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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555130283<strong>01</strong> EPOGEN INJ 10000/ML 12/31/9999 2<strong>01</strong>2355513028310 EPOGEN INJ 10000/ML 12/31/9999 2<strong>01</strong>2355513<strong>01</strong>26<strong>01</strong> EPOGEN INJ 2000/ML 12/31/9999 2<strong>01</strong>2355513<strong>01</strong>2610 EPOGEN INJ 2000/ML 12/31/9999 2<strong>01</strong>23555130478<strong>01</strong> EPOGEN INJ 20000/ML 12/31/9999 2<strong>01</strong>2355513047810 EPOGEN INJ 20000/ML 12/31/9999 2<strong>01</strong>23555130267<strong>01</strong> EPOGEN INJ 3000/ML 12/31/9999 2<strong>01</strong>2355513026710 EPOGEN INJ 3000/ML 12/31/9999 2<strong>01</strong>2355513<strong>01</strong>48<strong>01</strong> EPOGEN INJ 4000/ML 12/31/9999 2<strong>01</strong>2355513<strong>01</strong>4810 EPOGEN INJ 4000/ML 12/31/9999 2<strong>01</strong>23007031985<strong>01</strong> EPOPROSTENOL INJ 0.5MG 12/31/9999 2<strong>01</strong>23007031995<strong>01</strong> EPOPROSTENOL INJ 1.5MG 12/31/9999 2<strong>01</strong>2300378662993 EPROSART MES TAB 600MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73074200 EPZICOM TAB 07/31/2<strong>01</strong>3 2<strong>01</strong>2349702020613 EPZICOM TAB 12/31/9999 2<strong>01</strong>2350844022712 EQ ASPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>2350844022713 EQ ASPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>72850049 EQ HEARTBURN TAB RELIEF 12/31/9999 2<strong>01</strong>2300067482007 EQ NICOTINE DIS 7MG/24HR 12/31/9999 2<strong>01</strong>230<strong>01</strong>72855311 EQ TUSSIN CAP CLD/CONG 12/31/9999 2<strong>01</strong>2330698041912 EQUETRO CAP 100MG 12/31/9999 2<strong>01</strong>2330698042112 EQUETRO CAP 200MG 12/31/9999 2<strong>01</strong>2330698042312 EQUETRO CAP 300MG 12/31/9999 2<strong>01</strong>2300049<strong>01</strong>1628 ERAXIS INJ 100MG 12/31/9999 2<strong>01</strong>2300049<strong>01</strong>1428 ERAXIS INJ 50MG 12/31/9999 2<strong>01</strong>2366733094823 ERBITUX INJ 100MG 12/31/9999 2<strong>01</strong>2366733095823 ERBITUX INJ 200MG 12/31/9999 2<strong>01</strong>2300955025050 ERGOCALCIFER CAP 50000UNT 12/31/9999 2<strong>01</strong>2376439023460 ERGOCALCIFER SOL 8000/ML 12/31/9999 2<strong>01</strong>23534890281<strong>01</strong> ERGOLOID MES TAB 1MG ORAL 12/31/9999 2<strong>01</strong>230<strong>01</strong>432120<strong>01</strong> ERGOTAM/CAFF TAB 1/100 12/31/9999 2<strong>01</strong>23602580070<strong>01</strong> ERGOTAM/CAFF TAB 1/100 12/31/9999 2<strong>01</strong>2350242<strong>01</strong>40<strong>01</strong> ERIVEDGE CAP 150MG 12/31/9999 2<strong>01</strong>2300555034458 ERRIN TAB 0.35MG 12/31/9999 2<strong>01</strong>2300062165002 ERTACZO CRE 2% 12/31/9999 2<strong>01</strong>2300062165003 ERTACZO CRE 2% 12/31/9999 2<strong>01</strong>23579020249<strong>01</strong> ERWINAZE INJ 10000UNT 12/31/9999 2<strong>01</strong>2357902024905 ERWINAZE INJ 10000UNT 12/31/9999 2<strong>01</strong>2345802096272 ERY PAD 2% 12/31/9999 2<strong>01</strong>2300074630213 ERYPED SUS 200/5ML 03/22/2<strong>01</strong>4 2<strong>01</strong>2324338<strong>01</strong>3213 ERYPED SUS 200/5ML 12/31/9999 2<strong>01</strong>2300074630513 ERYPED SUS 400/5ML 03/29/2<strong>01</strong>4 2<strong>01</strong>2324338<strong>01</strong>3<strong>01</strong>3 ERYPED SUS 400/5ML 12/31/9999 2<strong>01</strong>2324338<strong>01</strong>2213 ERY-TAB TAB 250MG EC 12/31/9999 2<strong>01</strong>2324338<strong>01</strong>2413 ERY-TAB TAB 333MG EC 12/31/9999 2<strong>01</strong>2324338<strong>01</strong>2613 ERY-TAB TAB 500MG EC 12/31/9999 2<strong>01</strong>2300409647644 ERYTHROCIN INJ 500MG 12/31/9999 2<strong>01</strong>23004096482<strong>01</strong> ERYTHROCIN INJ 500MG 12/31/9999 2<strong>01</strong>2300074634620 ERYTHROCIN TAB 250MG 02/07/2<strong>01</strong>4 2<strong>01</strong>2324338<strong>01</strong>0620 ERYTHROCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300472097916 ERYTHROM EST SUS 250/5ML 12/31/9999 2<strong>01</strong>2300472097416 ERYTHROM ETH SUS 400/5ML 12/31/9999 2<strong>01</strong>2300472097433 ERYTHROM ETH SUS 400/5ML 12/31/9999 2<strong>01</strong>2300074258913 ERYTHROM ETH TAB 400MG 02/17/2<strong>01</strong>3 2<strong>01</strong>2324338<strong>01</strong>1<strong>01</strong>3 ERYTHROM ETH TAB 400MG 12/31/9999 2<strong>01</strong>230007463<strong>01</strong>13 ERYTHROMYCIN CAP 250MG EC 11/23/2<strong>01</strong>2 2<strong>01</strong>2324338<strong>01</strong>2<strong>01</strong>3 ERYTHROMYCIN CAP 250MG EC 12/31/9999 2<strong>01</strong>2300781705449 ERYTHROMYCIN GEL /BENZOYL 12/31/9999 2<strong>01</strong>2300781705459 ERYTHROMYCIN GEL /BENZOYL 11/30/2<strong>01</strong>3 2<strong>01</strong>2300781709459 ERYTHROMYCIN GEL /BENZOYL 12/31/9999 2<strong>01</strong>23

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