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

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0<strong>01</strong>68027860 AMCINONIDE CRE 0.1% 12/31/9999 2<strong>01</strong>23516724054<strong>01</strong> AMCINONIDE CRE 0.1% 12/31/9999 2<strong>01</strong>2351672405402 AMCINONIDE CRE 0.1% 12/31/9999 2<strong>01</strong>2351672405403 AMCINONIDE CRE 0.1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68028060 AMCINONIDE LOT 0.1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68027960 AMCINONIDE OIN 0.1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>73056100 AMERGE TAB 1MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73056200 AMERGE TAB 2.5MG 12/31/9999 2<strong>01</strong>2363921<strong>01</strong>3004 AMERICERIN CRE 12/31/9999 2<strong>01</strong>2363921<strong>01</strong>3<strong>01</strong>6 AMERICERIN CRE 12/31/9999 2<strong>01</strong>2363921<strong>01</strong>4004 AMERIPHOR OIN 12/31/9999 2<strong>01</strong>2363921<strong>01</strong>4<strong>01</strong>6 AMERIPHOR OIN 12/31/9999 2<strong>01</strong>2300409321805 A-METHAPRED INJ 125MG 12/31/9999 2<strong>01</strong>2300409568523 A-METHAPRED INJ 125MG 12/31/9999 2<strong>01</strong>2300409321705 A-METHAPRED INJ 40MG 12/31/9999 2<strong>01</strong>2300409568423 A-METHAPRED INJ 40MG 12/31/9999 2<strong>01</strong>2352544026829 AMETHIA TAB 12/31/9999 2<strong>01</strong>2352544022829 AMETHIA LO TAB 12/31/9999 2<strong>01</strong>2352544029528 AMETHYST TAB 90-20MCG 12/31/9999 2<strong>01</strong>2300469002103 AMEVIVE INJ 15MG 12/31/9999 2<strong>01</strong>2300469002104 AMEVIVE INJ 15MG 12/31/9999 2<strong>01</strong>2366479002356 AMICAR SYP 25% <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2366479002282 AMICAR TAB 1000MG 06/30/2<strong>01</strong>4 2<strong>01</strong>2366479002182 AMICAR TAB 500MG 08/31/2<strong>01</strong>4 2<strong>01</strong>23004096695<strong>01</strong> AMIDATE INJ 2MG/ML 12/31/9999 2<strong>01</strong>2300409669502 AMIDATE INJ 2MG/ML 12/31/9999 2<strong>01</strong>2300409806029 AMIDATE INJ 2MG/ML 12/31/9999 2<strong>01</strong>23004098061<strong>01</strong> AMIDATE INJ 2MG/ML 12/31/9999 2<strong>01</strong>23004098062<strong>01</strong> AMIDATE INJ 2MG/ML 12/31/9999 2<strong>01</strong>2347335058140 AMIFOSTINE INJ 500MG 12/31/9999 2<strong>01</strong>2347335058142 AMIFOSTINE INJ 500MG 12/31/9999 2<strong>01</strong>2355390030803 AMIFOSTINE INJ 500MG 12/31/9999 2<strong>01</strong>2362756058140 AMIFOSTINE INJ 500MG 12/31/9999 2<strong>01</strong>2362756058142 AMIFOSTINE INJ 500MG 12/31/9999 2<strong>01</strong>23007039040<strong>01</strong> AMIKACIN INJ 1GM/4ML 12/31/9999 2<strong>01</strong>2300703904003 AMIKACIN INJ 1GM/4ML 12/31/9999 2<strong>01</strong>2355390022604 AMIKACIN INJ 1GM/4ML 12/31/9999 2<strong>01</strong>23007039032<strong>01</strong> AMIKACIN INJ 500/2ML 12/31/9999 2<strong>01</strong>2300703903203 AMIKACIN INJ 500/2ML 12/31/9999 2<strong>01</strong>2355390022602 AMIKACIN INJ 500/2ML 12/31/9999 2<strong>01</strong>23003780577<strong>01</strong> AMILOR/HCTZ TAB 5-50 12/31/9999 2<strong>01</strong>2300378057705 AMILOR/HCTZ TAB 5-50 12/31/9999 2<strong>01</strong>2300555048302 AMILOR/HCTZ TAB 5-50 12/31/9999 2<strong>01</strong>2300555048305 AMILOR/HCTZ TAB 5-50 12/31/9999 2<strong>01</strong>23005740292<strong>01</strong> AMILORIDE TAB 5MG 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>17<strong>01</strong> AMILORIDE TAB 5MG 12/31/9999 2<strong>01</strong>2349884<strong>01</strong>1710 AMILORIDE TAB 5MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>51<strong>01</strong> AMILORIDE TAB 5MG 12/31/9999 2<strong>01</strong>2300264320055 AMINO ACIDS INJ 15% 12/31/9999 2<strong>01</strong>2300264230250 AMINOAC ACID SOL 1.5% IRR 12/31/9999 2<strong>01</strong>2300264230270 AMINOAC ACID SOL 1.5% IRR 12/31/9999 2<strong>01</strong>2300409434673 AMINOCAPR AC INJ 250MG/ML 12/31/9999 2<strong>01</strong>2300517912025 AMINOCAPR AC INJ 250MG/ML 12/31/9999 2<strong>01</strong>2361748004408 AMINOCAPR AC SYP 25% 12/31/9999 2<strong>01</strong>2361748004416 AMINOCAPR AC SYP 25% 12/31/9999 2<strong>01</strong>23617480046<strong>01</strong> AMINOCAPR AC TAB 1000MG 12/31/9999 2<strong>01</strong>23617480045<strong>01</strong> AMINOCAPR AC TAB 500MG 12/31/9999 2<strong>01</strong>2361748004511 AMINOCAPR AC TAB 500MG 12/31/9999 2<strong>01</strong>2338779098904 AMINOCAPROIC POW ACID 12/31/9999 2<strong>01</strong>2338779098905 AMINOCAPROIC POW ACID 12/31/9999 2<strong>01</strong>23

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