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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0<strong>01</strong>15112108 GALANTAMINE CAP 16MG ER 12/31/9999 2<strong>01</strong>2300378810693 GALANTAMINE CAP 16MG ER 12/31/9999 2<strong>01</strong>23005551021<strong>01</strong> GALANTAMINE CAP 16MG ER 12/31/9999 2<strong>01</strong>2300591349730 GALANTAMINE CAP 16MG ER 12/31/9999 2<strong>01</strong>231<strong>01</strong>47089203 GALANTAMINE CAP 16MG ER 12/31/9999 2<strong>01</strong>2347335083683 GALANTAMINE CAP 16MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>15112208 GALANTAMINE CAP 24MG ER 12/31/9999 2<strong>01</strong>2300378810793 GALANTAMINE CAP 24MG ER 12/31/9999 2<strong>01</strong>23005551022<strong>01</strong> GALANTAMINE CAP 24MG ER 12/31/9999 2<strong>01</strong>2300591349830 GALANTAMINE CAP 24MG ER 12/31/9999 2<strong>01</strong>231<strong>01</strong>47089303 GALANTAMINE CAP 24MG ER 12/31/9999 2<strong>01</strong>2347335083783 GALANTAMINE CAP 24MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>15112008 GALANTAMINE CAP 8MG ER 12/31/9999 2<strong>01</strong>2300378810593 GALANTAMINE CAP 8MG ER 12/31/9999 2<strong>01</strong>23005551020<strong>01</strong> GALANTAMINE CAP 8MG ER 12/31/9999 2<strong>01</strong>2300591349630 GALANTAMINE CAP 8MG ER 12/31/9999 2<strong>01</strong>231<strong>01</strong>47089103 GALANTAMINE CAP 8MG ER 12/31/9999 2<strong>01</strong>2347335083583 GALANTAMINE CAP 8MG ER 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>3749 GALANTAMINE SOL 4MG/ML 12/31/9999 2<strong>01</strong>2300378272391 GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>4009 GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>47088306 GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>23510790854<strong>01</strong> GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>2351079085403 GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>23597620<strong>01</strong>0<strong>01</strong> GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>2365862046060 GALANTAMINE TAB 12MG 12/31/9999 2<strong>01</strong>2300378272191 GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>3809 GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>47088106 GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>23510790852<strong>01</strong> GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>2351079085203 GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>23597620008<strong>01</strong> GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>2365862045860 GALANTAMINE TAB 4MG 12/31/9999 2<strong>01</strong>2300378272291 GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>3909 GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>47088206 GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>23510790853<strong>01</strong> GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>2351079085303 GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>23597620009<strong>01</strong> GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>2365862045960 GALANTAMINE TAB 8MG 12/31/9999 2<strong>01</strong>2357844021552 GALZIN CAP 25MG 12/31/9999 2<strong>01</strong>2357844020852 GALZIN CAP 50MG 12/31/9999 2<strong>01</strong>2313533063504 GAMASTAN S/D INJ 12/31/9999 2<strong>01</strong>2313533063512 GAMASTAN S/D INJ 12/31/9999 2<strong>01</strong>2300944270005 GAMMAGARD INJ 10GM/100 12/31/9999 2<strong>01</strong>2300944270002 GAMMAGARD INJ 1GM/10ML 12/31/9999 2<strong>01</strong>2300944270003 GAMMAGARD INJ 2.5GM/25 12/31/9999 2<strong>01</strong>2300944270006 GAMMAGARD INJ 20GM/200 12/31/9999 2<strong>01</strong>2300944270007 GAMMAGARD INJ 30GM/300 12/31/9999 2<strong>01</strong>2300944270004 GAMMAGARD INJ 5GM/50ML 12/31/9999 2<strong>01</strong>2300944262004 GAMMAGARD SD INJ 10GM HU 12/31/9999 2<strong>01</strong>2300944265504 GAMMAGARD SD INJ 10GM HU 12/31/9999 2<strong>01</strong>2300944262002 GAMMAGARD SD INJ 2.5GM HU 12/31/9999 2<strong>01</strong>2300944262003 GAMMAGARD SD INJ 5GM HU 12/31/9999 2<strong>01</strong>2300944265503 GAMMAGARD SD INJ 5GM HU 12/31/9999 2<strong>01</strong>2376125090<strong>01</strong>0 GAMMAKED INJ 10GM/100 12/31/9999 2<strong>01</strong>23761250900<strong>01</strong> GAMMAKED INJ 1GM/10ML 12/31/9999 2<strong>01</strong>2376125090025 GAMMAKED INJ 2.5GM/25 12/31/9999 2<strong>01</strong>2376125090020 GAMMAKED INJ 20GM/200 12/31/9999 2<strong>01</strong>2376125090050 GAMMAKED INJ 5GM/50ML 12/31/9999 2<strong>01</strong>23

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