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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00067096946 DESENEX SPRY AER LIQUID 12/31/9999 2<strong>01</strong>2300078034751 DESFERAL INJ 2GM 12/31/9999 2<strong>01</strong>2300078034761 DESFERAL INJ 2GM 12/31/9999 2<strong>01</strong>2300078046761 DESFERAL INJ 500MG 12/31/9999 2<strong>01</strong>2300078046791 DESFERAL INJ 500MG 12/31/9999 2<strong>01</strong>23007811975<strong>01</strong> DESIPRAMINE TAB 100MG 12/31/9999 2<strong>01</strong>2345963034502 DESIPRAMINE TAB 100MG 12/31/9999 2<strong>01</strong>2352152034502 DESIPRAMINE TAB 100MG 12/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>850029<strong>01</strong> DESIPRAMINE TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85002910 DESIPRAMINE TAB 10MG 12/31/9999 2<strong>01</strong>23007811971<strong>01</strong> DESIPRAMINE TAB 10MG 12/31/9999 2<strong>01</strong>2345963034102 DESIPRAMINE TAB 10MG 12/31/9999 2<strong>01</strong>2352152034102 DESIPRAMINE TAB 10MG 03/31/2<strong>01</strong>4 2<strong>01</strong>230<strong>01</strong>850760<strong>01</strong> DESIPRAMINE TAB 150MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85076053 DESIPRAMINE TAB 150MG 12/31/9999 2<strong>01</strong>2300781197650 DESIPRAMINE TAB 150MG 12/31/9999 2<strong>01</strong>2345963034650 DESIPRAMINE TAB 150MG 12/31/9999 2<strong>01</strong>2352152034650 DESIPRAMINE TAB 150MG 12/31/2<strong>01</strong>3 2<strong>01</strong>23007811972<strong>01</strong> DESIPRAMINE TAB 25MG 12/31/9999 2<strong>01</strong>2345963034202 DESIPRAMINE TAB 25MG 12/31/9999 2<strong>01</strong>2352152034204 DESIPRAMINE TAB 25MG 12/31/9999 2<strong>01</strong>2352152034205 DESIPRAMINE TAB 25MG 08/30/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>850721<strong>01</strong> DESIPRAMINE TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85072105 DESIPRAMINE TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85072110 DESIPRAMINE TAB 50MG 12/31/9999 2<strong>01</strong>23007811973<strong>01</strong> DESIPRAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2345963034302 DESIPRAMINE TAB 50MG 12/31/9999 2<strong>01</strong>2352152034304 DESIPRAMINE TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850722<strong>01</strong> DESIPRAMINE TAB 75MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85072205 DESIPRAMINE TAB 75MG 12/31/9999 2<strong>01</strong>23007811974<strong>01</strong> DESIPRAMINE TAB 75MG 12/31/9999 2<strong>01</strong>2345963034402 DESIPRAMINE TAB 75MG 12/31/9999 2<strong>01</strong>23003784<strong>01</strong>7<strong>01</strong> DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>23003784<strong>01</strong>705 DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>2362756052313 DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>2362756052388 DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>2376439<strong>01</strong>0710 DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>2376439<strong>01</strong>0730 DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>2376439<strong>01</strong>0750 DESLORATADIN TAB 5MG 12/31/9999 2<strong>01</strong>23004092265<strong>01</strong> DESMOPRESSIN INJ 4MCG/ML 12/31/9999 2<strong>01</strong>23007035051<strong>01</strong> DESMOPRESSIN INJ 4MCG/ML 12/31/9999 2<strong>01</strong>2300703505103 DESMOPRESSIN INJ 4MCG/ML 12/31/9999 2<strong>01</strong>23007035054<strong>01</strong> DESMOPRESSIN INJ 4MCG/ML 12/31/9999 2<strong>01</strong>23555665030<strong>01</strong> DESMOPRESSIN INJ 4MCG/ML 12/31/9999 2<strong>01</strong>23555665040<strong>01</strong> DESMOPRESSIN INJ 4MCG/ML 12/31/9999 2<strong>01</strong>23555665020<strong>01</strong> DESMOPRESSIN SOL 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2355566502002 DESMOPRESSIN SOL 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2324208034205 DESMOPRESSIN SPR 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2360505081500 DESMOPRESSIN SPR 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>2362756<strong>01</strong>6191 DESMOPRESSIN SPR 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>23000937316<strong>01</strong> DESMOPRESSIN TAB 0.1MG 12/31/9999 2<strong>01</strong>23005912225<strong>01</strong> DESMOPRESSIN TAB 0.1MG 11/30/2<strong>01</strong>2 2<strong>01</strong>23005912464<strong>01</strong> DESMOPRESSIN TAB 0.1MG 12/31/9999 2<strong>01</strong>23555665060<strong>01</strong> DESMOPRESSIN TAB 0.1MG 12/31/9999 2<strong>01</strong>23605050257<strong>01</strong> DESMOPRESSIN TAB 0.1MG 12/31/9999 2<strong>01</strong>23000937317<strong>01</strong> DESMOPRESSIN TAB 0.2MG 12/31/9999 2<strong>01</strong>23005912226<strong>01</strong> DESMOPRESSIN TAB 0.2MG 07/31/2<strong>01</strong>3 2<strong>01</strong>23005912465<strong>01</strong> DESMOPRESSIN TAB 0.2MG 12/31/9999 2<strong>01</strong>23510790446<strong>01</strong> DESMOPRESSIN TAB 0.2MG 12/31/9999 2<strong>01</strong>2351079044603 DESMOPRESSIN TAB 0.2MG 12/31/9999 2<strong>01</strong>23

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