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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51552<strong>01</strong>2808 ALMOND OIL SWEET 12/31/9999 2<strong>01</strong>2300023884205 ALOCRIL SOL 2% 12/31/9999 2<strong>01</strong>2324385008334 ALOE VERA/ GEL LIDOCAIN 12/31/9999 2<strong>01</strong>2343553324913 ALOE VESTA OIN PROTECT 12/31/9999 2<strong>01</strong>2300065034510 ALOMIDE SOL 0.1% OP 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>8750 ALOPRIM INJ 500MG 12/31/9999 2<strong>01</strong>2352544088408 ALORA DIS 0.025MG 12/31/9999 2<strong>01</strong>2352544047108 ALORA DIS 0.05MG 12/31/9999 2<strong>01</strong>2352544047208 ALORA DIS 0.075MG 12/31/9999 2<strong>01</strong>2352544047308 ALORA DIS 0.1MG 12/31/9999 2<strong>01</strong>23628560797<strong>01</strong> ALOXI INJ 0.25MG/5 12/31/9999 2<strong>01</strong>2300023932105 ALPHAGAN P SOL 0.1% 12/31/9999 2<strong>01</strong>2300023932110 ALPHAGAN P SOL 0.1% 12/31/9999 2<strong>01</strong>2300023932115 ALPHAGAN P SOL 0.1% 12/31/9999 2<strong>01</strong>2300023917705 ALPHAGAN P SOL 0.15% 12/31/9999 2<strong>01</strong>2300023917710 ALPHAGAN P SOL 0.15% 12/31/9999 2<strong>01</strong>2300023917715 ALPHAGAN P SOL 0.15% 12/31/9999 2<strong>01</strong>236851646<strong>01</strong><strong>01</strong> ALPHANATE INJ VWF/HUM 12/31/9999 2<strong>01</strong>23685164602<strong>01</strong> ALPHANATE INJ VWF/HUM 12/31/9999 2<strong>01</strong>2368516460302 ALPHANATE INJ VWF/HUM 12/31/9999 2<strong>01</strong>2368516460402 ALPHANATE INJ VWF/HUM 12/31/9999 2<strong>01</strong>2368516360202 ALPHANINE SD INJ 1000UNIT 12/31/9999 2<strong>01</strong>2368516360302 ALPHANINE SD INJ 1500UNIT 12/31/9999 2<strong>01</strong>236851636<strong>01</strong>02 ALPHANINE SD INJ 500UNIT 12/31/9999 2<strong>01</strong>2358980058<strong>01</strong>0 ALPHAQUIN HP CRE 4% 12/31/9999 2<strong>01</strong>2358980058020 ALPHAQUIN HP CRE 4% 12/31/9999 2<strong>01</strong>2300054306844 ALPRAZOLAM CON 1 MG/ML 12/31/9999 2<strong>01</strong>23002284<strong>01</strong>911 ALPRAZOLAM TAB 0.25 ODT 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>1074 ALPRAZOLAM TAB 0.25 ODT 12/31/9999 2<strong>01</strong>2300228202710 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300228202750 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300228202796 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>230037840<strong>01</strong><strong>01</strong> ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>230037840<strong>01</strong>05 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>230037840<strong>01</strong>77 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300603212721 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300603212728 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300603212732 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>23007811061<strong>01</strong> ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300781106105 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300781106110 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300904585861 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2347335060313 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2347335060318 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2347335060388 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>23510790788<strong>01</strong> ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2351079078820 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>23597623719<strong>01</strong> ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2359762371903 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2359762371904 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>23643760630<strong>01</strong> ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2364376063005 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2364376063<strong>01</strong>0 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2367253090009 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2367253090<strong>01</strong>0 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2367253090<strong>01</strong>1 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2367253090050 ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>23680840<strong>01</strong>8<strong>01</strong> ALPRAZOLAM TAB 0.25MG 12/31/9999 2<strong>01</strong>2300228202910 ALPRAZOLAM TAB 0.5MG 12/31/9999 2<strong>01</strong>2300228202950 ALPRAZOLAM TAB 0.5MG 12/31/9999 2<strong>01</strong>23

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