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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00024059<strong>01</strong>0 ELOXATIN INJ 50MG 12/31/9999 2<strong>01</strong>2367386041151 ELSPAR INJ 10000UNT 12/31/9999 2<strong>01</strong>2300065032505 EMADINE SOL 0.05% OP 12/31/9999 2<strong>01</strong>23607930437<strong>01</strong> EMBEDA CAP 100-4MG 12/31/9999 2<strong>01</strong>23607930430<strong>01</strong> EMBEDA CAP 20-0.8MG 12/31/9999 2<strong>01</strong>23607930431<strong>01</strong> EMBEDA CAP 30-1.2MG 12/31/9999 2<strong>01</strong>23607930433<strong>01</strong> EMBEDA CAP 50-2MG 12/31/9999 2<strong>01</strong>23607930434<strong>01</strong> EMBEDA CAP 60-2.4MG 12/31/9999 2<strong>01</strong>23607930435<strong>01</strong> EMBEDA CAP 80-3.2MG 12/31/9999 2<strong>01</strong>2300<strong>01</strong>3<strong>01</strong>3202 EMCYT CAP 140MG 12/31/9999 2<strong>01</strong>2300006046206 EMEND CAP 125MG 12/31/9999 2<strong>01</strong>2300006046405 EMEND CAP 40MG 12/31/9999 2<strong>01</strong>2300006046410 EMEND CAP 40MG 12/31/9999 2<strong>01</strong>2300006046102 EMEND CAP 80MG 12/31/9999 2<strong>01</strong>2300006046106 EMEND CAP 80MG 12/31/9999 2<strong>01</strong>2300006386203 EMEND PAK 80 & 125 12/31/9999 2<strong>01</strong>2300006394132 EMEND SOL 150MG 12/31/9999 2<strong>01</strong>2363323028955 EMLA CRE 11/30/2<strong>01</strong>3 2<strong>01</strong>2351552069906 EMOLLIENT CRE BASE 12/31/9999 2<strong>01</strong>2300603754<strong>01</strong>7 EMOQUETTE TAB 12/31/9999 2<strong>01</strong>2300603754049 EMOQUETTE TAB 12/31/9999 2<strong>01</strong>23515521332<strong>01</strong> EMPTY CAPSUL CAP SIZE 3 12/31/9999 2<strong>01</strong>2351552133202 EMPTY CAPSUL CAP SIZE 3 12/31/9999 2<strong>01</strong>2351552133203 EMPTY CAPSUL CAP SIZE 3 12/31/9999 2<strong>01</strong>2349502090230 EMSAM DIS 12MG/24H 12/31/9999 2<strong>01</strong>2349502090030 EMSAM DIS 6MG/24HR 12/31/9999 2<strong>01</strong>234950209<strong>01</strong>30 EMSAM DIS 9MG/24HR 12/31/9999 2<strong>01</strong>236195806<strong>01</strong><strong>01</strong> EMTRIVA CAP 200MG 12/31/9999 2<strong>01</strong>23619580602<strong>01</strong> EMTRIVA SOL 10MG/ML 12/31/9999 2<strong>01</strong>2300078042<strong>01</strong>5 ENABLEX TAB 15MG 06/30/2<strong>01</strong>4 2<strong>01</strong>2300078042034 ENABLEX TAB 15MG 06/30/2<strong>01</strong>4 2<strong>01</strong>2300430<strong>01</strong>7115 ENABLEX TAB 15MG 12/31/9999 2<strong>01</strong>2300430<strong>01</strong>7123 ENABLEX TAB 15MG 12/31/9999 2<strong>01</strong>2300078041915 ENABLEX TAB 7.5MG 06/30/2<strong>01</strong>4 2<strong>01</strong>2300078041934 ENABLEX TAB 7.5MG 06/30/2<strong>01</strong>4 2<strong>01</strong>2300430<strong>01</strong>7<strong>01</strong>5 ENABLEX TAB 7.5MG 12/31/9999 2<strong>01</strong>2300430<strong>01</strong>7023 ENABLEX TAB 7.5MG 12/31/9999 2<strong>01</strong>23000931052<strong>01</strong> ENALAPR/HCTZ TAB 10-25MG 12/31/9999 2<strong>01</strong>23003780723<strong>01</strong> ENALAPR/HCTZ TAB 10-25MG 12/31/9999 2<strong>01</strong>23516724046<strong>01</strong> ENALAPR/HCTZ TAB 10-25MG 12/31/9999 2<strong>01</strong>23605050209<strong>01</strong> ENALAPR/HCTZ TAB 10-25MG 12/31/9999 2<strong>01</strong>23000931044<strong>01</strong> ENALAPR/HCTZ TAB 5-12.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>51<strong>01</strong> ENALAPR/HCTZ TAB 5-12.5MG 12/31/9999 2<strong>01</strong>23003780712<strong>01</strong> ENALAPR/HCTZ TAB 5-12.5MG 12/31/9999 2<strong>01</strong>23516724045<strong>01</strong> ENALAPR/HCTZ TAB 5-12.5MG 12/31/9999 2<strong>01</strong>23605050208<strong>01</strong> ENALAPR/HCTZ TAB 5-12.5MG 12/31/9999 2<strong>01</strong>23000930028<strong>01</strong> ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300093002810 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300093002850 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300228266096 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23003781053<strong>01</strong> ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300378105310 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300904561061 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2315338022030 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23491580502<strong>01</strong> ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2349158050210 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23510790952<strong>01</strong> ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2351079095220 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23516724039<strong>01</strong> ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2351672403903 ENALAPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23

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