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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65162073409 FELBAMATE TAB 400MG 12/31/9999 2<strong>01</strong>23515250431<strong>01</strong> FELBAMATE TAB 600MG 12/31/9999 2<strong>01</strong>2365162073503 FELBAMATE TAB 600MG 12/31/9999 2<strong>01</strong>2365162073509 FELBAMATE TAB 600MG 12/31/9999 2<strong>01</strong>2365162073518 FELBAMATE TAB 600MG 12/31/9999 2<strong>01</strong>2300037044217 FELBATOL SUS 600/5ML 12/31/9999 2<strong>01</strong>2300037044267 FELBATOL SUS 600/5ML 12/31/9999 2<strong>01</strong>23000370430<strong>01</strong> FELBATOL TAB 400MG 12/31/9999 2<strong>01</strong>23000370431<strong>01</strong> FELBATOL TAB 600MG 12/31/9999 2<strong>01</strong>2300069322066 FELDENE CAP 10MG 12/31/9999 2<strong>01</strong>2300069323066 FELDENE CAP 20MG 12/31/9999 2<strong>01</strong>23003785<strong>01</strong>3<strong>01</strong> FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>23003785<strong>01</strong>305 FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>23510790468<strong>01</strong> FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>2351079046820 FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>23534890370<strong>01</strong> FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>23633040437<strong>01</strong> FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>23684620235<strong>01</strong> FELODIPINE TAB 10MG ER 12/31/9999 2<strong>01</strong>23003785<strong>01</strong>1<strong>01</strong> FELODIPINE TAB 2.5MG ER 12/31/9999 2<strong>01</strong>23003785<strong>01</strong>105 FELODIPINE TAB 2.5MG ER 12/31/9999 2<strong>01</strong>23534890368<strong>01</strong> FELODIPINE TAB 2.5MG ER 12/31/9999 2<strong>01</strong>23633040435<strong>01</strong> FELODIPINE TAB 2.5MG ER 12/31/9999 2<strong>01</strong>23684620233<strong>01</strong> FELODIPINE TAB 2.5MG ER 12/31/9999 2<strong>01</strong>23003785<strong>01</strong>2<strong>01</strong> FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>23003785<strong>01</strong>205 FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>23510790467<strong>01</strong> FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>2351079046720 FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>23534890369<strong>01</strong> FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>23633040436<strong>01</strong> FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>23684620234<strong>01</strong> FELODIPINE TAB 5MG ER 12/31/9999 2<strong>01</strong>2300813079955 FEM PH GEL 12/31/9999 2<strong>01</strong>2300078024915 FEMARA TAB 2.5MG 12/31/9999 2<strong>01</strong>2300904531246 FEMATROL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300430048214 FEMCON FE CHW 12/31/9999 2<strong>01</strong>2300430<strong>01</strong>4514 FEMHRT TAB 0.5-2.5 12/31/9999 2<strong>01</strong>2300430<strong>01</strong>4523 FEMHRT TAB 0.5-2.5 04/30/2<strong>01</strong>3 2<strong>01</strong>2300430054414 FEMHRT 1/5 TAB 02/28/2<strong>01</strong>3 2<strong>01</strong>2300430054423 FEMHRT 1/5 TAB 02/28/2<strong>01</strong>3 2<strong>01</strong>2337205029865 FEMININE LAX TAB 5MG EC 12/31/9999 2<strong>01</strong>230043062<strong>01</strong>40 FEMRING MIS 0.05/24H 12/31/9999 2<strong>01</strong>2300430620240 FEMRING MIS 0.1MG/24 12/31/9999 2<strong>01</strong>2300430038924 FEMTRACE TAB 0.45MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2300430039024 FEMTRACE TAB 0.9MG <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>230<strong>01</strong>150522<strong>01</strong> FENOFIBRATE CAP 134MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>150533<strong>01</strong> FENOFIBRATE CAP 200MG 12/31/9999 2<strong>01</strong>2368084032921 FENOFIBRATE CAP 200MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>150511<strong>01</strong> FENOFIBRATE CAP 67MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>15552202 FENOFIBRATE TAB 160MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>15552210 FENOFIBRATE TAB 160MG 12/31/9999 2<strong>01</strong>230037871<strong>01</strong>77 FENOFIBRATE TAB 160MG 12/31/9999 2<strong>01</strong>236330409<strong>01</strong>05 FENOFIBRATE TAB 160MG 12/31/9999 2<strong>01</strong>236330409<strong>01</strong>90 FENOFIBRATE TAB 160MG 12/31/9999 2<strong>01</strong>2368084032821 FENOFIBRATE TAB 160MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>15551110 FENOFIBRATE TAB 54MG 12/31/9999 2<strong>01</strong>2300378710077 FENOFIBRATE TAB 54MG 12/31/9999 2<strong>01</strong>2363304090090 FENOFIBRATE TAB 54MG 12/31/9999 2<strong>01</strong>2353489067807 FENOFIBRIC TAB 105MG 12/31/9999 2<strong>01</strong>2353489067890 FENOFIBRIC TAB 105MG 12/31/9999 2<strong>01</strong>2353489067707 FENOFIBRIC TAB 35MG 12/31/9999 2<strong>01</strong>2300781300571 FENOLDOPAM INJ 10MG/ML 12/31/9999 2<strong>01</strong>23

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