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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00998022515 ISO CARBACHO SOL 3% OP 11/30/2<strong>01</strong>2 2<strong>01</strong>2300998031105 ISO HOMATROP SOL 2% OP 09/30/2<strong>01</strong>3 2<strong>01</strong>2300998031505 ISO HOMATROP SOL 5% OP 07/31/2<strong>01</strong>3 2<strong>01</strong>2300998033105 ISO HYOSCINE SOL 0.25% OP <strong>01</strong>/31/2<strong>01</strong>5 2<strong>01</strong>2300264771900 ISOLYTE-H INJ /D5W 11/30/2<strong>01</strong>2 2<strong>01</strong>2300264772000 ISOLYTE-M INJ /D5W 12/31/9999 2<strong>01</strong>2300264773<strong>01</strong>0 ISOLYTE-P INJ /D5W 12/31/9999 2<strong>01</strong>2300264770300 ISOLYTE-S INJ 12/31/9999 2<strong>01</strong>2300264770700 ISOLYTE-S INJ PH 7.4 12/31/9999 2<strong>01</strong>2300264770710 ISOLYTE-S INJ PH 7.4 12/31/9999 2<strong>01</strong>23441830440<strong>01</strong> ISOMETH/APAP CAP DICHLOR 12/31/9999 2<strong>01</strong>2362584<strong>01</strong>39<strong>01</strong> ISOMETH/APAP CAP DICHLOR 12/31/9999 2<strong>01</strong>2350967062050 ISOMETH/CAFF TAB /APAP 12/31/9999 2<strong>01</strong>23617480<strong>01</strong>760 ISONARIF CAP 12/31/9999 2<strong>01</strong>2300781305670 ISONIAZID INJ 100MG/ML 12/31/9999 2<strong>01</strong>2351552086004 ISONIAZID POW 12/31/9999 2<strong>01</strong>2351552086005 ISONIAZID POW 12/31/9999 2<strong>01</strong>23462870009<strong>01</strong> ISONIAZID SYP 50MG/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>431260<strong>01</strong> ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43126<strong>01</strong>0 ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>854351<strong>01</strong> ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85435110 ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85435130 ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>2300555006602 ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>2300555006605 ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>23617480<strong>01</strong>6<strong>01</strong> ISONIAZID TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431261<strong>01</strong> ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43126110 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43126130 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>854350<strong>01</strong> ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85435<strong>01</strong>0 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85435030 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>23005550071<strong>01</strong> ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>2300555007102 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>2300555007105 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>2300904620360 ISONIAZID TAB 300MG 07/31/2<strong>01</strong>3 2<strong>01</strong>23510790083<strong>01</strong> ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>2351079008320 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>23617480<strong>01</strong>3<strong>01</strong> ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>23617480<strong>01</strong>310 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>23617480<strong>01</strong>330 ISONIAZID TAB 300MG 12/31/9999 2<strong>01</strong>2351552046606 ISOP ALCOHOL SOL 50% 12/31/9999 2<strong>01</strong>2324385024916 ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2349348003038 ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2349348003040 ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2351552040406 ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2351552040408 ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2351552040409 ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>07<strong>01</strong> ISOP ALCOHOL SOL 70% 12/31/9999 2<strong>01</strong>2300904604516 ISOP ALCOHOL SOL 70% RUB 12/31/9999 2<strong>01</strong>2300574006710 ISOP ALCOHOL SOL 70% WG 12/31/9999 2<strong>01</strong>2300574006716 ISOP ALCOHOL SOL 70% WG 12/31/9999 2<strong>01</strong>2349348000438 ISOP ALCOHOL SOL 91% 12/31/9999 2<strong>01</strong>2351552042006 ISOP ALCOHOL SOL 91% 12/31/9999 2<strong>01</strong>2351552042008 ISOP ALCOHOL SOL 91% 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>08<strong>01</strong> ISOP ALCOHOL SOL 91% 12/31/9999 2<strong>01</strong>2300574006610 ISOP ALCOHOL SOL 99% <strong>01</strong>/31/2<strong>01</strong>6 2<strong>01</strong>2300574006616 ISOP ALCOHOL SOL 99% 12/31/9999 2<strong>01</strong>23387790810<strong>01</strong> ISOP ALCOHOL SOL 99% 12/31/9999 2<strong>01</strong>2338779081008 ISOP ALCOHOL SOL 99% 12/31/9999 2<strong>01</strong>23

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