Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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62<strong>01</strong>1<strong>01</strong>48<strong>01</strong> HM ANTACID SUS ANTI-GAS 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>49<strong>01</strong> HM ANTACID SUS ANTI-GAS 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10021<strong>01</strong> HM ASPIRIN CHW 81MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10028<strong>01</strong> HM ASPIRIN CHW 81MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10020<strong>01</strong> HM ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10041<strong>01</strong> HM ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>14<strong>01</strong> HM CALAMINE LOT 8-8% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>41<strong>01</strong> HM CASTOR OIL 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10064<strong>01</strong> HM CGH RELF LIQ 15MG/5ML 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10075<strong>01</strong> HM CHEST RUB OIN 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>53<strong>01</strong> HM CLEARLAX POW 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>5302 HM CLEARLAX POW 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10063<strong>01</strong> HM COLD/CGH ELX CHILDREN 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10066<strong>01</strong> HM DAY TIME CAP 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10065<strong>01</strong> HM DAYTIME LIQ COLD/FLU 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>54<strong>01</strong> HM ENEMA ENE 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>09<strong>01</strong> HM EPSOM GRA SALT 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>02<strong>01</strong> HM EYE DROPS SOL 0.05% OP 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>00<strong>01</strong> HM EYE DROPS SOL RED RELF 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10053<strong>01</strong> HM FIBER CAP 0.52GM 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>33<strong>01</strong> HM FIBER POW 28.3% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>35<strong>01</strong> HM FIBER POW 30.9% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>36<strong>01</strong> HM FIBER POW 48.57% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>37<strong>01</strong> HM FIBER POW 58.6% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>34<strong>01</strong> HM FIBER TAB 500MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>38<strong>01</strong> HM GAS RELF CHW 80MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>15<strong>01</strong> HM GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10096<strong>01</strong> HM HYDROCORT CRE 1% PLUS 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10<strong>01</strong>3<strong>01</strong> HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10<strong>01</strong>4<strong>01</strong> HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10<strong>01</strong>402 HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10<strong>01</strong>403 HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10<strong>01</strong>5<strong>01</strong> HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10<strong>01</strong>502 HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10039<strong>01</strong> HM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>17<strong>01</strong> HM IODINE TIN 2% MILD 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>59<strong>01</strong> HM LAXATIVE TAB 5MG EC 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>56<strong>01</strong> HM MINERAL ENE OIL 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>25<strong>01</strong> HM MINERAL OIL 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10080<strong>01</strong> HM NASAL SPR 0.05% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10081<strong>01</strong> HM NASAL SPR 0.05% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10006<strong>01</strong> HM NIGHTTIME CAP 50MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10085<strong>01</strong> HM NOSE DRO 1% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>18<strong>01</strong> HM POVID-IOD SOL 10% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10086<strong>01</strong> HM SALINE SPR 0.65% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>62<strong>01</strong> HM SENNA TAB 8.6MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10098<strong>01</strong> HM TRIPLE OIN ANTIBIOT 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10091<strong>01</strong> HM TUSSIN LIQ ADLT DM 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1009102 HM TUSSIN LIQ ADLT DM 12/31/9999 2<strong>01</strong>230<strong>01</strong>730806<strong>01</strong> HORIZANT TAB 600MG 12/31/9999 2<strong>01</strong>23000027510<strong>01</strong> HUMALOG INJ 100/ML 12/31/9999 2<strong>01</strong>2300002751<strong>01</strong>7 HUMALOG INJ 100/ML 12/31/9999 2<strong>01</strong>23000027516<strong>01</strong> HUMALOG INJ 100/ML 12/31/9999 2<strong>01</strong>2300002751659 HUMALOG INJ 100/ML 12/31/9999 2<strong>01</strong>23000028799<strong>01</strong> HUMALOG KWIK INJ 100/ML 12/31/9999 2<strong>01</strong>2300002879959 HUMALOG KWIK INJ 100/ML 12/31/9999 2<strong>01</strong>23000027512<strong>01</strong> HUMALOG MIX INJ 50/50 12/31/9999 2<strong>01</strong>23000028798<strong>01</strong> HUMALOG MIX INJ 50/50KWP 12/31/9999 2<strong>01</strong>2300002879859 HUMALOG MIX INJ 50/50KWP 12/31/9999 2<strong>01</strong>23000028797<strong>01</strong> HUMALOG MIX INJ 75/25KWP 12/31/9999 2<strong>01</strong>23
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