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

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

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

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60505021309 DILTZAC CAP 300MG/24 12/31/9999 2<strong>01</strong>2360505021403 DILTZAC CAP 360MG/24 12/31/9999 2<strong>01</strong>2360505021409 DILTZAC CAP 360MG/24 12/31/9999 2<strong>01</strong>2300904578109 DIMAPHEN ELX CHILDREN 12/31/9999 2<strong>01</strong>2300904578120 DIMAPHEN ELX CHILDREN 12/31/9999 2<strong>01</strong>2300904578220 DIMAPHEN DM ELX COLD/CGH 12/31/9999 2<strong>01</strong>23633230366<strong>01</strong> DIMENHYDRIN INJ 50MG/ML 12/31/9999 2<strong>01</strong>2338779028105 DIMENHYDRIN POW USP 12/31/9999 2<strong>01</strong>2338779028108 DIMENHYDRIN POW USP 12/31/9999 2<strong>01</strong>2300603332721 DIMENHYDRIN TAB 50MG 12/31/9999 2<strong>01</strong>2300603332732 DIMENHYDRIN TAB 50MG 12/31/9999 2<strong>01</strong>2315310<strong>01</strong>0604 DIMETANE DX SYP 03/31/2<strong>01</strong>3 2<strong>01</strong>2300031224713 DIMETAPP LIQ NIGHTTIM 12/31/9999 2<strong>01</strong>2300031223813 DIMETAPP SYP CGH/COLD 12/31/9999 2<strong>01</strong>2300031223512 DIMETAPP CLD ELX /ALLERGY 12/31/9999 2<strong>01</strong>2300031223513 DIMETAPP CLD ELX /ALLERGY 12/31/9999 2<strong>01</strong>2300031223518 DIMETAPP CLD ELX /ALLERGY 12/31/9999 2<strong>01</strong>2300031223519 DIMETAPP CLD ELX /ALLERGY 12/31/9999 2<strong>01</strong>2300031223412 DIMETAPP DM LIQ COLD/CGH 12/31/9999 2<strong>01</strong>2300031223413 DIMETAPP DM LIQ COLD/CGH 12/31/9999 2<strong>01</strong>2300031223418 DIMETAPP DM LIQ COLD/CGH 12/31/9999 2<strong>01</strong>2300031223419 DIMETAPP DM LIQ COLD/CGH 12/31/9999 2<strong>01</strong>2300031224612 DIMETAPP MS LIQ COLD/FLU 12/31/9999 2<strong>01</strong>2300472093628 DIOCTO LIQ 150/15ML 12/31/9999 2<strong>01</strong>2300536059085 DIOCTO LIQ 50MG/5ML 12/31/9999 2<strong>01</strong>2300904093616 DIOCTO LIQ 50MG/5ML 12/31/9999 2<strong>01</strong>2300472092428 DIOCTO SYP 60/15ML 12/31/9999 2<strong>01</strong>2300536060085 DIOCTO SYP 60/15ML 12/31/9999 2<strong>01</strong>2300472093<strong>01</strong>6 DIOCTO-C SYP 60-30/15 12/31/9999 2<strong>01</strong>2300472093028 DIOCTO-C SYP 60-30/15 12/31/9999 2<strong>01</strong>2300078035906 DIOVAN TAB 160MG 12/31/9999 2<strong>01</strong>2300078035917 DIOVAN TAB 160MG 12/31/9999 2<strong>01</strong>2300078035934 DIOVAN TAB 160MG 12/31/9999 2<strong>01</strong>2300078035961 DIOVAN TAB 160MG 12/31/9999 2<strong>01</strong>2300078036<strong>01</strong>1 DIOVAN TAB 320MG 12/31/9999 2<strong>01</strong>2300078036034 DIOVAN TAB 320MG 12/31/9999 2<strong>01</strong>2300078042306 DIOVAN TAB 40MG 12/31/9999 2<strong>01</strong>2300078042315 DIOVAN TAB 40MG 12/31/9999 2<strong>01</strong>2300078042361 DIOVAN TAB 40MG 12/31/9999 2<strong>01</strong>2300078035806 DIOVAN TAB 80MG 12/31/9999 2<strong>01</strong>2300078035833 DIOVAN TAB 80MG 12/31/9999 2<strong>01</strong>2300078035834 DIOVAN TAB 80MG 12/31/9999 2<strong>01</strong>2300078035861 DIOVAN TAB 80MG 12/31/9999 2<strong>01</strong>2300078031506 DIOVAN HCT TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078031515 DIOVAN HCT TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078031517 DIOVAN HCT TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078031534 DIOVAN HCT TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078031561 DIOVAN HCT TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078031567 DIOVAN HCT TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078038306 DIOVAN HCT TAB 160-25MG 12/31/9999 2<strong>01</strong>2300078038315 DIOVAN HCT TAB 160-25MG 12/31/9999 2<strong>01</strong>2300078038317 DIOVAN HCT TAB 160-25MG 12/31/9999 2<strong>01</strong>2300078038334 DIOVAN HCT TAB 160-25MG 12/31/9999 2<strong>01</strong>2300078038361 DIOVAN HCT TAB 160-25MG 12/31/9999 2<strong>01</strong>2300078038367 DIOVAN HCT TAB 160-25MG 12/31/9999 2<strong>01</strong>2300078047111 DIOVAN HCT TAB 320-12.5 12/31/9999 2<strong>01</strong>2300078047115 DIOVAN HCT TAB 320-12.5 12/31/9999 2<strong>01</strong>2300078047134 DIOVAN HCT TAB 320-12.5 12/31/9999 2<strong>01</strong>2300078047167 DIOVAN HCT TAB 320-12.5 12/31/9999 2<strong>01</strong>2300078047211 DIOVAN HCT TAB 320-25MG 12/31/9999 2<strong>01</strong>23

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