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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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67253090250 ALPRAZOLAM TAB 1MG 12/31/9999 2<strong>01</strong>23680840020<strong>01</strong> ALPRAZOLAM TAB 1MG 12/31/9999 2<strong>01</strong>2300093545106 ALPRAZOLAM TAB 1MG ER 12/31/9999 2<strong>01</strong>2300228308406 ALPRAZOLAM TAB 1MG ER 12/31/9999 2<strong>01</strong>2300378502291 ALPRAZOLAM TAB 1MG ER 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>4106 ALPRAZOLAM TAB 1MG ER 12/31/9999 2<strong>01</strong>2365162081006 ALPRAZOLAM TAB 1MG ER 12/31/9999 2<strong>01</strong>2365862045560 ALPRAZOLAM TAB 1MG ER 12/31/9999 2<strong>01</strong>2300228402411 ALPRAZOLAM TAB 1MG ODT 12/31/9999 2<strong>01</strong>2349884021374 ALPRAZOLAM TAB 1MG ODT 12/31/9999 2<strong>01</strong>2300228203910 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2300228203950 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>23003784007<strong>01</strong> ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2300603213021 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2300603213028 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>23007811089<strong>01</strong> ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2300781108905 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2300904586161 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2347335060688 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>23597623722<strong>01</strong> ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2359762372203 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>23643760633<strong>01</strong> ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2364376063305 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2367253090310 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2367253090350 ALPRAZOLAM TAB 2MG 12/31/9999 2<strong>01</strong>2300093545206 ALPRAZOLAM TAB 2MG ER 12/31/9999 2<strong>01</strong>2300228308706 ALPRAZOLAM TAB 2MG ER 12/31/9999 2<strong>01</strong>2300378502391 ALPRAZOLAM TAB 2MG ER 05/31/2<strong>01</strong>3 2<strong>01</strong>2364980<strong>01</strong>4206 ALPRAZOLAM TAB 2MG ER 12/31/9999 2<strong>01</strong>2365162081206 ALPRAZOLAM TAB 2MG ER 12/31/9999 2<strong>01</strong>2365862045660 ALPRAZOLAM TAB 2MG ER 12/31/9999 2<strong>01</strong>2300228402511 ALPRAZOLAM TAB 2MG ODT 12/31/9999 2<strong>01</strong>2349884021474 ALPRAZOLAM TAB 2MG ODT 12/31/9999 2<strong>01</strong>2300093545306 ALPRAZOLAM TAB 3MG ER 12/31/9999 2<strong>01</strong>2300228308606 ALPRAZOLAM TAB 3MG ER 12/31/9999 2<strong>01</strong>2300378502491 ALPRAZOLAM TAB 3MG ER 11/30/2<strong>01</strong>2 2<strong>01</strong>2364980<strong>01</strong>4306 ALPRAZOLAM TAB 3MG ER 12/31/9999 2<strong>01</strong>2365162081306 ALPRAZOLAM TAB 3MG ER 12/31/9999 2<strong>01</strong>2365862045760 ALPRAZOLAM TAB 3MG ER 12/31/9999 2<strong>01</strong>23597620057<strong>01</strong> ALPRAZOLAM TAB XR 0.5MG 12/31/9999 2<strong>01</strong>23597620059<strong>01</strong> ALPRAZOLAM TAB XR 1MG 12/31/9999 2<strong>01</strong>23597620066<strong>01</strong> ALPRAZOLAM TAB XR 2MG 12/31/9999 2<strong>01</strong>23597620068<strong>01</strong> ALPRAZOLAM TAB XR 3MG 12/31/9999 2<strong>01</strong>230070315<strong>01</strong><strong>01</strong> ALPROSTADIL INJ 500MCG 12/31/9999 2<strong>01</strong>230070315<strong>01</strong>02 ALPROSTADIL INJ 500MCG 12/31/9999 2<strong>01</strong>2324208035305 ALREX SUS 0.2% 12/31/9999 2<strong>01</strong>2324208035310 ALREX SUS 0.2% 12/31/9999 2<strong>01</strong>2300007518022 ALTABAX OIN 1% 12/31/9999 2<strong>01</strong>2300007518025 ALTABAX OIN 1% 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>10<strong>01</strong> ALTACE CAP 1.25MG 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>20<strong>01</strong> ALTACE CAP 10MG 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>11<strong>01</strong> ALTACE CAP 2.5MG 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>12<strong>01</strong> ALTACE CAP 5MG 12/31/9999 2<strong>01</strong>2300781558307 ALTAVERA TAB 12/31/9999 2<strong>01</strong>2300781558315 ALTAVERA TAB 12/31/9999 2<strong>01</strong>2300781558336 ALTAVERA TAB 06/30/2<strong>01</strong>3 2<strong>01</strong>2359630062830 ALTOPREV TAB 20MG ER 12/31/9999 2<strong>01</strong>2359630062930 ALTOPREV TAB 40MG ER 12/31/9999 2<strong>01</strong>2359630063030 ALTOPREV TAB 60MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>21073330 ALUM HYDROX SUS 320/5ML 12/31/9999 2<strong>01</strong>23

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