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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10<strong>01</strong>9003725 FENTANYL CIT INJ 1000MCG 12/31/9999 2<strong>01</strong>23006416024<strong>01</strong> FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>2300641602410 FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>23006416027<strong>01</strong> FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>2300641602725 FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003702 FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003727 FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003839 FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003867 FENTANYL CIT INJ 100MCG 12/31/9999 2<strong>01</strong>23006416030<strong>01</strong> FENTANYL CIT INJ 2500MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003739 FENTANYL CIT INJ 2500MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003783 FENTANYL CIT INJ 2500MCG 12/31/9999 2<strong>01</strong>23006416028<strong>01</strong> FENTANYL CIT INJ 250MCG 12/31/9999 2<strong>01</strong>2300641602825 FENTANYL CIT INJ 250MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003705 FENTANYL CIT INJ 250MCG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9003730 FENTANYL CIT INJ 250MCG 12/31/9999 2<strong>01</strong>2300093537419 FENTANYL OT LOZ 1200MCG 06/30/2<strong>01</strong>3 2<strong>01</strong>2300093537465 FENTANYL OT LOZ 1200MCG 06/30/2<strong>01</strong>3 2<strong>01</strong>2300406921230 FENTANYL OT LOZ 1200MCG 12/31/9999 2<strong>01</strong>2349884046355 FENTANYL OT LOZ 1200MCG 12/31/9999 2<strong>01</strong>2355253007430 FENTANYL OT LOZ 1200MCG 12/31/9999 2<strong>01</strong>2300093537519 FENTANYL OT LOZ 1600MCG 12/31/2<strong>01</strong>2 2<strong>01</strong>2300093537565 FENTANYL OT LOZ 1600MCG 12/31/2<strong>01</strong>2 2<strong>01</strong>2300406921630 FENTANYL OT LOZ 1600MCG 12/31/9999 2<strong>01</strong>2349884046455 FENTANYL OT LOZ 1600MCG 12/31/9999 2<strong>01</strong>2355253007530 FENTANYL OT LOZ 1600MCG 12/31/9999 2<strong>01</strong>2300093537<strong>01</strong>9 FENTANYL OT LOZ 200MCG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300093537065 FENTANYL OT LOZ 200MCG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300406920230 FENTANYL OT LOZ 200MCG 12/31/9999 2<strong>01</strong>2349884045955 FENTANYL OT LOZ 200MCG 12/31/9999 2<strong>01</strong>2355253007030 FENTANYL OT LOZ 200MCG 12/31/9999 2<strong>01</strong>2300093537119 FENTANYL OT LOZ 400MCG 05/31/2<strong>01</strong>3 2<strong>01</strong>2300093537165 FENTANYL OT LOZ 400MCG 05/31/2<strong>01</strong>3 2<strong>01</strong>2300406920430 FENTANYL OT LOZ 400MCG 12/31/9999 2<strong>01</strong>2349884046055 FENTANYL OT LOZ 400MCG 12/31/9999 2<strong>01</strong>2355253007130 FENTANYL OT LOZ 400MCG 12/31/9999 2<strong>01</strong>2300093537219 FENTANYL OT LOZ 600MCG 06/30/2<strong>01</strong>3 2<strong>01</strong>2300093537265 FENTANYL OT LOZ 600MCG 06/30/2<strong>01</strong>3 2<strong>01</strong>2300406920630 FENTANYL OT LOZ 600MCG 12/31/9999 2<strong>01</strong>2349884046155 FENTANYL OT LOZ 600MCG 12/31/9999 2<strong>01</strong>2355253007230 FENTANYL OT LOZ 600MCG 12/31/9999 2<strong>01</strong>2300093537319 FENTANYL OT LOZ 800MCG 06/30/2<strong>01</strong>3 2<strong>01</strong>2300093537365 FENTANYL OT LOZ 800MCG 06/30/2<strong>01</strong>3 2<strong>01</strong>2300406920830 FENTANYL OT LOZ 800MCG 12/31/9999 2<strong>01</strong>2349884046255 FENTANYL OT LOZ 800MCG 12/31/9999 2<strong>01</strong>2355253007330 FENTANYL OT LOZ 800MCG 12/31/9999 2<strong>01</strong>2346672060816 FENTEX SOL 12/31/9999 2<strong>01</strong>2363459054128 FENTORA TAB 100MCG 12/31/9999 2<strong>01</strong>2363459054228 FENTORA TAB 200MCG 12/31/9999 2<strong>01</strong>2363459054428 FENTORA TAB 400MCG 12/31/9999 2<strong>01</strong>2363459054628 FENTORA TAB 600MCG 12/31/9999 2<strong>01</strong>2363459054828 FENTORA TAB 800MCG 12/31/9999 2<strong>01</strong>23593380775<strong>01</strong> FERAHEME INJ 510/17ML 12/31/9999 2<strong>01</strong>2359338077510 FERAHEME INJ 510/17ML 12/31/9999 2<strong>01</strong>23519910635<strong>01</strong> FEROCON CAP 12/31/9999 2<strong>01</strong>2364376080506 FEROTRIN CAP 12/31/9999 2<strong>01</strong>23102670464<strong>01</strong> FEROTRINSIC CAP 12/31/9999 2<strong>01</strong>230<strong>01</strong>78008990 FERRALET 90 TAB 12/31/9999 2<strong>01</strong>23138110<strong>01</strong>290 FERRAPLUS 90 TAB 12/31/9999 2<strong>01</strong>23008130<strong>01</strong>206 FERRETTS TAB 325MG 12/31/9999 2<strong>01</strong>23

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