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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24385049464 EYE ITCH REL DRO 0.025%OP 12/31/9999 2<strong>01</strong>2337205084917 EYE ITCH REL DRO 0.025%OP 12/31/9999 2<strong>01</strong>2349348<strong>01</strong>6317 EYE ITCH REL DRO 0.025%OP 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>05<strong>01</strong> EYE ITCH REL DRO 0.025%OP 12/31/9999 2<strong>01</strong>23000650530<strong>01</strong> EYE STREAM SOL OP 12/31/9999 2<strong>01</strong>2300065053004 EYE STREAM SOL OP 12/31/9999 2<strong>01</strong>2300904537720 EYE WASH SOL 12/31/9999 2<strong>01</strong>2337205002326 EYE WASH SOL 12/31/9999 2<strong>01</strong>23503830<strong>01</strong>804 EYE WASH SOL 12/31/9999 2<strong>01</strong>2361755000502 EYLEA INJ 2/0.05ML 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>2225 EZ CHAR SUS PELLETS 12/31/9999 2<strong>01</strong>23128300824<strong>01</strong> EZFE 200 CAP 200MG 12/31/9999 2<strong>01</strong>2312830082430 EZFE 200 CAP 200MG 12/31/9999 2<strong>01</strong>23128300831<strong>01</strong> EZFE FORTE CAP 12/31/9999 2<strong>01</strong>2300245<strong>01</strong>8311 FA-B6-B12 TAB 12/31/9999 2<strong>01</strong>2368308032610 FABB TAB 12/31/9999 2<strong>01</strong>23584680040<strong>01</strong> FABRAZYME INJ 35MG 12/31/9999 2<strong>01</strong>23584680041<strong>01</strong> FABRAZYME INJ 5MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>22032105 FACTIVE TAB 320MG 03/31/2<strong>01</strong>5 2<strong>01</strong>231<strong>01</strong>22032107 FACTIVE TAB 320MG 03/15/2<strong>01</strong>5 2<strong>01</strong>2300054<strong>01</strong>9613 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2300093811756 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2300378449093 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2300591327130 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2300781562031 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>23167140300<strong>01</strong> FAMCICLOVIR TAB 125MG 12/31/2020 2<strong>01</strong>2333342002407 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>23597622700<strong>01</strong> FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2360505324503 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2365862046530 FAMCICLOVIR TAB 125MG 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>9713 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2300093811856 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2300378449193 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2300591327230 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2300781562131 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>23167140304<strong>01</strong> FAMCICLOVIR TAB 250MG 12/31/2020 2<strong>01</strong>2333342002507 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>235976227<strong>01</strong>02 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2360505324603 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2365862046630 FAMCICLOVIR TAB 250MG 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>9813 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2300093811956 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2300378449293 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2300591327330 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2300781562231 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>23167140305<strong>01</strong> FAMCICLOVIR TAB 500MG 12/31/2020 2<strong>01</strong>2333342002607 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>23597622703<strong>01</strong> FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2360505324703 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2365862046730 FAMCICLOVIR TAB 500MG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9004502 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9004517 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9004603 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9004604 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9004614 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9004663 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>23553900026<strong>01</strong> FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>23553900027<strong>01</strong> FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2355390002810 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2355390002910 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>23

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