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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00<strong>01</strong>3257691 IDAMYCIN PFS INJ 5MG/5ML 12/31/9999 2<strong>01</strong>2300703415511 IDARUBICIN INJ 10/10ML 12/31/9999 2<strong>01</strong>2300703415591 IDARUBICIN INJ 10/10ML <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2363323<strong>01</strong>9410 IDARUBICIN INJ 10/10ML 12/31/9999 2<strong>01</strong>2300703415611 IDARUBICIN INJ 20/20ML 12/31/9999 2<strong>01</strong>2300703415691 IDARUBICIN INJ 20/20ML <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2363323<strong>01</strong>9420 IDARUBICIN INJ 20/20ML 12/31/9999 2<strong>01</strong>2300703415411 IDARUBICIN INJ 5MG/5ML 12/31/9999 2<strong>01</strong>2300703415491 IDARUBICIN INJ 5MG/5ML 12/31/2<strong>01</strong>2 2<strong>01</strong>2363323<strong>01</strong>9405 IDARUBICIN INJ 5MG/5ML 12/31/9999 2<strong>01</strong>23515520890<strong>01</strong> IDOXURIDINE POW 12/31/9999 2<strong>01</strong>23630440203<strong>01</strong> IFEREX 150 CAP 12/31/9999 2<strong>01</strong>2363044020361 IFEREX 150 CAP 12/31/9999 2<strong>01</strong>2363044<strong>01</strong>98<strong>01</strong> IFEREX 150 CAP FORTE 12/31/9999 2<strong>01</strong>2363044<strong>01</strong>9862 IFEREX 150 CAP FORTE 12/31/9999 2<strong>01</strong>23003383991<strong>01</strong> IFEX INJ 1GM 12/31/9999 2<strong>01</strong>23003383993<strong>01</strong> IFEX INJ 3GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90925<strong>01</strong> IFOSFAMIDE INJ 1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9092582 IFOSFAMIDE INJ 1GM 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>4210 IFOSFAMIDE INJ 1GM 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>4212 IFOSFAMIDE INJ 1GM 12/31/9999 2<strong>01</strong>2300703342711 IFOSFAMIDE INJ 1GM/20ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>7420 IFOSFAMIDE INJ 1GM/20ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9092602 IFOSFAMIDE INJ 3GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9092616 IFOSFAMIDE INJ 3GM 12/31/9999 2<strong>01</strong>2300703342911 IFOSFAMIDE INJ 3GM/60ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>7460 IFOSFAMIDE INJ 3GM/60ML 12/31/9999 2<strong>01</strong>2300703410048 IFOSFAMIDE KIT MESNA 12/31/9999 2<strong>01</strong>2300703410058 IFOSFAMIDE KIT MESNA 12/31/9999 2<strong>01</strong>2300703410068 IFOSFAMIDE KIT MESNA 12/31/9999 2<strong>01</strong>2300078058261 ILARIS INJ 180MG 12/31/9999 2<strong>01</strong>23481020<strong>01</strong>611 ILOTYCIN OIN OP 12/31/9999 2<strong>01</strong>23000850091<strong>01</strong> IMDUR TAB 120MG ER 12/31/9999 2<strong>01</strong>23000851374<strong>01</strong> IMDUR TAB 30MG ER 12/31/9999 2<strong>01</strong>23000852028<strong>01</strong> IMDUR TAB 60MG ER 12/31/9999 2<strong>01</strong>23004093508<strong>01</strong> IMIPENEM/CIL INJ 250MG 12/31/9999 2<strong>01</strong>2300409350810 IMIPENEM/CIL INJ 250MG 12/31/9999 2<strong>01</strong>2363323034920 IMIPENEM/CIL INJ 250MG 12/31/9999 2<strong>01</strong>23004093507<strong>01</strong> IMIPENEM/CIL INJ 500MG 12/31/9999 2<strong>01</strong>2300409350710 IMIPENEM/CIL INJ 500MG 12/31/9999 2<strong>01</strong>2363323032220 IMIPENEM/CIL INJ 500MG 12/31/9999 2<strong>01</strong>23007811762<strong>01</strong> IMIPRAM HCL TAB 10MG 12/31/9999 2<strong>01</strong>23498840054<strong>01</strong> IMIPRAM HCL TAB 10MG 12/31/9999 2<strong>01</strong>2349884005405 IMIPRAM HCL TAB 10MG 12/31/9999 2<strong>01</strong>2349884005410 IMIPRAM HCL TAB 10MG 12/31/9999 2<strong>01</strong>23534890330<strong>01</strong> IMIPRAM HCL TAB 10MG 12/31/9999 2<strong>01</strong>23681800311<strong>01</strong> IMIPRAM HCL TAB 10MG 12/31/9999 2<strong>01</strong>23007811764<strong>01</strong> IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300781176410 IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>2300781176413 IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>23498840055<strong>01</strong> IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>2349884005505 IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>2349884005510 IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>23534890331<strong>01</strong> IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>23681800312<strong>01</strong> IMIPRAM HCL TAB 25MG 12/31/9999 2<strong>01</strong>23007811766<strong>01</strong> IMIPRAM HCL TAB 50MG 12/31/9999 2<strong>01</strong>2300781176610 IMIPRAM HCL TAB 50MG 12/31/9999 2<strong>01</strong>2300781176613 IMIPRAM HCL TAB 50MG 12/31/9999 2<strong>01</strong>23498840056<strong>01</strong> IMIPRAM HCL TAB 50MG 12/31/9999 2<strong>01</strong>2349884005605 IMIPRAM HCL TAB 50MG 12/31/9999 2<strong>01</strong>23

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