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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64208823403 GAMMAPLEX INJ 10GM 12/31/9999 2<strong>01</strong>23642088234<strong>01</strong> GAMMAPLEX INJ 2.5GM 12/31/9999 2<strong>01</strong>2364208823402 GAMMAPLEX INJ 5GM 12/31/9999 2<strong>01</strong>2313533064512 GAMUNEX INJ 10% 03/24/2<strong>01</strong>3 2<strong>01</strong>2313533064515 GAMUNEX INJ 10% 04/19/2<strong>01</strong>3 2<strong>01</strong>2313533064520 GAMUNEX INJ 10% 06/26/2<strong>01</strong>4 2<strong>01</strong>2313533064524 GAMUNEX INJ 10% 10/17/2<strong>01</strong>3 2<strong>01</strong>2313533064571 GAMUNEX INJ 10% 10/22/2<strong>01</strong>3 2<strong>01</strong>2313533080071 GAMUNEX-C INJ 10GM/100 12/31/9999 2<strong>01</strong>2313533080<strong>01</strong>2 GAMUNEX-C INJ 1GM/10ML 12/31/9999 2<strong>01</strong>2313533080<strong>01</strong>5 GAMUNEX-C INJ 2.5GM/25 12/31/9999 2<strong>01</strong>2313533080024 GAMUNEX-C INJ 20GM/200 12/31/9999 2<strong>01</strong>2313533080020 GAMUNEX-C INJ 5GM/50ML 12/31/9999 2<strong>01</strong>2363304063628 GANCICLOVIR CAP 250MG 12/31/9999 2<strong>01</strong>2363304063728 GANCICLOVIR CAP 500MG 12/31/9999 2<strong>01</strong>2363323031510 GANCICLOVIR INJ 500MG 12/31/9999 2<strong>01</strong>230005203<strong>01</strong>51 GANIRELIX AC INJ 12/31/9999 2<strong>01</strong>2360258026116 GANI-TUSS NR LIQ 100-10/5 12/31/2<strong>01</strong>2 2<strong>01</strong>2348102000935 GARAMYCIN OIN 0.3% OP 12/31/9999 2<strong>01</strong>2348102002205 GARAMYCIN SOL 0.3% OP 12/31/9999 2<strong>01</strong>2300904545846 GAS FREE CAP 125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13042860 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2324385042865 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2336800042860 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2336800042871 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2337205029565 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2349348026309 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2349348094644 GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>60<strong>01</strong> GAS RELIEF CAP 125MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13065772 GAS RELIEF CAP 180MG 12/31/9999 2<strong>01</strong>2300904557252 GAS RELIEF CAP 180MG 12/31/9999 2<strong>01</strong>2337205029272 GAS RELIEF CAP 180MG 12/31/9999 2<strong>01</strong>2349348048912 GAS RELIEF CAP 180MG 12/31/9999 2<strong>01</strong>2368<strong>01</strong>6067154 GAS RELIEF CHW 125MG 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>1278 GAS RELIEF CHW 80MG 12/31/9999 2<strong>01</strong>2300904589430 GAS RELIEF DRO 20/0.3ML 12/31/9999 2<strong>01</strong>2324385078530 GAS RELIEF DRO 20/0.3ML 12/31/9999 2<strong>01</strong>2336800088210 GAS RELIEF DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2349348057734 GAS RELIEF DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2350383078530 GAS RELIEF DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>39<strong>01</strong> GAS RELIEF DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2363868005230 GAS RELIEF DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2318860067870 GASTROCROM CON 100/5ML 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>3410 GAS-X CAP 125MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>3472 GAS-X CAP 125MG 12/31/9999 2<strong>01</strong>2300067627510 GAS-X CAP 125MG 12/31/9999 2<strong>01</strong>2300067627520 GAS-X CAP 125MG 12/31/9999 2<strong>01</strong>2300067627550 GAS-X CAP 125MG 12/31/9999 2<strong>01</strong>2300067627572 GAS-X CAP 125MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>1336 GAS-X CHW 80MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>1636 GAS-X CHW 80MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>1718 GAS-X EX-STR CHW 125MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>1748 GAS-X EX-STR CHW 125MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>2918 GAS-X EX-STR CHW 125MG 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>3008 GAS-X/MAALOX CHW EXTRA ST 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>3024 GAS-X/MAALOX CHW EXTRA ST 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>3208 GAS-X/MAALOX CHW EXTRA ST 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>3224 GAS-X/MAALOX CHW EXTRA ST 12/31/9999 2<strong>01</strong>2343386031208 GAVILAX POW 12/31/9999 2<strong>01</strong>2343386031214 GAVILAX POW 12/31/9999 2<strong>01</strong>23

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