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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00781119110 GLYBURIDE TAB 5MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2300904613980 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>23231550058<strong>01</strong> GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2323155005810 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>23510790873<strong>01</strong> GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2351079087317 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2351079087319 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2351079087320 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2359762702205 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2359762702209 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2363739<strong>01</strong>1910 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2364720<strong>01</strong>2510 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2364720<strong>01</strong>2511 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>23658620030<strong>01</strong> GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2365862003099 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2368645021154 GLYBURIDE TAB 5MG 12/31/9999 2<strong>01</strong>2351552009404 GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2351552009405 GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2351552009406 GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2351552009408 GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2351552009409 GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>02 GLYCERIN SUP 2.1GM 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>13 GLYCERIN SUP 2.1GM 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>26 GLYCERIN SUP 2.1GM 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>51 GLYCERIN SUP 2.1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>32007912 GLYCERIN SUP 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>32007924 GLYCERIN SUP 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>32007950 GLYCERIN SUP 2GM 12/31/9999 2<strong>01</strong>2300904266757 GLYCERIN SUP 3GM 12/31/9999 2<strong>01</strong>2349614032063 GLYCERIN SUP 3GM 12/31/9999 2<strong>01</strong>2300603051119 GLYCERIN SUP 80.7% 12/31/9999 2<strong>01</strong>2300904266612 GLYCERIN SUP 80.7% 12/31/9999 2<strong>01</strong>2300904266617 GLYCERIN SUP 80.7% 12/31/9999 2<strong>01</strong>2300904266717 GLYCERIN SUP 80.7% 12/31/9999 2<strong>01</strong>2300904266760 GLYCERIN SUP 80.7% 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0213 GLYCERIN PED SUP 1.2GM 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0226 GLYCERIN PED SUP 1.2GM 12/31/9999 2<strong>01</strong>2351552097006 GLYCEROL LIQ FORMAL 12/31/9999 2<strong>01</strong>2351552097008 GLYCEROL LIQ FORMAL 12/31/9999 2<strong>01</strong>2351552032006 GLYCERYL MIS MONOSTEA 12/31/9999 2<strong>01</strong>2351552032008 GLYCERYL MIS MONOSTEA 12/31/9999 2<strong>01</strong>2351552032009 GLYCERYL MIS MONOSTEA 12/31/9999 2<strong>01</strong>2300338028947 GLYCINE SOL 1.5% IRR 12/31/9999 2<strong>01</strong>2300409797408 GLYCINE SOL 1.5% IRR 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>9007 GLYCOLAX POW 3350 NF 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>9<strong>01</strong>5 GLYCOLAX POW 3350 NF 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>9031 GLYCOLAX POW 3350 NF 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>8304 GLYCOLIC ACD CRY 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>8305 GLYCOLIC ACD CRY 12/31/9999 2<strong>01</strong>230051746<strong>01</strong>25 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2300517460225 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2300517460525 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2300517462025 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>23006416033<strong>01</strong> GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2300641603325 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>23006416035<strong>01</strong> GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2300641603525 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>602 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>617 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>629 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>23

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