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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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63323073804 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2363323073820 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2363323073912 FAMOTIDINE INJ 10MG/ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>26<strong>01</strong> FAMOTIDINE INJ 200/20ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>2602 FAMOTIDINE INJ 200/20ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>21<strong>01</strong> FAMOTIDINE INJ 20MG/2ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>2102 FAMOTIDINE INJ 20MG/2ML 12/31/9999 2<strong>01</strong>23006416022<strong>01</strong> FAMOTIDINE INJ 20MG/2ML 12/31/9999 2<strong>01</strong>2300641602225 FAMOTIDINE INJ 20MG/2ML 12/31/9999 2<strong>01</strong>2300338519741 FAMOTIDINE INJ 20MG/50M 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>25<strong>01</strong> FAMOTIDINE INJ 40MG/4ML 12/31/9999 2<strong>01</strong>2300069<strong>01</strong>2502 FAMOTIDINE INJ 40MG/4ML 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>4704 FAMOTIDINE SUS 40MG/5ML 12/31/9999 2<strong>01</strong>2368180<strong>01</strong>50<strong>01</strong> FAMOTIDINE SUS 40MG/5ML 12/31/9999 2<strong>01</strong>2368382044405 FAMOTIDINE SUS 40MG/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>72266246 FAMOTIDINE TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72266248 FAMOTIDINE TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72266272 FAMOTIDINE TAB 10MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>42<strong>01</strong> FAMOTIDINE TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572800 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572810 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572860 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572870 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572880 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>23003783020<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2300378302005 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2300904555360 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2300904555361 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2300904555380 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>23167140361<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/2020 2<strong>01</strong>2316714036104 FAMOTIDINE TAB 20MG 12/31/2020 2<strong>01</strong>2316714036105 FAMOTIDINE TAB 20MG 12/31/2020 2<strong>01</strong>2316714036106 FAMOTIDINE TAB 20MG 12/31/2020 2<strong>01</strong>23510790966<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2351079096617 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2351079096619 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2351079096620 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>19<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/2<strong>01</strong>4 2<strong>01</strong>2355111<strong>01</strong>1910 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2361442<strong>01</strong>21<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2361442<strong>01</strong>2110 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>43<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2363739048410 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>23646790936<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2364679093602 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2364679093603 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2368084<strong>01</strong>72<strong>01</strong> FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>2368645<strong>01</strong>4059 FAMOTIDINE TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572900 FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572910 FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572960 FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72572970 FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>23003783040<strong>01</strong> FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>2300904555461 FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>23167140362<strong>01</strong> FAMOTIDINE TAB 40MG 12/31/2020 2<strong>01</strong>2316714036204 FAMOTIDINE TAB 40MG 12/31/2020 2<strong>01</strong>2355111<strong>01</strong>20<strong>01</strong> FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>2361442<strong>01</strong>22<strong>01</strong> FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>2361442<strong>01</strong>2210 FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>23646790937<strong>01</strong> FAMOTIDINE TAB 40MG 12/31/9999 2<strong>01</strong>23

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