Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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00002879759 HUMALOG MIX INJ 75/25KWP 12/31/9999 2<strong>01</strong>23000027511<strong>01</strong> HUMALOG MIX SUS 75/25 12/31/9999 2<strong>01</strong>23000028725<strong>01</strong> HUMALOG PEN INJ 100/ML 08/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2300002872559 HUMALOG PEN INJ 100/ML 08/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2363833061502 HUMATE-P INJ 600UNIT 12/31/9999 2<strong>01</strong>2363833061602 HUMATE-P SOL 1200UNIT 12/31/9999 2<strong>01</strong>2363833061702 HUMATE-P SOL 2400UNIT 12/31/9999 2<strong>01</strong>23000028148<strong>01</strong> HUMATROPE INJ 12MG 12/31/9999 2<strong>01</strong>23000028149<strong>01</strong> HUMATROPE INJ 24MG 12/31/9999 2<strong>01</strong>2300002733511 HUMATROPE INJ 5MG 12/31/9999 2<strong>01</strong>2300002733516 HUMATROPE INJ 5MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23000027349<strong>01</strong> HUMATROPE INJ 5MG 12/31/9999 2<strong>01</strong>23000028147<strong>01</strong> HUMATROPE INJ 6MG 12/31/9999 2<strong>01</strong>2300074937402 HUMIRA KIT 20MG/0.4 12/31/9999 2<strong>01</strong>2300074379902 HUMIRA KIT 40MG/0.8 12/31/9999 2<strong>01</strong>2300074433902 HUMIRA PEN KIT 40MG/0.8 12/31/9999 2<strong>01</strong>2300074433906 HUMIRA PEN KIT CROHNS 12/31/9999 2<strong>01</strong>2300074433907 HUMIRA PEN KIT PSORIASI 12/31/9999 2<strong>01</strong>23000028715<strong>01</strong> HUMULIN INJ 70/30 12/31/9999 2<strong>01</strong>2300002871517 HUMULIN INJ 70/30 12/31/9999 2<strong>01</strong>2300002871591 HUMULIN INJ 70/30 12/31/9999 2<strong>01</strong>23000028315<strong>01</strong> HUMULIN N INJ U-100 12/31/9999 2<strong>01</strong>2300002831517 HUMULIN N INJ U-100 12/31/9999 2<strong>01</strong>2300002831591 HUMULIN N INJ U-100 12/31/9999 2<strong>01</strong>23000028730<strong>01</strong> HUMULIN N PN INJ U-100 12/31/9999 2<strong>01</strong>2300002873059 HUMULIN N PN INJ U-100 12/31/9999 2<strong>01</strong>23000028770<strong>01</strong> HUMULIN PEN INJ 70/30 12/31/9999 2<strong>01</strong>2300002877059 HUMULIN PEN INJ 70/30 12/31/9999 2<strong>01</strong>23000028215<strong>01</strong> HUMULIN R INJ U-100 12/31/9999 2<strong>01</strong>2300002821517 HUMULIN R INJ U-100 12/31/9999 2<strong>01</strong>2300002821591 HUMULIN R INJ U-100 12/31/9999 2<strong>01</strong>230000285<strong>01</strong><strong>01</strong> HUMULIN R INJ U-500 12/31/9999 2<strong>01</strong>23515521089<strong>01</strong> HYALURONIC POW SODIUM 12/31/9999 2<strong>01</strong>2351552108909 HYALURONIC POW SODIUM 12/31/9999 2<strong>01</strong>2300007420511 HYCAMTIN CAP 0.25MG 12/31/9999 2<strong>01</strong>2300007420711 HYCAMTIN CAP 1MG 12/31/9999 2<strong>01</strong>230000742<strong>01</strong><strong>01</strong> HYCAMTIN INJ 4MG 12/31/9999 2<strong>01</strong>231355108<strong>01</strong>05 HYCET SOL 7.5-325 12/31/9999 2<strong>01</strong>2376<strong>01</strong>400<strong>01</strong>25 HYCET SOL 7.5-325 12/31/9999 2<strong>01</strong>2349884023533 HYD POLST-CH LIQ LOR POLS 12/31/9999 2<strong>01</strong>2349884023537 HYD POLST-CH LIQ LOR POLS 12/31/9999 2<strong>01</strong>2362175049064 HYD POLST-CH LIQ LOR POLS 12/31/9999 2<strong>01</strong>2362175049070 HYD POLST-CH LIQ LOR POLS 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>4505 HYDRAL/HCTZ CAP 100/50 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>4510 HYDRAL/HCTZ CAP 100/50 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>4310 HYDRAL/HCTZ CAP 25/25 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>4410 HYDRAL/HCTZ CAP 50/50 12/31/9999 2<strong>01</strong>230051709<strong>01</strong>25 HYDRALAZINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>23174780934<strong>01</strong> HYDRALAZINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>23633230614<strong>01</strong> HYDRALAZINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2363323061455 HYDRALAZINE INJ 20MG/ML 12/31/9999 2<strong>01</strong>2351552080202 HYDRALAZINE POW HCL 12/31/9999 2<strong>01</strong>23231550004<strong>01</strong> HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>23317220522<strong>01</strong> HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>21<strong>01</strong> HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>2110 HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110397<strong>01</strong> HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>2368084052021 HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>23684620344<strong>01</strong> HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>2368462034405 HYDRALAZINE TAB 100MG 12/31/9999 2<strong>01</strong>23

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