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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000540<strong>01</strong>121 FLECAINIDE TAB 100MG 12/31/9999 2<strong>01</strong>23000540<strong>01</strong>125 FLECAINIDE TAB 100MG 12/31/9999 2<strong>01</strong>2300555086002 FLECAINIDE TAB 100MG 12/31/9999 2<strong>01</strong>2365162064210 FLECAINIDE TAB 100MG 12/31/9999 2<strong>01</strong>2368084054021 FLECAINIDE TAB 100MG 12/31/9999 2<strong>01</strong>23000540<strong>01</strong>221 FLECAINIDE TAB 150MG 12/31/9999 2<strong>01</strong>23000540<strong>01</strong>225 FLECAINIDE TAB 150MG 12/31/9999 2<strong>01</strong>2300555086102 FLECAINIDE TAB 150MG 12/31/9999 2<strong>01</strong>23633040796<strong>01</strong> FLECAINIDE TAB 150MG 12/31/2<strong>01</strong>2 2<strong>01</strong>2365162064310 FLECAINIDE TAB 150MG 12/31/9999 2<strong>01</strong>23000540<strong>01</strong>021 FLECAINIDE TAB 50MG 12/31/9999 2<strong>01</strong>23000540<strong>01</strong>025 FLECAINIDE TAB 50MG 12/31/9999 2<strong>01</strong>2300555085902 FLECAINIDE TAB 50MG 12/31/9999 2<strong>01</strong>2365162064110 FLECAINIDE TAB 50MG 12/31/9999 2<strong>01</strong>2360793041130 FLECTOR DIS 1.3% 12/31/9999 2<strong>01</strong>230<strong>01</strong>3202<strong>01</strong>40 FLEET ENE 12/31/9999 2<strong>01</strong>230<strong>01</strong>3202<strong>01</strong>42 FLEET ENE 12/31/9999 2<strong>01</strong>230<strong>01</strong>3202<strong>01</strong>45 FLEET ENE 12/31/9999 2<strong>01</strong>230<strong>01</strong>3208<strong>01</strong>99 FLEET ENE 12/31/9999 2<strong>01</strong>230<strong>01</strong>32<strong>01</strong>1946 FLEET ENE ENEMA 12/31/9999 2<strong>01</strong>230<strong>01</strong>32020220 FLEET ENE PED 12/31/9999 2<strong>01</strong>230<strong>01</strong>32070336 FLEET BISACO ENE 10/30ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>32070402 FLEET LAXATI TAB 5MG EC 12/31/9999 2<strong>01</strong>230<strong>01</strong>32<strong>01</strong>8582 FLEET LIQUID ENE GLYCERIN 12/31/9999 2<strong>01</strong>230<strong>01</strong>32<strong>01</strong>21<strong>01</strong> FLEET NATURL ENE CLEANSNG 12/31/9999 2<strong>01</strong>230<strong>01</strong>3203<strong>01</strong>40 FLEET OIL ENE 12/31/9999 2<strong>01</strong>23009440493<strong>01</strong> FLEXBUMIN INJ 25% 12/31/9999 2<strong>01</strong>2300944049302 FLEXBUMIN INJ 25% 12/31/9999 2<strong>01</strong>230<strong>01</strong>73051700 FLOLAN INJ 0.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73051900 FLOLAN INJ 1.5MG 12/31/9999 2<strong>01</strong>23005970058<strong>01</strong> FLOMAX CAP 0.4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730453<strong>01</strong> FLONASE SPR 0.05% 12/31/9999 2<strong>01</strong>2351672133803 FLO-PRED SUS 12/31/9999 2<strong>01</strong>2300482400030 FLORA-Q CAP 12/31/9999 2<strong>01</strong>2310337040030 FLORA-Q CAP 12/31/9999 2<strong>01</strong>231033700<strong>01</strong>30 FLORA-Q 2 CAP 12/31/9999 2<strong>01</strong>230<strong>01</strong>73060200 FLOVENT DISK AER 100MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73060202 FLOVENT DISK AER 100MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>7306<strong>01</strong>00 FLOVENT DISK AER 250MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>7306<strong>01</strong>02 FLOVENT DISK AER 250MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73060002 FLOVENT DISK AER 50MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071920 FLOVENT HFA AER 110MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73072020 FLOVENT HFA AER 220MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071820 FLOVENT HFA AER 44MCG 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>35<strong>01</strong> FLOXURIDINE INJ 0.5GM 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>4507 FLOXURIDINE INJ 0.5GM 12/31/9999 2<strong>01</strong>2336800<strong>01</strong>3391 FLU & SORE POW THROAT 12/31/9999 2<strong>01</strong>2346122003713 FLU/COLD/CGH PAK NIGHTTIM 12/31/9999 2<strong>01</strong>230<strong>01</strong>13009691 FLU/COLD/CGH POW DAYTIME 04/<strong>01</strong>/2<strong>01</strong>4 2<strong>01</strong>2346122002213 FLU/COLD/CGH POW DAYTIME 12/31/9999 2<strong>01</strong>2336800055291 FLU/SEVERE POW CLD DAY 12/31/9999 2<strong>01</strong>2300054000285 FLUCONAZOLE SUS 10MG/ML 12/31/9999 2<strong>01</strong>2300093541495 FLUCONAZOLE SUS 10MG/ML 12/31/9999 2<strong>01</strong>23167140695<strong>01</strong> FLUCONAZOLE SUS 10MG/ML 12/31/2020 2<strong>01</strong>23597625029<strong>01</strong> FLUCONAZOLE SUS 10MG/ML 12/31/9999 2<strong>01</strong>2363304097505 FLUCONAZOLE SUS 10MG/ML 12/31/9999 2<strong>01</strong>2365862029935 FLUCONAZOLE SUS 10MG/ML 12/31/9999 2<strong>01</strong>2300054000385 FLUCONAZOLE SUS 40MG/ML 12/31/9999 2<strong>01</strong>2300093541595 FLUCONAZOLE SUS 40MG/ML 12/31/9999 2<strong>01</strong>23167140696<strong>01</strong> FLUCONAZOLE SUS 40MG/ML 12/31/2020 2<strong>01</strong>23

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