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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00093585005 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2300093585<strong>01</strong>9 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2300093585093 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2300378385577 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2300378385593 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2331722024990 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>23605052780<strong>01</strong> ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2360505278008 ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>2368180<strong>01</strong>37<strong>01</strong> ESCITALOPRAM TAB 5MG 12/31/9999 2<strong>01</strong>23005350<strong>01</strong>2<strong>01</strong> ESGIC CAP 12/31/9999 2<strong>01</strong>23005350<strong>01</strong>1<strong>01</strong> ESGIC TAB 12/31/9999 2<strong>01</strong>23004560679<strong>01</strong> ESGIC-PLUS CAP 12/31/9999 2<strong>01</strong>23004560678<strong>01</strong> ESGIC-PLUS TAB 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9<strong>01</strong>20<strong>01</strong> ESMOLOL HCL INJ 100MG/10 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9<strong>01</strong>2039 ESMOLOL HCL INJ 100MG/10 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>8210 ESMOLOL HCL INJ 100MG/10 12/31/9999 2<strong>01</strong>2300641296541 ESMOLOL HCL INJ 10MG/ML 12/28/2<strong>01</strong>3 2<strong>01</strong>2300641296545 ESMOLOL HCL INJ 10MG/ML 12/28/2<strong>01</strong>3 2<strong>01</strong>2355390006210 ESMOLOL HCL INJ 10MG/ML 12/31/9999 2<strong>01</strong>2355390034<strong>01</strong>0 ESMOLOL HCL INJ 10MG/ML 12/31/9999 2<strong>01</strong>2363323065210 ESMOLOL HCL INJ 10MG/ML 12/31/9999 2<strong>01</strong>23537460078<strong>01</strong> EST ESTROGEN TAB MTEST 12/31/9999 2<strong>01</strong>2362559<strong>01</strong>49<strong>01</strong> EST ESTROGEN TAB MTEST 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>74<strong>01</strong> EST ESTROGEN TAB MTEST DS 12/31/9999 2<strong>01</strong>23537460077<strong>01</strong> EST ESTROGEN TAB MTEST HS 12/31/9999 2<strong>01</strong>2362559<strong>01</strong>50<strong>01</strong> EST ESTROGEN TAB MTEST HS 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>73<strong>01</strong> EST ESTROGEN TAB MTEST HS 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>29<strong>01</strong> ESTAZOLAM TAB 1MG 12/31/9999 2<strong>01</strong>23005910744<strong>01</strong> ESTAZOLAM TAB 1MG 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>30<strong>01</strong> ESTAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>23005910745<strong>01</strong> ESTAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2351991062328 ESTRA/NORETH TAB 0.5-0.1 12/31/9999 2<strong>01</strong>2351991047428 ESTRA/NORETH TAB 1-0.5MG 12/31/9999 2<strong>01</strong>2300430072024 ESTRACE TAB 0.5MG 12/31/9999 2<strong>01</strong>2300430072124 ESTRACE TAB 1MG 12/31/9999 2<strong>01</strong>2300430072224 ESTRACE TAB 2MG 12/31/9999 2<strong>01</strong>2300430375414 ESTRACE VAG CRE 0.1MG/GM 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>34<strong>01</strong> ESTRAD VAL INJ 10MG/ML 12/31/9999 2<strong>01</strong>2300574087205 ESTRAD VAL INJ 200MG/5 12/31/9999 2<strong>01</strong>2300574087005 ESTRAD VAL INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300781302975 ESTRAD VAL INJ 20MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>35<strong>01</strong> ESTRAD VAL INJ 20MG/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>36<strong>01</strong> ESTRAD VAL INJ 40MG/ML 12/31/9999 2<strong>01</strong>2300378334999 ESTRADIOL DIS 0.025MG 12/31/9999 2<strong>01</strong>2347781020404 ESTRADIOL DIS 0.025MG 12/31/9999 2<strong>01</strong>2300378336099 ESTRADIOL DIS 0.0375MG 12/31/9999 2<strong>01</strong>2347781020504 ESTRADIOL DIS 0.0375MG 12/31/9999 2<strong>01</strong>2300378335099 ESTRADIOL DIS 0.05MG 12/31/9999 2<strong>01</strong>2347781020604 ESTRADIOL DIS 0.05MG 12/31/9999 2<strong>01</strong>2300378336199 ESTRADIOL DIS 0.06MG 12/31/9999 2<strong>01</strong>2347781020704 ESTRADIOL DIS 0.06MG 12/31/9999 2<strong>01</strong>2300378335199 ESTRADIOL DIS 0.075MG 12/31/9999 2<strong>01</strong>2347781020804 ESTRADIOL DIS 0.075MG 12/31/9999 2<strong>01</strong>2300378335299 ESTRADIOL DIS 0.1MG 12/31/9999 2<strong>01</strong>2347781020904 ESTRADIOL DIS 0.1MG 12/31/9999 2<strong>01</strong>23515521056<strong>01</strong> ESTRADIOL POW CYP USP 12/31/9999 2<strong>01</strong>2351552105602 ESTRADIOL POW CYP USP 12/31/9999 2<strong>01</strong>23003781452<strong>01</strong> ESTRADIOL TAB 0.5MG 12/31/9999 2<strong>01</strong>2300378145205 ESTRADIOL TAB 0.5MG 12/31/9999 2<strong>01</strong>2300555089902 ESTRADIOL TAB 0.5MG 12/31/9999 2<strong>01</strong>23

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