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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0031<strong>01</strong>08730 DUTOPROL TAB 25-12.5 12/31/9999 2<strong>01</strong>230031<strong>01</strong>09530 DUTOPROL TAB 50-12.5 12/31/9999 2<strong>01</strong>2351552079304 D-VITAMIN E POW SUCCINAT 12/31/9999 2<strong>01</strong>2351552079305 D-VITAMIN E POW SUCCINAT 12/31/9999 2<strong>01</strong>2300007365022 DYAZIDE CAP 37.5-25 12/31/9999 2<strong>01</strong>2300007365030 DYAZIDE CAP 37.5-25 12/31/9999 2<strong>01</strong>2346672061416 DYFILIN-GG ELX 100-100 12/31/9999 2<strong>01</strong>2310892<strong>01</strong>5065 DYLIX ELX 100/15ML 12/31/9999 2<strong>01</strong>2300037024523 DYMISTA SPR 137-50 12/31/9999 2<strong>01</strong>2349884009803 DYNACIN TAB 100MG 12/31/9999 2<strong>01</strong>23498840096<strong>01</strong> DYNACIN TAB 50MG 12/31/9999 2<strong>01</strong>23498840097<strong>01</strong> DYNACIN TAB 75MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730785<strong>01</strong> DYNACIRC CR TAB 10MG 10/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>730784<strong>01</strong> DYNACIRC CR TAB 5MG 09/30/2<strong>01</strong>3 2<strong>01</strong>2354838051380 DYPHYLLIN-GG ELX 100-100 11/30/2<strong>01</strong>2 2<strong>01</strong>2315054053006 DYSPORT INJ 300UNIT 12/31/9999 2<strong>01</strong>23150540500<strong>01</strong> DYSPORT INJ 500UNIT 12/31/9999 2<strong>01</strong>2310892<strong>01</strong>1265 DYTUSS SYP 12.5/5ML 12/31/9999 2<strong>01</strong>2324338<strong>01</strong>0<strong>01</strong>3 E.E.S. 400 TAB 400MG 12/31/9999 2<strong>01</strong>2300074636902 E.E.S. GRAN SUS 200/5ML 08/23/2<strong>01</strong>3 2<strong>01</strong>2300074636910 E.E.S. GRAN SUS 200/5ML 08/23/2<strong>01</strong>3 2<strong>01</strong>2324338<strong>01</strong>3402 E.E.S. GRAN SUS 200/5ML 12/31/9999 2<strong>01</strong>2324338<strong>01</strong>3610 E.E.S. GRAN SUS 200/5ML 12/31/9999 2<strong>01</strong>2351285044521 E.S.P. SUS 200-600 12/31/9999 2<strong>01</strong>2351285044522 E.S.P. SUS 200-600 12/31/9999 2<strong>01</strong>2351285044523 E.S.P. SUS 200-600 12/31/9999 2<strong>01</strong>2300904322035 EAR DROPS SOL 6.5% OT 12/31/9999 2<strong>01</strong>2337205061710 EAR DRY LIQ 95% OTIC 12/31/9999 2<strong>01</strong>2300536300094 EAR WAX DRO 6.5% OT 12/31/9999 2<strong>01</strong>2337205061556 EAR WAX KIT CLEANSIN 12/31/9999 2<strong>01</strong>2368<strong>01</strong>6<strong>01</strong>12<strong>01</strong> EAR WAX REMO SOL 6.5% OT 12/31/9999 2<strong>01</strong>2315127<strong>01</strong>15<strong>01</strong> EAR WAX REMV DRO 6.5% OT 12/31/9999 2<strong>01</strong>2337205045705 EAR WAX REMV DRO 6.5% OT 12/31/9999 2<strong>01</strong>2363868005115 EAR WAX REMV DRO 6.5% OT 12/31/9999 2<strong>01</strong>2300904600435 EAR WAX REMV SOL 6.5% OT 12/31/9999 2<strong>01</strong>2337205045803 EAR WAX REMV SOL 6.5% OT 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>67<strong>01</strong> EARWAX REMV SOL 6.5% OT 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>69<strong>01</strong> EARWAX REMV SOL 6.5% OT 12/31/9999 2<strong>01</strong>23004850023<strong>01</strong> ECEE PLUS TAB 12/31/9999 2<strong>01</strong>2351552083306 ECHINACEA POW ROOT 12/31/9999 2<strong>01</strong>23000046415<strong>01</strong> EC-NAPROSYN TAB 375MG 12/31/9999 2<strong>01</strong>23000046416<strong>01</strong> EC-NAPROSYN TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>68031215 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68031230 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68031285 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2345802046611 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2345802046635 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2345802046653 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>23516721303<strong>01</strong> ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2351672130302 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2351672130308 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2366993087915 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2366993087931 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2366993087985 ECONAZOLE CRE 1% 12/31/9999 2<strong>01</strong>2351552131602 ECONAZOLE POW NITRATE 12/31/9999 2<strong>01</strong>2351552131604 ECONAZOLE POW NITRATE 12/31/9999 2<strong>01</strong>230<strong>01</strong>350<strong>01</strong>427 ECOTRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>350<strong>01</strong>430 ECOTRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>17<strong>01</strong> ECOTRIN LOW TAB 81MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>1702 ECOTRIN LOW TAB 81MG EC 12/31/9999 2<strong>01</strong>23

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