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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510790778<strong>01</strong> HYDROCO/APAP TAB 7.5-325 12/31/9999 2<strong>01</strong>2351079077821 HYDROCO/APAP TAB 7.5-325 12/31/9999 2<strong>01</strong>2357664<strong>01</strong>7<strong>01</strong>3 HYDROCO/APAP TAB 7.5-325 12/31/9999 2<strong>01</strong>2357664<strong>01</strong>7088 HYDROCO/APAP TAB 7.5-325 12/31/9999 2<strong>01</strong>23004060358<strong>01</strong> HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300406035805 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300406035862 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>23005910385<strong>01</strong> HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300591038505 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300603388202 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300603388204 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300603388212 HYDROCO/APAP TAB 7.5-500 04/30/2<strong>01</strong>3 2<strong>01</strong>2300603388216 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300603388220 HYDROCO/APAP TAB 7.5-500 <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300603388221 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300603388222 HYDROCO/APAP TAB 7.5-500 04/30/2<strong>01</strong>3 2<strong>01</strong>2300603388228 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2300603388232 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>12<strong>01</strong> HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>1205 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>1210 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2363739<strong>01</strong>4110 HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>2368084<strong>01</strong>45<strong>01</strong> HYDROCO/APAP TAB 7.5-500 12/31/9999 2<strong>01</strong>23004060359<strong>01</strong> HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>2300406035905 HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>23005910502<strong>01</strong> HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>2300591050205 HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>2300603388421 HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>2300603388428 HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>13<strong>01</strong> HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>1305 HYDROCO/APAP TAB 7.5-650 12/31/9999 2<strong>01</strong>23004060360<strong>01</strong> HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300406036005 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>23005910387<strong>01</strong> HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300591038705 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300603388302 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300603388320 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300603388321 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300603388322 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300603388328 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300603388332 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2300904763261 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>18<strong>01</strong> HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>1805 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>1810 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2363739<strong>01</strong>3110 HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>2368084<strong>01</strong>44<strong>01</strong> HYDROCO/APAP TAB 7.5-750 12/31/9999 2<strong>01</strong>230<strong>01</strong>21481105 HYDROCOD/HOM SYP 5-1.5/5 12/31/9999 2<strong>01</strong>2350383004316 HYDROCOD/HOM SYP 5-1.5/5 12/31/9999 2<strong>01</strong>2360432045516 HYDROCOD/HOM SYP 5-1.5/5 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>17<strong>01</strong> HYDROCOD/IBU TAB 10-200MG 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>16<strong>01</strong> HYDROCOD/IBU TAB 2.5-200 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>46<strong>01</strong> HYDROCOD/IBU TAB 5-200MG 12/31/9999 2<strong>01</strong>23000935161<strong>01</strong> HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>2300603389721 HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>2300603389728 HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>2353746<strong>01</strong>45<strong>01</strong> HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>23620370524<strong>01</strong> HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>2362037052405 HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>2363739055710 HYDROCOD/IBU TAB 7.5-200 12/31/9999 2<strong>01</strong>23

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