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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0<strong>01</strong>35<strong>01</strong>1784 ECOTRIN LOW TAB 81MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>1786 ECOTRIN LOW TAB 81MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>1788 ECOTRIN LOW TAB 81MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>350<strong>01</strong>624 ECOTRIN M/S TAB 500MG EC 12/31/9999 2<strong>01</strong>23621070028<strong>01</strong> ECPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>2362107002832 ECPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>2361480<strong>01</strong>2705 ECZEMOL TAB 12/31/9999 2<strong>01</strong>2300485<strong>01</strong>5516 ED A-HIST LIQ 4-10/5ML 12/31/9999 2<strong>01</strong>23004850210<strong>01</strong> ED A-HIST TAB 2.5-60MG 12/31/9999 2<strong>01</strong>2300485<strong>01</strong>7116 ED A-HIST DM LIQ 12/31/9999 2<strong>01</strong>23004850090<strong>01</strong> ED BACLOFEN TAB 10MG 12/31/9999 2<strong>01</strong>2300485020816 ED BRON GP LIQ 12/31/9999 2<strong>01</strong>2300485009602 ED CHLORPED DRO D 12/31/9999 2<strong>01</strong>2300485009402 ED CHLORPED LIQ 2MG/ML 12/31/9999 2<strong>01</strong>2300485009804 ED CHLORPED SYP JR 12/31/9999 2<strong>01</strong>2300485009816 ED CHLORPED SYP JR 12/31/9999 2<strong>01</strong>23004850065<strong>01</strong> ED CYTE F TAB 12/31/9999 2<strong>01</strong>2300485<strong>01</strong>54<strong>01</strong> ED-A-HIST TAB 3-10MG 12/31/9999 2<strong>01</strong>2300485005708 ED-APAP LIQ 80MG/2.5 12/31/9999 2<strong>01</strong>2364764084430 EDARBI TAB 40MG 12/31/9999 2<strong>01</strong>2364764088430 EDARBI TAB 80MG 12/31/9999 2<strong>01</strong>2364764094430 EDARBYCLOR TAB 40-12.5 12/31/9999 2<strong>01</strong>2364764099430 EDARBYCLOR TAB 40-25MG 12/31/9999 2<strong>01</strong>23004850085<strong>01</strong> ED-CHLORTAN TAB 4MG 12/31/9999 2<strong>01</strong>2325<strong>01</strong>0020515 EDECRIN TAB 25MG 12/31/2<strong>01</strong>4 2<strong>01</strong>2325<strong>01</strong>0021515 EDECRIN TAB 25MG 12/31/9999 2<strong>01</strong>2300091111<strong>01</strong>6 EDEX KIT 10MCG 12/31/9999 2<strong>01</strong>2300091111020 EDEX KIT 10MCG 12/31/9999 2<strong>01</strong>23522440<strong>01</strong>002 EDEX KIT 10MCG 12/31/9999 2<strong>01</strong>23522440<strong>01</strong>006 EDEX KIT 10MCG 12/31/9999 2<strong>01</strong>2300091112<strong>01</strong>6 EDEX KIT 20MCG 12/31/9999 2<strong>01</strong>2300091112020 EDEX KIT 20MCG 12/31/9999 2<strong>01</strong>2352244002002 EDEX KIT 20MCG 12/31/9999 2<strong>01</strong>2352244002006 EDEX KIT 20MCG 12/31/9999 2<strong>01</strong>2300091114<strong>01</strong>6 EDEX KIT 40MCG 12/31/9999 2<strong>01</strong>2352244004002 EDEX KIT 40MCG 12/31/9999 2<strong>01</strong>2352244004006 EDEX KIT 40MCG 12/31/9999 2<strong>01</strong>23004850066<strong>01</strong> ED-FLEX CAP 12/31/9999 2<strong>01</strong>23000376<strong>01</strong>030 EDLUAR SUB 10MG 12/31/9999 2<strong>01</strong>2300037605030 EDLUAR SUB 5MG 12/31/9999 2<strong>01</strong>23004850082<strong>01</strong> ED-SPAZ TAB 0.125MG 12/31/9999 2<strong>01</strong>2351552058804 EDTA DISODIU POW DIHYDRAT 12/31/9999 2<strong>01</strong>2351552058806 EDTA DISODIU POW DIHYDRAT 12/31/9999 2<strong>01</strong>23596760278<strong>01</strong> EDURANT TAB 25MG 12/31/9999 2<strong>01</strong>23153100<strong>01</strong>0<strong>01</strong> EEMT TAB 12/31/9999 2<strong>01</strong>23153100020<strong>01</strong> EEMT HS TAB 12/31/9999 2<strong>01</strong>23518<strong>01</strong>0<strong>01</strong>330 EFFER-K TAB 10MEQ 12/31/9999 2<strong>01</strong>23518<strong>01</strong>0<strong>01</strong>430 EFFER-K TAB 10MEQ 12/31/9999 2<strong>01</strong>23518<strong>01</strong>0<strong>01</strong>130 EFFER-K TAB 20MEQ 12/31/9999 2<strong>01</strong>23518<strong>01</strong>0<strong>01</strong>230 EFFER-K TAB 20MEQ 12/31/9999 2<strong>01</strong>23518<strong>01</strong>00<strong>01</strong>30 EFFER-K TAB 25MEQ EF 12/31/9999 2<strong>01</strong>23518<strong>01</strong>00<strong>01</strong>40 EFFER-K TAB 25MEQ EF 12/31/9999 2<strong>01</strong>2300008083602 EFFEXOR XR CAP 150MG 12/31/9999 2<strong>01</strong>2300008083603 EFFEXOR XR CAP 150MG 12/31/9999 2<strong>01</strong>2300008083620 EFFEXOR XR CAP 150MG 12/31/9999 2<strong>01</strong>2300008083621 EFFEXOR XR CAP 150MG 12/31/9999 2<strong>01</strong>2300008083622 EFFEXOR XR CAP 150MG 12/31/9999 2<strong>01</strong>2300008083702 EFFEXOR XR CAP 37.5MG 12/31/9999 2<strong>01</strong>2300008083703 EFFEXOR XR CAP 37.5MG 12/31/9999 2<strong>01</strong>2300008083720 EFFEXOR XR CAP 37.5MG 12/31/9999 2<strong>01</strong>23

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