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

00941041146 DIANEAL PD-2 SOL 1.5% DEX 03/31/2013 2012300941041149 DIANEAL PD-2 SOL 1.5% DEX 02/28/2013 2012300941041301 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 2012300941041304 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 2012300941041305 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 2012300941041306 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 2012300941041307 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 2012300941041325 DIANEAL PD-2 SOL 2.5% DEX 05/31/2013 2012300941041328 DIANEAL PD-2 SOL 2.5% DEX 02/28/2013 2012300941041347 DIANEAL PD-2 SOL 2.5% DEX 03/31/2013 2012300941041501 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 2012300941041504 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 2012300941041505 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 2012300941041506 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 2012300941041507 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 2012300941041528 DIANEAL PD-2 SOL 4.25%DEX 11/30/2012 2012300713025804 DIAPER RASH OIN 40% 12/31/9999 2012337205063726 DIAPER RASH OIN 40% 12/31/9999 2012346122001346 DIAPER RASH OIN CREAMY 12/31/9999 2012300187065920 DIASTAT ACDL GEL 12.5-20 12/31/9999 2012300187065820 DIASTAT ACDL GEL 5-10MG 12/31/9999 2012366490065020 DIASTAT PED GEL 2.5M GEL 12/31/9999 2012300054318544 DIAZEPAM CON 5MG/ML 12/31/9999 2012300093613832 DIAZEPAM GEL 10MG 12/31/9999 2012300093613732 DIAZEPAM GEL 2.5MG 12/31/9999 2012300093613932 DIAZEPAM GEL 20MG 12/31/9999 2012300409127332 DIAZEPAM INJ 5MG/ML 12/31/9999 2012300409321312 DIAZEPAM INJ 5MG/ML 12/31/9999 2012351552133002 DIAZEPAM POW 12/31/9999 2012351552133004 DIAZEPAM POW 12/31/9999 2012351552133005 DIAZEPAM POW 12/31/9999 2012300054318863 DIAZEPAM SOL 1MG/ML 12/31/9999 2012300054820716 DIAZEPAM SOL 1MG/ML 03/31/2014 2012368094075062 DIAZEPAM SOL 5MG/5ML 12/31/9999 2012300172392760 DIAZEPAM TAB 10MG 12/31/9999 2012300172392770 DIAZEPAM TAB 10MG 12/31/9999 2012300172392780 DIAZEPAM TAB 10MG 12/31/9999 2012300228205396 DIAZEPAM TAB 10MG 12/31/9999 2012300378047701 DIAZEPAM TAB 10MG 12/31/9999 2012300378047705 DIAZEPAM TAB 10MG 12/31/9999 2012300555016405 DIAZEPAM TAB 10MG 08/31/2013 2012300591562001 DIAZEPAM TAB 10MG 12/31/9999 2012300591562005 DIAZEPAM TAB 10MG 12/31/9999 2012300591562010 DIAZEPAM TAB 10MG 12/31/9999 2012300603321502 DIAZEPAM TAB 10MG 12/31/9999 2012300603321516 DIAZEPAM TAB 10MG 12/31/9999 2012300603321520 DIAZEPAM TAB 10MG 12/31/9999 2012300603321521 DIAZEPAM TAB 10MG 12/31/9999 2012300603321522 DIAZEPAM TAB 10MG 12/31/9999 2012300603321528 DIAZEPAM TAB 10MG 12/31/9999 2012300603321532 DIAZEPAM TAB 10MG 12/31/9999 2012300904588161 DIAZEPAM TAB 10MG 12/31/9999 2012351079028601 DIAZEPAM TAB 10MG 12/31/9999 2012351079028620 DIAZEPAM TAB 10MG 12/31/9999 2012300172392560 DIAZEPAM TAB 2MG 12/31/9999 2012300172392570 DIAZEPAM TAB 2MG 12/31/9999 2012300228205196 DIAZEPAM TAB 2MG 12/31/9999 2012300378027101 DIAZEPAM TAB 2MG 12/31/9999 2012300378027105 DIAZEPAM TAB 2MG 12/31/9999 2012300591562101 DIAZEPAM TAB 2MG 12/31/9999 20123