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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00049350079 DIFLUCAN TAB 150MG 12/31/9999 2<strong>01</strong>2300049343030 DIFLUCAN TAB 200MG 12/31/9999 2<strong>01</strong>2300049343041 DIFLUCAN TAB 200MG 12/31/9999 2<strong>01</strong>2300049341030 DIFLUCAN TAB 50MG 12/31/9999 2<strong>01</strong>2300049337226 DIFLUCAN/ INJ NACL 400 11/<strong>01</strong>/2<strong>01</strong>4 2<strong>01</strong>23000930755<strong>01</strong> DIFLUNISAL TAB 500MG 12/31/9999 2<strong>01</strong>2300093075505 DIFLUNISAL TAB 500MG 12/31/9999 2<strong>01</strong>2300093075506 DIFLUNISAL TAB 500MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>81<strong>01</strong> DIFLUNISAL TAB 500MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>8106 DIFLUNISAL TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73023044 DIGIBIND SOL <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300641141031 DIGOXIN INJ 0.25MG/1 12/31/9999 2<strong>01</strong>2300641141035 DIGOXIN INJ 0.25MG/1 12/31/9999 2<strong>01</strong>2300781305995 DIGOXIN INJ 0.25MG/1 12/31/9999 2<strong>01</strong>2300054005746 DIGOXIN SOL 50MCG/ML 12/31/9999 2<strong>01</strong>2368094075262 DIGOXIN SOL 50MCG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>159811<strong>01</strong> DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>15981103 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431240<strong>01</strong> DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43124<strong>01</strong>0 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43124051 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>23005271324<strong>01</strong> DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>2300527132410 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>2300904592161 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>23510790847<strong>01</strong> DIGOXIN TAB 0.125MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2351079084720 DIGOXIN TAB 0.125MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2357664043718 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>2357664043788 DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>23625840989<strong>01</strong> DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>23680840508<strong>01</strong> DIGOXIN TAB 0.125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>159822<strong>01</strong> DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>15982203 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431241<strong>01</strong> DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43124110 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43124151 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>23005271325<strong>01</strong> DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>2300527132510 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>2300904592261 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>23510790848<strong>01</strong> DIGOXIN TAB 0.25MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2351079084820 DIGOXIN TAB 0.25MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2357664044118 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>2357664044188 DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>23625840990<strong>01</strong> DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>23680840509<strong>01</strong> DIGOXIN TAB 0.25MG 12/31/9999 2<strong>01</strong>2300472164004 DIHISTINE LIQ EXPECT 12/31/9999 2<strong>01</strong>2300472163928 DIHISTINE DH LIQ 12/31/9999 2<strong>01</strong>2300574085005 DIHYDROERGOT INJ 1MG/ML 12/31/9999 2<strong>01</strong>2300574085<strong>01</strong>0 DIHYDROERGOT INJ 1MG/ML 12/31/9999 2<strong>01</strong>23553900<strong>01</strong>310 DIHYDROERGOT INJ 1MG/ML 12/31/9999 2<strong>01</strong>2338779030303 DIHYDROERGOT POW MESYLATE 12/31/9999 2<strong>01</strong>2338779030306 DIHYDROERGOT POW MESYLATE 12/31/9999 2<strong>01</strong>23525440484<strong>01</strong> DILACOR XR CAP 240MG/24 12/31/9999 2<strong>01</strong>2300071036924 DILANTIN CAP 100MG 12/31/9999 2<strong>01</strong>2300071036932 DILANTIN CAP 100MG 12/31/9999 2<strong>01</strong>2300071036940 DILANTIN CAP 100MG 12/31/9999 2<strong>01</strong>2300071374066 DILANTIN CAP 30MG 12/31/9999 2<strong>01</strong>2300071000724 DILANTIN CHW 50MG 12/31/9999 2<strong>01</strong>2300071000740 DILANTIN CHW 50MG 12/31/9999 2<strong>01</strong>2300071221420 DILANTIN-125 SUS 125/5ML 12/31/9999 2<strong>01</strong>2352244092<strong>01</strong>0 DILATRATE SR CAP 40MG 12/31/9999 2<strong>01</strong>23

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