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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51552020504 FORMALDEHYDE SOL 37% 12/31/9999 2<strong>01</strong>2351552020506 FORMALDEHYDE SOL 37% 12/31/9999 2<strong>01</strong>2351552020508 FORMALDEHYDE SOL 37% 12/31/9999 2<strong>01</strong>2300904792960 FORMULA B TAB PLUS 12/31/9999 2<strong>01</strong>2300904004920 FORMULA EM SOL 12/31/9999 2<strong>01</strong>2300713060434 FORMULATION CRE R 12/31/9999 2<strong>01</strong>2300713060435 FORMULATION CRE R 12/31/9999 2<strong>01</strong>2300713065035 FORMULATION CRE R 12/31/9999 2<strong>01</strong>2300713029831 FORMULATION OIN R 12/31/9999 2<strong>01</strong>2300713029832 FORMULATION OIN R 12/31/9999 2<strong>01</strong>2359630057560 FORTAMET TAB 1000MG 12/31/9999 2<strong>01</strong>2359630057460 FORTAMET TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73037810 FORTAZ INJ 1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73041200 FORTAZ INJ 1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73043400 FORTAZ INJ 1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73037934 FORTAZ INJ 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73041300 FORTAZ INJ 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73043500 FORTAZ INJ 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73037710 FORTAZ INJ 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73038237 FORTAZ INJ 6GM 12/31/9999 2<strong>01</strong>23000028400<strong>01</strong> FORTEO SOL 600/2.4 12/31/9999 2<strong>01</strong>2363481<strong>01</strong>8316 FORTESTA GEL 10MG/ACT 12/31/9999 2<strong>01</strong>2300245000835 FORTICAL SPR 200/ACT 12/31/9999 2<strong>01</strong>2300006003144 FOSAMAX TAB 70MG 12/31/9999 2<strong>01</strong>2300006071044 FOSAMAX + D TAB 70-2800 12/31/9999 2<strong>01</strong>2300006027044 FOSAMAX + D TAB 70-5600 12/31/9999 2<strong>01</strong>2300409386302 FOSCARNET INJ 24MG/ML 12/31/9999 2<strong>01</strong>2300409386305 FOSCARNET INJ 24MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>78003112 FOSFREE TAB 12/31/9999 2<strong>01</strong>230<strong>01</strong>78003160 FOSFREE TAB 12/31/9999 2<strong>01</strong>230<strong>01</strong>850341<strong>01</strong> FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>23231550060<strong>01</strong> FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>23597625250<strong>01</strong> FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>2359762525004 FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>23633040403<strong>01</strong> FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>23658620308<strong>01</strong> FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>23684620554<strong>01</strong> FOSINOP/HCTZ TAB 10/12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>850342<strong>01</strong> FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>23231550061<strong>01</strong> FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>23597625251<strong>01</strong> FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>2359762525104 FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>23633040404<strong>01</strong> FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>23658620309<strong>01</strong> FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>23684620555<strong>01</strong> FOSINOP/HCTZ TAB 20/12.5 12/31/9999 2<strong>01</strong>2300093722210 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300093722298 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85004109 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85004110 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2331722020090 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2360505251002 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2360505251004 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2363304077510 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2363304077590 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2365862047190 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2368462036790 FOSINOPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300093722310 FOSINOPRIL TAB 20MG 12/31/9999 2<strong>01</strong>2300093722398 FOSINOPRIL TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85004209 FOSINOPRIL TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85004210 FOSINOPRIL TAB 20MG 12/31/9999 2<strong>01</strong>233172202<strong>01</strong>90 FOSINOPRIL TAB 20MG 12/31/9999 2<strong>01</strong>23

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