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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10631<strong>01</strong>0030 EXELDERM SOL 1% 12/31/9999 2<strong>01</strong>2300078032306 EXELON CAP 1.5MG 12/31/9999 2<strong>01</strong>2300078032344 EXELON CAP 1.5MG 12/31/9999 2<strong>01</strong>2300078032361 EXELON CAP 1.5MG 12/31/9999 2<strong>01</strong>2300078032406 EXELON CAP 3MG 12/31/9999 2<strong>01</strong>2300078032444 EXELON CAP 3MG 12/31/9999 2<strong>01</strong>2300078032461 EXELON CAP 3MG 12/31/9999 2<strong>01</strong>2300078032506 EXELON CAP 4.5MG 12/31/9999 2<strong>01</strong>2300078032544 EXELON CAP 4.5MG 12/31/9999 2<strong>01</strong>2300078032561 EXELON CAP 4.5MG 12/31/9999 2<strong>01</strong>2300078032606 EXELON CAP 6MG 12/31/9999 2<strong>01</strong>2300078032644 EXELON CAP 6MG 12/31/9999 2<strong>01</strong>2300078032661 EXELON CAP 6MG 12/31/9999 2<strong>01</strong>230007805<strong>01</strong>15 EXELON DIS 4.6MG/24 12/31/9999 2<strong>01</strong>230007805<strong>01</strong>61 EXELON DIS 4.6MG/24 12/31/9999 2<strong>01</strong>2300078050215 EXELON DIS 9.5MG/24 12/31/9999 2<strong>01</strong>2300078050261 EXELON DIS 9.5MG/24 12/31/9999 2<strong>01</strong>2300078033931 EXELON SOL 2MG/ML 12/31/9999 2<strong>01</strong>2300054008<strong>01</strong>3 EXEMESTANE TAB 25MG 12/31/9999 2<strong>01</strong>23597622858<strong>01</strong> EXEMESTANE TAB 25MG 12/31/9999 2<strong>01</strong>2300078048915 EXFORGE TAB 10-160MG 12/31/9999 2<strong>01</strong>2300078049115 EXFORGE TAB 10-320MG 12/31/9999 2<strong>01</strong>2300078048815 EXFORGE TAB 5-160MG 12/31/9999 2<strong>01</strong>2300078049<strong>01</strong>5 EXFORGE TAB 5-320MG 12/31/9999 2<strong>01</strong>2300078056115 EXFORGEH/10- TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078056215 EXFORGEH/10- TAB 160-25 12/31/9999 2<strong>01</strong>2300078056315 EXFORGEH/10- TAB 320-25 12/31/9999 2<strong>01</strong>2300078055915 EXFORGEH/5- TAB 160-12.5 12/31/9999 2<strong>01</strong>2300078056<strong>01</strong>5 EXFORGEH/5- TAB 160-25 12/31/9999 2<strong>01</strong>2300078046815 EXJADE TAB 125MG 12/31/9999 2<strong>01</strong>2300078046915 EXJADE TAB 250MG 12/31/9999 2<strong>01</strong>2300078047<strong>01</strong>5 EXJADE TAB 500MG 12/31/9999 2<strong>01</strong>2300067000518 EX-LAX CHW 15MG 12/31/9999 2<strong>01</strong>2300067000524 EX-LAX CHW 15MG 12/31/9999 2<strong>01</strong>2300067000548 EX-LAX CHW 15MG 12/31/9999 2<strong>01</strong>2300067000308 EX-LAX TAB 15MG 12/31/9999 2<strong>01</strong>2300067000330 EX-LAX TAB 15MG 12/31/9999 2<strong>01</strong>23000670<strong>01</strong>624 EX-LAX TAB MAX ST 12/31/9999 2<strong>01</strong>23000670<strong>01</strong>648 EX-LAX TAB MAX ST 12/31/9999 2<strong>01</strong>23000670<strong>01</strong>690 EX-LAX TAB MAX ST 12/31/9999 2<strong>01</strong>2300067002712 EX-LAX MILK SUS OF MAGNE 12/31/9999 2<strong>01</strong>2300067002812 EX-LAX MILK SUS OF MAGNE 12/31/9999 2<strong>01</strong>2300067002912 EX-LAX MILK SUS OF MAGNE 12/31/9999 2<strong>01</strong>2300067034724 EX-LAX ULTRA TAB 5MG EC 12/31/9999 2<strong>01</strong>2300078056912 EXTAVIA INJ 0.3MG 12/31/9999 2<strong>01</strong>2300078056961 EXTAVIA INJ 0.3MG 12/31/9999 2<strong>01</strong>2363032005100 EXTINA AER 2% 12/31/9999 2<strong>01</strong>2363032005150 EXTINA AER 2% 12/31/9999 2<strong>01</strong>2300536097085 EXTRA ACTION SYP COUGH 12/31/9999 2<strong>01</strong>2300536097097 EXTRA ACTION SYP COUGH 12/31/9999 2<strong>01</strong>2300941067905 EXTRANEAL SOL 12/31/9999 2<strong>01</strong>2300941067906 EXTRANEAL SOL 12/31/9999 2<strong>01</strong>2300941067947 EXTRANEAL SOL <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300941067952 EXTRANEAL SOL 12/31/9999 2<strong>01</strong>2300941067953 EXTRANEAL SOL 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>04<strong>01</strong> EYE DROPS DRO ADV RELF 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>3905 EYE DROPS SOL 0.05% OP 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>3805 EYE DROPS SOL A/R 12/31/9999 2<strong>01</strong>230053609<strong>01</strong>97 EYE IRRIGATI SOL OP 12/31/9999 2<strong>01</strong>2300023346805 EYE ITCH REL DRO 0.025%OP 12/31/9999 2<strong>01</strong>23

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