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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00555088202 HYDROXYUREA CAP 500MG 12/31/9999 2<strong>01</strong>23498840724<strong>01</strong> HYDROXYUREA CAP 500MG 12/31/9999 2<strong>01</strong>23680840284<strong>01</strong> HYDROXYUREA CAP 500MG 12/31/9999 2<strong>01</strong>2338779135402 HYDROXYUREA POW 12/31/9999 2<strong>01</strong>2338779135407 HYDROXYUREA POW 12/31/9999 2<strong>01</strong>230051742<strong>01</strong>25 HYDROXYZ HCL INJ 25MG/ML 12/31/9999 2<strong>01</strong>230051756<strong>01</strong>25 HYDROXYZ HCL INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300517560225 HYDROXYZ HCL INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300517561025 HYDROXYZ HCL INJ 50MG/ML 12/31/9999 2<strong>01</strong>2350383079616 HYDROXYZ HCL SOL 10MG/5ML 12/31/9999 2<strong>01</strong>2300472077116 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2300472077128 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2300603131054 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2300603131058 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2310702005216 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2360432<strong>01</strong>5004 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2360432<strong>01</strong>5<strong>01</strong>6 HYDROXYZ HCL SYP 10MG/5ML 12/31/9999 2<strong>01</strong>23003782586<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300378258610 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300603396721 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300603396728 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300603396732 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300904035740 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300904035760 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2300904035780 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>0<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23107020<strong>01</strong><strong>01</strong>0 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>050 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2316714008104 HYDROXYZ HCL TAB 10MG 12/31/2020 2<strong>01</strong>2316714008105 HYDROXYZ HCL TAB 10MG 12/31/2020 2<strong>01</strong>2323155<strong>01</strong>05<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2323155<strong>01</strong>0505 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2323155<strong>01</strong>0510 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110307<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11030702 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11030703 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23510790796<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2351079079620 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2363739048310 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2367405057510 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2367405057550 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2367405057596 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23680840253<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23684620360<strong>01</strong> HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>2368462036005 HYDROXYZ HCL TAB 10MG 12/31/9999 2<strong>01</strong>23000935061<strong>01</strong> HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300093506105 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300093506110 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>23003782587<strong>01</strong> HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300378258710 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300603396821 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300603396828 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300603396832 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300904035840 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300904035860 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300904035880 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>1<strong>01</strong> HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>110 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>150 HYDROXYZ HCL TAB 25MG 12/31/9999 2<strong>01</strong>2316714008204 HYDROXYZ HCL TAB 25MG 12/31/2020 2<strong>01</strong>23

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