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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24385044567 GNP MEDICATD PAD WIPES 12/31/9999 2<strong>01</strong>2346122005567 GNP MEDICATD PAD WIPES 12/31/9999 2<strong>01</strong>2324385060602 GNP MICONAZO KIT COMBO PK 12/31/9999 2<strong>01</strong>2324385036578 GNP MIGRAINE TAB RELIEF 12/31/9999 2<strong>01</strong>2324385033240 GNP MILK MAG SUS 12/31/9999 2<strong>01</strong>2324385039640 GNP MILK MAG SUS 12/31/9999 2<strong>01</strong>2324385060840 GNP MILK MAG SUS 12/31/9999 2<strong>01</strong>2324385036028 GNP MINERAL ENE 12/31/9999 2<strong>01</strong>2324385068516 GNP MINERAL OIL HEAVY 12/31/9999 2<strong>01</strong>23243850<strong>01</strong>121 GNP MUSCLE CRE RUB 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>4126 GNP MUSCLE CRE RUB 12/31/9999 2<strong>01</strong>2324385006710 GNP NASAL SPR 0.05% 12/31/9999 2<strong>01</strong>2324385035210 GNP NASAL SPR 0.05% 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>7058 GNP NICOTINE GUM 2MG MINT 12/31/9999 2<strong>01</strong>2324385059471 GNP NICOTINE GUM 2MG MINT 12/31/9999 2<strong>01</strong>2324385059771 GNP NICOTINE GUM 2MG ORIG 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>7158 GNP NICOTINE GUM 4MG MINT 12/31/9999 2<strong>01</strong>2324385059871 GNP NICOTINE GUM 4MG MINT 12/31/9999 2<strong>01</strong>2324385059971 GNP NICOTINE GUM 4MG ORIG 12/31/9999 2<strong>01</strong>2324385097567 GNP NICOTINE LOZ 2MG MINT 12/31/9999 2<strong>01</strong>2324385097667 GNP NICOTINE LOZ 4MG MINT 12/31/9999 2<strong>01</strong>2324385039<strong>01</strong>0 GNP NOSE DRO 1% 12/31/9999 2<strong>01</strong>2346122003005 GNP ORAL LIQ PAIN REL 12/31/9999 2<strong>01</strong>2324385009227 GNP PETROLEU GEL JELLY 12/31/9999 2<strong>01</strong>2346122002162 GNP PMS RELF TAB MAX ST 12/31/9999 2<strong>01</strong>2324385007878 GNP PRENATAL TAB 28-0.8MG 12/31/9999 2<strong>01</strong>2324385040840 GNP RI-MAG SUS 540/5ML 12/31/9999 2<strong>01</strong>2324385095962 GNP SINUS PAK CNG/PAIN 12/31/9999 2<strong>01</strong>2324385008862 GNP SINUS TAB CNG/PAIN 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>6962 GNP SINUS TAB CNG/PAIN 12/31/9999 2<strong>01</strong>2346122007462 GNP SINUS TAB CNG/PAIN 12/31/9999 2<strong>01</strong>2324385050726 GNP SUPHEDRN LIQ 15MG/5ML 12/31/9999 2<strong>01</strong>23243850061<strong>01</strong> GNP TRIPLE OIN ANTIBIOT 12/31/9999 2<strong>01</strong>2324385006103 GNP TRIPLE OIN ANTIBIOT 12/31/9999 2<strong>01</strong>2324385035926 GNP TUSSIN LIQ DM 12/31/9999 2<strong>01</strong>2324385035934 GNP TUSSIN LIQ DM 12/31/9999 2<strong>01</strong>2324385057826 GNP TUSSIN LIQ DM COUGH 12/31/9999 2<strong>01</strong>23461220<strong>01</strong>726 GNP TUSSIN LIQ DM MAX 12/31/9999 2<strong>01</strong>23461220<strong>01</strong>734 GNP TUSSIN LIQ DM MAX 12/31/9999 2<strong>01</strong>2324385031026 GNP TUSSIN SYP 100/5ML 12/31/9999 2<strong>01</strong>2324385031034 GNP TUSSIN SYP 100/5ML 12/31/9999 2<strong>01</strong>2324385090426 GNP TUSSIN SYP CF 12/31/9999 2<strong>01</strong>2324385090434 GNP TUSSIN SYP CF 12/31/9999 2<strong>01</strong>2324385007<strong>01</strong>0 GNP VIT A&D OIN 12/31/9999 2<strong>01</strong>2346122006965 GNP VIT C LOZ 60MG 12/31/9999 2<strong>01</strong>2350383078608 GOLDEN AGE LIQ VIT/MIN 12/31/9999 2<strong>01</strong>2352268<strong>01</strong>00<strong>01</strong> GOLYTELY SOL 12/31/9999 2<strong>01</strong>23522680700<strong>01</strong> GOLYTELY SOL 12/31/9999 2<strong>01</strong>2352268<strong>01</strong><strong>01</strong><strong>01</strong> GOLYTELY SOL PINEAPPL 12/31/9999 2<strong>01</strong>23440879070<strong>01</strong> GONAL-F INJ 1050UNIT 12/31/9999 2<strong>01</strong>23440879030<strong>01</strong> GONAL-F INJ 450UNIT 12/31/9999 2<strong>01</strong>23440871113<strong>01</strong> GONAL-F RFF INJ 300 12/31/9999 2<strong>01</strong>23440871112<strong>01</strong> GONAL-F RFF INJ 450 12/31/9999 2<strong>01</strong>23440879005<strong>01</strong> GONAL-F RFF INJ 75UNIT 12/31/9999 2<strong>01</strong>2344087900506 GONAL-F RFF INJ 75UNIT 12/31/9999 2<strong>01</strong>23440871114<strong>01</strong> GONAL-F RFF INJ 900 12/31/9999 2<strong>01</strong>230<strong>01</strong>350462<strong>01</strong> GOODYS POW EX ST 12/31/9999 2<strong>01</strong>230<strong>01</strong>35046202 GOODYS POW EX ST 12/31/9999 2<strong>01</strong>231<strong>01</strong>5800<strong>01</strong><strong>01</strong> GOODYS POW EX ST 12/31/9999 2<strong>01</strong>231<strong>01</strong>5800<strong>01</strong>02 GOODYS POW EX ST 12/31/9999 2<strong>01</strong>23

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