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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2448606<strong>01</strong>10 HYOMAX-SL SUB 0.125MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2360258080215 HYOSCYAMINE DRO 0.125/ML 12/31/9999 2<strong>01</strong>236025808<strong>01</strong>16 HYOSCYAMINE ELX 0.125/5 12/31/9999 2<strong>01</strong>23005740250<strong>01</strong> HYOSCYAMINE SUB 0.125MG 12/31/9999 2<strong>01</strong>2300904512060 HYOSCYAMINE SUB 0.125MG 12/31/2<strong>01</strong>2 2<strong>01</strong>23102672734<strong>01</strong> HYOSCYAMINE SUB 0.125MG 12/31/9999 2<strong>01</strong>2313811<strong>01</strong>0210 HYOSCYAMINE SUB 0.125MG 11/30/2<strong>01</strong>2 2<strong>01</strong>23431990<strong>01</strong>1<strong>01</strong> HYOSCYAMINE SUB 0.125MG 12/31/9999 2<strong>01</strong>23519910656<strong>01</strong> HYOSCYAMINE SUB 0.125MG 12/31/9999 2<strong>01</strong>2376439030910 HYOSCYAMINE SUB 0.125MG 12/31/9999 2<strong>01</strong>23005740246<strong>01</strong> HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>23005740247<strong>01</strong> HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>23102671621<strong>01</strong> HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>2313811<strong>01</strong><strong>01</strong>10 HYOSCYAMINE TAB 0.125MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2313811<strong>01</strong>0310 HYOSCYAMINE TAB 0.125MG 11/30/2<strong>01</strong>2 2<strong>01</strong>23431990<strong>01</strong>2<strong>01</strong> HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>23431990<strong>01</strong>3<strong>01</strong> HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>23519910325<strong>01</strong> HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>2376439030710 HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>2376439030810 HYOSCYAMINE TAB 0.125MG 12/31/9999 2<strong>01</strong>2354838050615 HYOSYNE DRO 0.125/ML 12/31/9999 2<strong>01</strong>2354838051180 HYOSYNE ELX 0.125/5 12/31/9999 2<strong>01</strong>2358980<strong>01</strong>5<strong>01</strong>0 HYPERCARE SOL 20% 12/31/9999 2<strong>01</strong>2358980<strong>01</strong>5<strong>01</strong>1 HYPERCARE SOL 20% 12/31/9999 2<strong>01</strong>2358980<strong>01</strong>5020 HYPERCARE SOL 20% 12/31/9999 2<strong>01</strong>2358980<strong>01</strong>5022 HYPERCARE SOL 20% 12/31/9999 2<strong>01</strong>2313533063602 HYPERHEP B INJ S/D 12/31/9999 2<strong>01</strong>2313533063603 HYPERHEP B INJ S/D 12/31/9999 2<strong>01</strong>2313533063605 HYPERHEP B INJ S/D 12/31/9999 2<strong>01</strong>2300264194320 HYPERLYTE-CR INJ 12/31/9999 2<strong>01</strong>2313533061802 HYPERRAB S/D INJ 150/ML 12/31/9999 2<strong>01</strong>2313533061810 HYPERRAB S/D INJ 150/ML 12/31/9999 2<strong>01</strong>2313533063102 HYPERRHO S/D INJ 300MCG 12/31/9999 2<strong>01</strong>2313533063106 HYPERRHO S/D INJ 50MCG 12/31/9999 2<strong>01</strong>2368405802736 HYPERTENEVID PAK 12.5MG 12/31/9999 2<strong>01</strong>2368405803736 HYPERTENIPIN PAK 2.5MG 12/31/9999 2<strong>01</strong>2368405100702 HYPERTENSA CAP 12/31/9999 2<strong>01</strong>2368405100703 HYPERTENSA CAP 12/31/9999 2<strong>01</strong>23684058<strong>01</strong>736 HYPERTENSOLO PAK 12/31/9999 2<strong>01</strong>2313533063402 HYPERTET S/D INJ 250/ML 12/31/9999 2<strong>01</strong>2300078051924 HYPOTEARS SOL 1-1% 12/31/9999 2<strong>01</strong>2300078051982 HYPOTEARS SOL 1-1% 12/31/9999 2<strong>01</strong>2351552104106 HYPROMELLOSE POW 100CPS 12/31/9999 2<strong>01</strong>2300006074531 HYZAAR TAB 100-12.5 12/31/9999 2<strong>01</strong>2300006074554 HYZAAR TAB 100-12.5 12/31/9999 2<strong>01</strong>2300006074582 HYZAAR TAB 100-12.5 12/31/9999 2<strong>01</strong>2300006074731 HYZAAR TAB 100-25 12/31/9999 2<strong>01</strong>2300006074754 HYZAAR TAB 100-25 12/31/9999 2<strong>01</strong>2300006074781 HYZAAR TAB 100-25 12/31/9999 2<strong>01</strong>2300006074782 HYZAAR TAB 100-25 12/31/9999 2<strong>01</strong>2300006071731 HYZAAR TAB 50-12.5 12/31/9999 2<strong>01</strong>2300006071754 HYZAAR TAB 50-12.5 12/31/9999 2<strong>01</strong>2300006071782 HYZAAR TAB 50-12.5 12/31/9999 2<strong>01</strong>2300378521553 IBANDRONATE TAB 150MG 12/31/9999 2<strong>01</strong>2300591377031 IBANDRONATE TAB 150MG 12/31/9999 2<strong>01</strong>2355111057503 IBANDRONATE TAB 150MG 12/31/9999 2<strong>01</strong>2360505279500 IBANDRONATE TAB 150MG 12/31/9999 2<strong>01</strong>2363868033632 IBU/DIPHENHY CAP 200-25MG 12/31/9999 2<strong>01</strong>23509910579<strong>01</strong> IBUDONE TAB 10-200MG 12/31/9999 2<strong>01</strong>23509910578<strong>01</strong> IBUDONE TAB 5-200MG 12/31/9999 2<strong>01</strong>23

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