NIGHT LIQ CGH/COLD 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>8364 DELSYM NIGHT LIQ MULTI-S 12/31/9999 2<strong>01</strong>230003750<strong>01</strong><strong>01</strong> DEMADEX TAB 100MG 12/31/9999 2<strong>01</strong>23000375<strong>01</strong>0<strong>01</strong> DEMADEX TAB 10MG 12/31/9999 2<strong>01</strong>23

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