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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10267<strong>01</strong>2004 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2315338<strong>01</strong>7000 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>05<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>0517 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>0519 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>0520 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>235199102<strong>01</strong>10 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23597460<strong>01</strong>210 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23625840897<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23637390537<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2363739053710 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2364125<strong>01</strong>27<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2364125<strong>01</strong>2710 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2365162036110 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2365162036111 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23762820210<strong>01</strong> FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>2376282021<strong>01</strong>0 FOLIC ACID TAB 1MG 12/31/9999 2<strong>01</strong>23005363844<strong>01</strong> FOLIC ACID TAB 400MCG 12/31/9999 2<strong>01</strong>23005363843<strong>01</strong> FOLIC ACID TAB 800MCG 12/31/9999 2<strong>01</strong>2313811053890 FOLIVANE-F CAP 12/31/9999 2<strong>01</strong>2313811053530 FOLIVANE-OB CAP 12/31/9999 2<strong>01</strong>2313811053990 FOLIVANE-PLS CAP 12/31/9999 2<strong>01</strong>2313811054430 FOLIVANE-PRX CAP DHA NF 12/31/9999 2<strong>01</strong>2300052030902 FOLLISTIM AQ INJ 150UNIT 12/31/9999 2<strong>01</strong>23000520313<strong>01</strong> FOLLISTIM AQ INJ 300UNIT 12/31/9999 2<strong>01</strong>23000520316<strong>01</strong> FOLLISTIM AQ INJ 600UNIT 12/31/9999 2<strong>01</strong>2300052030802 FOLLISTIM AQ INJ 75UNIT 12/31/9999 2<strong>01</strong>23000520326<strong>01</strong> FOLLISTIM AQ INJ 900UNIT 12/31/9999 2<strong>01</strong>234881800<strong>01</strong><strong>01</strong> FOLOTYN INJ 20MG/ML 12/31/9999 2<strong>01</strong>234881800<strong>01</strong>02 FOLOTYN INJ 40MG/2ML 12/31/9999 2<strong>01</strong>23682200<strong>01</strong>890 FOLPACE RX TAB 12/31/9999 2<strong>01</strong>23519910252<strong>01</strong> FOLPLEX 2.2 TAB 12/31/9999 2<strong>01</strong>2368308032560 FOLTABS 800 TAB 12/31/9999 2<strong>01</strong>23509910323<strong>01</strong> FOLTRATE TAB 12/31/9999 2<strong>01</strong>2300781318273 FOMEPIZOLE INJ 1.5GM 12/31/9999 2<strong>01</strong>2300781318284 FOMEPIZOLE INJ 1.5GM 12/31/9999 2<strong>01</strong>231<strong>01</strong>39091<strong>01</strong>5 FOMEPIZOLE INJ 1.5GM 12/31/9999 2<strong>01</strong>2367457021102 FOMEPIZOLE INJ 1.5GM 12/31/9999 2<strong>01</strong>23398220710<strong>01</strong> FOMEPIZOLE INJ 1GM/ML 12/31/9999 2<strong>01</strong>2355111068102 FONDAPARINUX SOL 10/0.8 12/31/9999 2<strong>01</strong>2355111068110 FONDAPARINUX SOL 10/0.8 12/31/9999 2<strong>01</strong>2360505608104 FONDAPARINUX SOL 10/0.8 12/31/9999 2<strong>01</strong>2355111067802 FONDAPARINUX SOL 2.5/0.5 12/31/9999 2<strong>01</strong>2355111067810 FONDAPARINUX SOL 2.5/0.5 12/31/9999 2<strong>01</strong>2360505607804 FONDAPARINUX SOL 2.5/0.5 12/31/9999 2<strong>01</strong>2355111067902 FONDAPARINUX SOL 5.0/0.4 12/31/9999 2<strong>01</strong>2355111067910 FONDAPARINUX SOL 5.0/0.4 12/31/9999 2<strong>01</strong>2360505607904 FONDAPARINUX SOL 5.0/0.4 12/31/9999 2<strong>01</strong>2355111068002 FONDAPARINUX SOL 7.5/0.6 12/31/9999 2<strong>01</strong>2355111068<strong>01</strong>0 FONDAPARINUX SOL 7.5/0.6 12/31/9999 2<strong>01</strong>2360505608004 FONDAPARINUX SOL 7.5/0.6 12/31/9999 2<strong>01</strong>230008514<strong>01</strong><strong>01</strong> FORADIL CAP AEROLIZE 12/31/9999 2<strong>01</strong>23000851402<strong>01</strong> FORADIL CAP AEROLIZE 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9036040 FORANE SOL 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9036060 FORANE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000505 FORDUSTIN POW 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000516 FORDUSTIN POW 12/31/9999 2<strong>01</strong>2349908<strong>01</strong>6790 FORMALDEHYDE SOL 10% 12/31/9999 2<strong>01</strong>2351552042706 FORMALDEHYDE SOL 10% 12/31/9999 2<strong>01</strong>2351552042708 FORMALDEHYDE SOL 10% 12/31/9999 2<strong>01</strong>23

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