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

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0<strong>01</strong>82090500 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82090589 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>2300615051639 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>232315500<strong>01</strong><strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>232315500<strong>01</strong>10 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>23317220519<strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>23498840029<strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>2349884002910 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110398<strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11039803 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>23510790074<strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>2351079007420 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>23680840447<strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>23684620341<strong>01</strong> HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>2368462034105 HYDRALAZINE TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82055400 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82055489 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2300615053139 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>23231550002<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2323155000210 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>23317220520<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2331722052<strong>01</strong>0 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>23498840027<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2349884002710 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110327<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11032703 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>23510790075<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2351079007517 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2351079007519 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2351079007520 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>23625840733<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2363739<strong>01</strong>2610 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>23684620342<strong>01</strong> HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>2368462034205 HYDRALAZINE TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82055500 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82055589 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>23231550003<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2323155000310 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>23317220521<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2331722052110 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>23498840028<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2349884002810 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110328<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11032803 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>23510790076<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2351079007620 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>23625840734<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2363739<strong>01</strong>2710 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>23684620343<strong>01</strong> HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2368462034305 HYDRALAZINE TAB 50MG 12/31/9999 2<strong>01</strong>2300003083050 HYDREA CAP 500MG 12/31/9999 2<strong>01</strong>2300884221114 HYDRISALIC GEL 17% 12/31/9999 2<strong>01</strong>23008842296<strong>01</strong> HYDRISALIC GEL 6% <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300884<strong>01</strong>4204 HYDRISINOL CRE 12/31/9999 2<strong>01</strong>2300884304208 HYDRISINOL LOT 12/31/9999 2<strong>01</strong>2351552132206 HYDROCHL ACD LIQ 10% 12/31/9999 2<strong>01</strong>2351552132006 HYDROCHL ACD LIQ 37% 12/31/9999 2<strong>01</strong>23000932080<strong>01</strong> HYDROCHLOROT CAP 12.5MG 12/31/9999 2<strong>01</strong>2300093208<strong>01</strong>0 HYDROCHLOROT CAP 12.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>433125<strong>01</strong> HYDROCHLOROT CAP 12.5MG 12/31/9999 2<strong>01</strong>23

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