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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10<strong>01</strong>90<strong>01</strong>636 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>637 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>639 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>654 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90<strong>01</strong>681 GLYCOPYRROL INJ 0.2MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>431250<strong>01</strong> GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>2300603318021 GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>23006771931<strong>01</strong> GLYCOPYRROL TAB 1MG 05/25/2<strong>01</strong>3 2<strong>01</strong>23498840065<strong>01</strong> GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>23510790700<strong>01</strong> GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>2351079070020 GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>23551110648<strong>01</strong> GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>23680840231<strong>01</strong> GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>23680840499<strong>01</strong> GLYCOPYRROL TAB 1MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431251<strong>01</strong> GLYCOPYRROL TAB 2MG 12/31/9999 2<strong>01</strong>2300603318121 GLYCOPYRROL TAB 2MG 12/31/9999 2<strong>01</strong>23006771932<strong>01</strong> GLYCOPYRROL TAB 2MG 12/31/9999 2<strong>01</strong>23498840066<strong>01</strong> GLYCOPYRROL TAB 2MG 12/31/9999 2<strong>01</strong>23551110649<strong>01</strong> GLYCOPYRROL TAB 2MG 12/31/9999 2<strong>01</strong>23000090341<strong>01</strong> GLYNASE TAB 1.5MG 12/31/9999 2<strong>01</strong>23000090352<strong>01</strong> GLYNASE TAB 3MG 12/31/9999 2<strong>01</strong>2300009035204 GLYNASE TAB 3MG 12/31/9999 2<strong>01</strong>23000093449<strong>01</strong> GLYNASE TAB 6MG 12/31/9999 2<strong>01</strong>2300009344903 GLYNASE TAB 6MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35009963 GLY-OXIDE SOL 10% 12/31/9999 2<strong>01</strong>230<strong>01</strong>35009965 GLY-OXIDE SOL 10% 12/31/9999 2<strong>01</strong>23000095<strong>01</strong>4<strong>01</strong> GLYSET TAB 100MG 12/31/9999 2<strong>01</strong>23000095<strong>01</strong>2<strong>01</strong> GLYSET TAB 25MG 12/31/9999 2<strong>01</strong>23000095<strong>01</strong>3<strong>01</strong> GLYSET TAB 50MG 12/31/9999 2<strong>01</strong>2346122004803 GNP 4X TAB PROBIOTI 12/31/9999 2<strong>01</strong>2324385006578 GNP ALCOHOL PAD SWABS 12/31/9999 2<strong>01</strong>2346122004378 GNP ALCOHOL PAD SWABS 12/31/9999 2<strong>01</strong>2324385099865 GNP ALL DAY TAB ALLERGY 12/31/9999 2<strong>01</strong>2324385099874 GNP ALL DAY TAB ALLERGY 12/31/9999 2<strong>01</strong>2324385099875 GNP ALL DAY TAB ALLERGY 12/31/9999 2<strong>01</strong>2324385046262 GNP ALLERGY CAP 25MG 12/31/9999 2<strong>01</strong>2324385046278 GNP ALLERGY CAP 25MG 12/31/9999 2<strong>01</strong>2346122004022 GNP ALLERGY TAB 180MG 12/31/9999 2<strong>01</strong>2346122004061 GNP ALLERGY TAB 180MG 12/31/9999 2<strong>01</strong>2346122004065 GNP ALLERGY TAB 180MG 12/31/9999 2<strong>01</strong>2346122004075 GNP ALLERGY TAB 180MG 12/31/9999 2<strong>01</strong>2324385047962 GNP ALLERGY TAB 25MG 12/31/9999 2<strong>01</strong>2324385047978 GNP ALLERGY TAB 25MG 12/31/9999 2<strong>01</strong>2324385046362 GNP ALLERGY TAB 4MG 12/31/9999 2<strong>01</strong>2324385046378 GNP ALLERGY TAB 4MG 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>4762 GNP ALLERGY TAB MULTI-SY 12/31/9999 2<strong>01</strong>2324385035640 GNP ANTACID SUS ANTI-GAS 12/31/9999 2<strong>01</strong>2324385036240 GNP ANTACID SUS CHERRY 12/31/9999 2<strong>01</strong>2324385002868 GNP ASPIRIN CHW 81MG 12/31/9999 2<strong>01</strong>2324385027868 GNP ASPIRIN CHW 81MG 12/31/9999 2<strong>01</strong>2324385036468 GNP ASPIRIN CHW 81MG 12/31/9999 2<strong>01</strong>2324385041678 GNP ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2324385041687 GNP ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2324385042902 GNP ASPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>2324385042990 GNP ASPIRIN TAB 325MG EC 12/31/9999 2<strong>01</strong>23243850205<strong>01</strong> GNP ATHLETES CRE 1% 12/31/9999 2<strong>01</strong>2324385020503 GNP ATHLETES CRE 1% 12/31/9999 2<strong>01</strong>2324385090378 GNP BISA-LAX TAB 5MG EC 12/31/9999 2<strong>01</strong>2324385041396 GNP CALAMINE LOT 8-8% 12/31/9999 2<strong>01</strong>2324385040796 GNP CALAMINE LOT PHENOLAT 12/31/9999 2<strong>01</strong>23

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