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

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0040902<strong>01</strong>20 DOCETAXEL INJ 160/16ML 12/31/9999 2<strong>01</strong>2366758005003 DOCETAXEL INJ 160/16ML 12/31/9999 2<strong>01</strong>2316729023165 DOCETAXEL INJ 160/8ML 12/31/9999 2<strong>01</strong>2316729<strong>01</strong>2049 DOCETAXEL INJ 20/0.5ML 12/31/9999 2<strong>01</strong>230040902<strong>01</strong>02 DOCETAXEL INJ 20MG/2ML 12/31/9999 2<strong>01</strong>23667580050<strong>01</strong> DOCETAXEL INJ 20MG/2ML 12/31/9999 2<strong>01</strong>23009551020<strong>01</strong> DOCETAXEL INJ 20MG/ML 12/31/9999 2<strong>01</strong>2316729022850 DOCETAXEL INJ 80MG/2ML 12/31/9999 2<strong>01</strong>2300955102104 DOCETAXEL INJ 80MG/4ML 12/31/9999 2<strong>01</strong>230040902<strong>01</strong>10 DOCETAXEL INJ 80MG/8ML 12/31/9999 2<strong>01</strong>2366758005002 DOCETAXEL INJ 80MG/8ML 12/31/9999 2<strong>01</strong>2300603<strong>01</strong>4521 DOCQLACE CAP 100MG 07/31/2<strong>01</strong>3 2<strong>01</strong>2300603<strong>01</strong>4532 DOCQLACE CAP 100MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300603<strong>01</strong>5021 DOCQLACE CAP 100MG 12/31/9999 2<strong>01</strong>2300603<strong>01</strong>5032 DOCQLACE CAP 100MG 12/31/9999 2<strong>01</strong>2300603074658 DOC-Q-LACE LIQ 150/15ML 07/13/2<strong>01</strong>3 2<strong>01</strong>2300603074758 DOC-Q-LACE SYP 60/15ML 12/31/2<strong>01</strong>4 2<strong>01</strong>2300603<strong>01</strong>4921 DOC-Q-LAX TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2300603<strong>01</strong>4932 DOC-Q-LAX TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2350383077116 DOCU LIQ 150/15ML 12/31/9999 2<strong>01</strong>23005363755<strong>01</strong> DOCUSATE CAL CAP 240MG 12/31/9999 2<strong>01</strong>2300536375505 DOCUSATE CAL CAP 240MG 12/31/9999 2<strong>01</strong>2300536375510 DOCUSATE CAL CAP 240MG 12/31/9999 2<strong>01</strong>2324385043578 DOCUSATE CAL CAP 240MG 12/31/9999 2<strong>01</strong>2349348028<strong>01</strong>0 DOCUSATE CAL CAP 240MG 12/31/9999 2<strong>01</strong>23638680<strong>01</strong>7<strong>01</strong> DOCUSATE CAL CAP 240MG 12/31/9999 2<strong>01</strong>23005363756<strong>01</strong> DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2300536375610 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2315127028810 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2316103038408 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2316103038411 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2345802048678 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>23625840683<strong>01</strong> DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>23637390478<strong>01</strong> DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2363739047804 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>2363739047810 DOCUSATE SOD CAP 100MG 12/31/9999 2<strong>01</strong>23005363757<strong>01</strong> DOCUSATE SOD CAP 250MG 12/31/9999 2<strong>01</strong>2300536375710 DOCUSATE SOD CAP 250MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>21054410 DOCUSATE SOD LIQ 50MG/5ML 12/31/9999 2<strong>01</strong>2324385046843 DOCUSATE SOD LIQ 50MG/5ML 12/31/9999 2<strong>01</strong>23516450750<strong>01</strong> DOCUSATE SOD TAB 100MG 12/31/9999 2<strong>01</strong>23621070033<strong>01</strong> DOCUSIL CAP 100MG 12/31/9999 2<strong>01</strong>2362107003310 DOCUSIL CAP 100MG 12/31/9999 2<strong>01</strong>23621070034<strong>01</strong> DOCUSIL PLUS CAP 100-30 12/31/9999 2<strong>01</strong>2362107003410 DOCUSIL PLUS CAP 100-30 12/31/9999 2<strong>01</strong>2300713040599 DOCUSOFT S CAP 100MG 12/31/9999 2<strong>01</strong>2300713040560 DOCUSOFT-S CAP 100MG 12/31/9999 2<strong>01</strong>2300713042560 DOCUSOFT-S CAP 100MG 12/31/9999 2<strong>01</strong>2317433987805 DOCUSOL MINI ENE 12/31/9999 2<strong>01</strong>2300904224461 DOK CAP 100MG 12/31/9999 2<strong>01</strong>2300904788959 DOK CAP 100MG 12/31/9999 2<strong>01</strong>2300904788960 DOK CAP 100MG 12/31/9999 2<strong>01</strong>2300904788980 DOK CAP 100MG 12/31/9999 2<strong>01</strong>2300904789159 DOK CAP 250MG 12/31/9999 2<strong>01</strong>2300904586960 DOK TAB 100MG 12/31/9999 2<strong>01</strong>2300904564360 DOK PLUS TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2300904564361 DOK PLUS TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2300904564380 DOK PLUS TAB NEW FORM 12/31/9999 2<strong>01</strong>2359630007410 DOLGIC PLUS TAB 12/31/9999 2<strong>01</strong>2368453007410 DOLGIC PLUS TAB 03/21/2<strong>01</strong>4 2<strong>01</strong>23

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