Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

00338001703 DEXTROSE INJ 5% 12/31/9999 2012300338001704 DEXTROSE INJ 5% 12/31/9999 2012300338001710 DEXTROSE INJ 5% 12/31/9999 2012300338001711 DEXTROSE INJ 5% 12/31/9999 2012300338001718 DEXTROSE INJ 5% 12/31/9999 2012300338001731 DEXTROSE INJ 5% 12/31/9999 2012300338001738 DEXTROSE INJ 5% 12/31/9999 2012300338001741 DEXTROSE INJ 5% 12/31/9999 2012300338001748 DEXTROSE INJ 5% 12/31/9999 2012300338634602 DEXTROSE INJ 5% 12/31/9999 2012300338634603 DEXTROSE INJ 5% 12/31/9999 2012300409152202 DEXTROSE INJ 5% 12/31/9999 2012300409152203 DEXTROSE INJ 5% 12/31/9999 2012300409710002 DEXTROSE INJ 5% 12/31/9999 2012300409710066 DEXTROSE INJ 5% 12/31/9999 2012300409710067 DEXTROSE INJ 5% 12/31/9999 2012300409792202 DEXTROSE INJ 5% 12/31/9999 2012300409792203 DEXTROSE INJ 5% 12/31/9999 2012300409792209 DEXTROSE INJ 5% 12/31/9999 2012300409792225 DEXTROSE INJ 5% 12/31/9999 2012300409792230 DEXTROSE INJ 5% 12/31/9999 2012300409792248 DEXTROSE INJ 5% 12/31/9999 2012300409792253 DEXTROSE INJ 5% 12/31/9999 2012300409792255 DEXTROSE INJ 5% 12/31/9999 2012300409792261 DEXTROSE INJ 5% 12/31/9999 2012300409792306 DEXTROSE INJ 5% 12/31/9999 2012300409792311 DEXTROSE INJ 5% 12/31/9999 2012300409792313 DEXTROSE INJ 5% 12/31/9999 2012300409792320 DEXTROSE INJ 5% 12/31/9999 2012300409792323 DEXTROSE INJ 5% 12/31/9999 2012300409792336 DEXTROSE INJ 5% 12/31/9999 2012300409792337 DEXTROSE INJ 5% 12/31/9999 2012300338055111 DEXTROSE INJ 5% PGBK 12/31/9999 2012300338055118 DEXTROSE INJ 5% PGBK 12/31/9999 2012300264128050 DEXTROSE INJ 50% 12/31/9999 2012300264128055 DEXTROSE INJ 50% 09/30/2014 2012300409490234 DEXTROSE INJ 50% 12/31/9999 2012300409664802 DEXTROSE INJ 50% 12/31/9999 2012300409751716 DEXTROSE INJ 50% 12/31/9999 2012300409793619 DEXTROSE INJ 50% 12/31/9999 2012300548330100 DEXTROSE INJ 50% 12/31/9999 2012300264129050 DEXTROSE INJ 70% 05/31/2013 2012300264129055 DEXTROSE INJ 70% 12/31/9999 2012300338071906 DEXTROSE INJ 70% 12/31/9999 2012300338071913 DEXTROSE INJ 70% 12/31/9999 2012300409712007 DEXTROSE INJ 70% 12/31/9999 2012300409791819 DEXTROSE INJ 70% 12/31/9999 2012351552012306 DEXTROSE POW MONOHYD 12/31/9999 2012351552012309 DEXTROSE POW MONOHYD 12/31/9999 2012360258053016 DEX-TUSS LIQ 300-10/5 12/31/9999 2012360258075016 DEX-TUSS LIQ 300-10/5 02/28/2013 2012300096072508 DHS SHA 12/31/9999 2012300096072516 DHS SHA 12/31/9999 2012300096072708 DHS SHA 12/31/9999 2012300096072716 DHS SHA 12/31/9999 2012300096072608 DHS CONDIT LIQ RINSE 12/31/9999 2012300096073104 DHS SAL SHA 3% 12/31/9999 2012300096072804 DHS TAR SHA 12/31/9999 2012300096072808 DHS TAR SHA 12/31/9999 2012300096072816 DHS TAR SHA 12/31/9999 20123