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 ...

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00078047215 DIOVAN HCT TAB 320-25MG 12/31/9999 2<strong>01</strong>2300078047234 DIOVAN HCT TAB 320-25MG 12/31/9999 2<strong>01</strong>2300078047267 DIOVAN HCT TAB 320-25MG 12/31/9999 2<strong>01</strong>2300078031406 DIOVAN HCT TAB 80/12.5 12/31/9999 2<strong>01</strong>2300078031433 DIOVAN HCT TAB 80/12.5 12/31/9999 2<strong>01</strong>2300078031434 DIOVAN HCT TAB 80/12.5 12/31/9999 2<strong>01</strong>2300078031461 DIOVAN HCT TAB 80/12.5 12/31/9999 2<strong>01</strong>23504740600<strong>01</strong> DIPENTUM CAP 250MG 12/31/9999 2<strong>01</strong>2368220<strong>01</strong>6<strong>01</strong>0 DIPENTUM CAP 250MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13037934 DIPHEDRYL ELX 12.5/5ML 12/31/2<strong>01</strong>2 2<strong>01</strong>2300054319446 DIPHEN/ATROP LIQ 2.5/5 12/31/9999 2<strong>01</strong>23003780415<strong>01</strong> DIPHEN/ATROP TAB 2.5MG 12/31/9999 2<strong>01</strong>2300378041510 DIPHEN/ATROP TAB 2.5MG 12/31/9999 2<strong>01</strong>2300378041577 DIPHEN/ATROP TAB 2.5MG 12/31/9999 2<strong>01</strong>23510790067<strong>01</strong> DIPHEN/ATROP TAB 2.5MG 12/31/9999 2<strong>01</strong>2351079006720 DIPHEN/ATROP TAB 2.5MG 12/31/9999 2<strong>01</strong>23597621061<strong>01</strong> DIPHEN/ATROP TAB 2.5MG 12/31/9999 2<strong>01</strong>23005363594<strong>01</strong> DIPHENHIST CAP 25MG 12/31/9999 2<strong>01</strong>2300536077085 DIPHENHIST LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2300536077097 DIPHENHIST LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>23005363597<strong>01</strong> DIPHENHIST TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850648<strong>01</strong> DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85064810 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85064824 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2300603333921 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2300603333932 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2300904530660 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2300904530661 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2300904530680 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>23102670835<strong>01</strong> DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2310267083504 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>9008 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>9<strong>01</strong>2 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>23664240020<strong>01</strong> DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>2366424002<strong>01</strong>0 DIPHENHYDRAM CAP 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850649<strong>01</strong> DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85064910 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85064924 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300555005902 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300555005905 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300603334021 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300603334032 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300904205661 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300904530760 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2300904530780 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>23102670836<strong>01</strong> DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2310267083604 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>23510790066<strong>01</strong> DIPHENHYDRAM CAP 50MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2351079006620 DIPHENHYDRAM CAP 50MG 05/31/2<strong>01</strong>3 2<strong>01</strong>23664240021<strong>01</strong> DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>2366424002110 DIPHENHYDRAM CAP 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>21048905 DIPHENHYDRAM ELX 12.5/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21048910 DIPHENHYDRAM ELX 12.5/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21048920 DIPHENHYDRAM ELX 12.5/5ML 12/31/9999 2<strong>01</strong>2300409229031 DIPHENHYDRAM INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300548139000 DIPHENHYDRAM INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300641037621 DIPHENHYDRAM INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300641037625 DIPHENHYDRAM INJ 50MG/ML 12/31/9999 2<strong>01</strong>23633230664<strong>01</strong> DIPHENHYDRAM INJ 50MG/ML 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>2410 DIPHENHYDRAM INJ 50MG/ML 12/31/9999 2<strong>01</strong>23

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