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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00517037510 INDIGO CARMI INJ 8MG/ML 12/31/9999 2<strong>01</strong>23174780508<strong>01</strong> INDIGO CARMI INJ 8MG/ML 12/31/9999 2<strong>01</strong>2342211<strong>01</strong>0243 INDOCIN SUP 50MG 12/31/9999 2<strong>01</strong>2342211<strong>01</strong><strong>01</strong>11 INDOCIN SUS 25MG/5ML 12/31/9999 2<strong>01</strong>2367386051151 INDOCIN IV INJ 1MG 12/31/9999 2<strong>01</strong>23000934029<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2300093402910 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2300093402919 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2300093402993 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>43<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>4310 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>23007812325<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2300781232510 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>23231550<strong>01</strong>0<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>23231550<strong>01</strong><strong>01</strong>0 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>23317220542<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2331722054210 INDOMETHACIN CAP 25MG 07/31/2<strong>01</strong>3 2<strong>01</strong>2351079<strong>01</strong>90<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>9020 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>9056 INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>23684620406<strong>01</strong> INDOMETHACIN CAP 25MG 12/31/9999 2<strong>01</strong>23000934030<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2300093403005 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2300093403<strong>01</strong>9 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2300093403093 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>47<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>4705 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>23007812350<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2300781235005 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>23231550<strong>01</strong>1<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>23231550<strong>01</strong>105 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>23317220543<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2331722054305 INDOMETHACIN CAP 50MG 08/31/2<strong>01</strong>3 2<strong>01</strong>2351079<strong>01</strong>91<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>9120 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>9156 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>23684620302<strong>01</strong> INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>2368462030205 INDOMETHACIN CAP 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850720<strong>01</strong> INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>85072005 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>85072060 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>93<strong>01</strong> INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>9360 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>6<strong>01</strong> INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>603 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>606 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>610 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>23107020<strong>01</strong>650 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2365162050603 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2365162050606 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2365162050609 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2365162050650 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>2368084041121 INDOMETHACIN CAP 75MG ER 12/31/9999 2<strong>01</strong>23553900299<strong>01</strong> INDOMETHACIN INJ 1MG 12/31/9999 2<strong>01</strong>2363323065903 INDOMETHACIN INJ 1MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>7630 INDOMETHACIN SUP 50MG 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>4515 INF SILAPAP DRO 80/0.8ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>4530 INF SILAPAP DRO 80/0.8ML 12/31/9999 2<strong>01</strong>2368094069258 INFANT APAP DRO 80/0.8ML 12/31/9999 2<strong>01</strong>2368094070358 INFANT APAP SUS 200/2ML 12/31/9999 2<strong>01</strong>23

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