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

68084022701 HYDROCOD/IBU TAB 7.5-200 12/31/9999 2012343386035001 HYDROCODONE/ TAB HOMATROP 12/31/9999 2012343386035003 HYDROCODONE/ TAB HOMATROP 12/31/9999 2012300168001431 HYDROCORT CRE 0.5% 12/31/9999 2012324385019003 HYDROCORT CRE 0.5% 12/31/9999 2012300168001516 HYDROCORT CRE 1% 12/31/9999 2012300168001531 HYDROCORT CRE 1% 12/31/9999 2012300168015408 HYDROCORT CRE 1% 12/31/9999 2012300168015431 HYDROCORT CRE 1% 12/31/9999 2012300472032126 HYDROCORT CRE 1% 12/31/9999 2012300472034356 HYDROCORT CRE 1% 12/31/9999 2012300603053550 HYDROCORT CRE 1% 12/31/9999 2012300904762331 HYDROCORT CRE 1% 12/31/9999 2012337205016210 HYDROCORT CRE 1% 12/31/9999 2012345802043802 HYDROCORT CRE 1% 08/03/2014 2012345802043803 HYDROCORT CRE 1% 12/31/9999 2012345802043805 HYDROCORT CRE 1% 12/31/9999 2012345802043870 HYDROCORT CRE 1% 12/31/9999 2012351672201301 HYDROCORT CRE 1% 12/31/9999 2012351672201302 HYDROCORT CRE 1% 12/31/9999 2012351672201309 HYDROCORT CRE 1% 12/31/9999 2012351672206302 HYDROCORT CRE 1% 12/31/9999 2012351672206902 HYDROCORT CRE 1% 12/31/9999 2012351672300402 HYDROCORT CRE 1% 12/31/9999 2012362107001003 HYDROCORT CRE 1% 12/31/9999 2012300168008016 HYDROCORT CRE 2.5% 12/31/9999 2012300168008031 HYDROCORT CRE 2.5% 12/31/9999 2012300472033716 HYDROCORT CRE 2.5% 12/31/9999 2012300472033720 HYDROCORT CRE 2.5% 12/31/9999 2012300472033730 HYDROCORT CRE 2.5% 12/31/9999 2012300603778178 HYDROCORT CRE 2.5% 12/31/9999 2012345802000402 HYDROCORT CRE 2.5% 12/31/9999 2012345802000403 HYDROCORT CRE 2.5% 12/31/9999 2012351672300302 HYDROCORT CRE 2.5% 12/31/9999 2012342769138001 HYDROCORT ENE 100MG 06/30/2014 2012342769138007 HYDROCORT ENE 100MG 06/30/2014 2012351991072867 HYDROCORT ENE 100MG 12/31/9999 2012362559013807 HYDROCORT ENE 100MG 12/31/9999 2012300536510597 HYDROCORT LOT 1% 12/31/9999 2012300603778454 HYDROCORT LOT 1% 01/31/2014 2012345802028306 HYDROCORT LOT 1% 12/31/9999 2012300168028802 HYDROCORT LOT 2.5% 12/31/9999 2012300603778552 HYDROCORT LOT 2.5% 12/31/9999 2012345802093716 HYDROCORT LOT 2.5% 12/31/9999 2012345802093726 HYDROCORT LOT 2.5% 12/31/9999 2012300168001631 HYDROCORT OIN 0.5% 12/31/9999 2012351672201501 HYDROCORT OIN 0.5% 12/31/9999 2012351672201502 HYDROCORT OIN 0.5% 12/31/9999 2012300168002016 HYDROCORT OIN 1% 12/31/9999 2012300168002031 HYDROCORT OIN 1% 12/31/9999 2012300168018131 HYDROCORT OIN 1% 12/31/9999 2012300472034556 HYDROCORT OIN 1% 12/31/9999 2012300472132626 HYDROCORT OIN 1% 12/31/9999 2012324385027603 HYDROCORT OIN 1% 12/31/9999 2012351672201801 HYDROCORT OIN 1% 12/31/9999 2012351672201802 HYDROCORT OIN 1% 12/31/9999 2012300168014616 HYDROCORT OIN 2.5% 12/31/9999 2012300168014630 HYDROCORT OIN 2.5% 12/31/9999 2012345802001402 HYDROCORT OIN 2.5% 12/31/9999 2012345802001405 HYDROCORT OIN 2.5% 12/31/9999 20123