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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1<strong>01</strong>5800<strong>01</strong>03 GOODYS POW EX ST 12/31/9999 2<strong>01</strong>231<strong>01</strong>5800<strong>01</strong>04 GOODYS POW EX ST 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000407 GOODYS TAB EX ST 12/31/9999 2<strong>01</strong>231<strong>01</strong>58099925 GOODYS BODY POW PAIN 12/31/9999 2<strong>01</strong>231<strong>01</strong>58099926 GOODYS BODY POW PAIN 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000308 GOODYS PM POW 38-500MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000309 GOODYS PM POW 38-500MG 12/31/9999 2<strong>01</strong>2313913000413 GRALISE TAB 300MG 12/31/9999 2<strong>01</strong>2313913000519 GRALISE TAB 600MG 12/31/9999 2<strong>01</strong>2313913000616 GRALISE STAR MIS 300/600 12/31/9999 2<strong>01</strong>23007037891<strong>01</strong> GRANISETRON INJ 0.1MG/ML 12/31/9999 2<strong>01</strong>23250210778<strong>01</strong> GRANISETRON INJ 0.1MG/ML 12/31/9999 2<strong>01</strong>2360505076402 GRANISETRON INJ 0.1MG/ML 12/31/9999 2<strong>01</strong>23633230317<strong>01</strong> GRANISETRON INJ 0.1MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>43974410 GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>23007037971<strong>01</strong> GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>2300703797103 GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>23007037973<strong>01</strong> GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>23174780546<strong>01</strong> GRANISETRON INJ 1MG/ML 03/31/2<strong>01</strong>3 2<strong>01</strong>2317478054602 GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>23250210779<strong>01</strong> GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>23633230318<strong>01</strong> GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>2364679066103 GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>23667580035<strong>01</strong> GRANISETRON INJ 1MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>43974505 GRANISETRON INJ 4MG/4ML 12/31/9999 2<strong>01</strong>2317478054605 GRANISETRON INJ 4MG/4ML 12/31/9999 2<strong>01</strong>2325021078104 GRANISETRON INJ 4MG/4ML 12/31/9999 2<strong>01</strong>2363323031904 GRANISETRON INJ 4MG/4ML 12/31/9999 2<strong>01</strong>2364679066102 GRANISETRON INJ 4MG/4ML 12/31/9999 2<strong>01</strong>23667580036<strong>01</strong> GRANISETRON INJ 4MG/4ML 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>4308 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>4387 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2300093748512 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2300093748519 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2300093748520 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2300378100394 GRANISETRON TAB 1MG 11/30/2<strong>01</strong>2 2<strong>01</strong>23167140221<strong>01</strong> GRANISETRON TAB 1MG 12/31/2020 2<strong>01</strong>2316714022130 GRANISETRON TAB 1MG 12/31/2020 2<strong>01</strong>2316714022132 GRANISETRON TAB 1MG 12/31/2020 2<strong>01</strong>23510790472<strong>01</strong> GRANISETRON TAB 1MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2351079047205 GRANISETRON TAB 1MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2351672413806 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2351991073520 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2351991073532 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2367877<strong>01</strong>8402 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>2367877<strong>01</strong>8420 GRANISETRON TAB 1MG 12/31/9999 2<strong>01</strong>235254708<strong>01</strong>30 GRANISOL SOL 2MG/10ML 12/31/9999 2<strong>01</strong>2351079062181 GRANULEX AER 12/31/9999 2<strong>01</strong>2351079062182 GRANULEX AER 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6503 GRAPE LIQ FLAVOR 12/31/9999 2<strong>01</strong>2351552083106 GRAPE SYP 12/31/9999 2<strong>01</strong>2351552130304 GRAPE SEED OIL 12/31/9999 2<strong>01</strong>2351552130307 GRAPE SEED OIL 12/31/9999 2<strong>01</strong>2351552098604 GRAPE SEED POW 95% 12/31/9999 2<strong>01</strong>2351552098605 GRAPE SEED POW 95% 12/31/9999 2<strong>01</strong>2351552098607 GRAPE SEED POW 95% 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>5104 GREEN SOAP TIN 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>5106 GREEN SOAP TIN 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>5108 GREEN SOAP TIN 12/31/9999 2<strong>01</strong>2351552098404 GREEN TEA EX LIQ 90% 12/31/9999 2<strong>01</strong>23

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