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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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00597<strong>01</strong>4760 JENTADUETO TAB 2.5-850 12/31/9999 2<strong>01</strong>2351552086506 JESSNERS SOL 12/31/9999 2<strong>01</strong>2351552118306 JESSNERS SOL 12/31/9999 2<strong>01</strong>2352544023719 JEVANTIQUE TAB 1MG-5MCG 05/31/2<strong>01</strong>3 2<strong>01</strong>2352544023772 JEVANTIQUE TAB 1MG-5MCG 05/31/2<strong>01</strong>3 2<strong>01</strong>2300024582411 JEVTANA INJ 60/1.5ML 12/31/9999 2<strong>01</strong>2300093312242 JINTELI TAB 1MG-5MCG 12/31/9999 2<strong>01</strong>2300093312298 JINTELI TAB 1MG-5MCG 12/31/9999 2<strong>01</strong>23646610<strong>01</strong>116 J-MAX SYP 5-200MG 12/31/9999 2<strong>01</strong>2364661007<strong>01</strong>6 J-MAX DHC LIQ 12/31/9999 2<strong>01</strong>230<strong>01</strong>13069590 JOCK ITCH AER 1% 12/31/9999 2<strong>01</strong>2300555912366 JOLESSA TAB 12/31/9999 2<strong>01</strong>2352544089228 JOLIVETTE TAB 0.35MG 12/31/9999 2<strong>01</strong>2364661003230 J-TAN D PD DRO 1-7.5MG 12/31/9999 2<strong>01</strong>2364661003130 J-TAN PD DRO 1MG/ML 12/31/9999 2<strong>01</strong>2300555902742 JUNEL 1.5/30 TAB 12/31/9999 2<strong>01</strong>2300555902542 JUNEL 1/20 TAB 12/31/9999 2<strong>01</strong>2300555902858 JUNEL FE TAB 1.5/30 12/31/9999 2<strong>01</strong>2300555902658 JUNEL FE TAB 1/20 12/31/9999 2<strong>01</strong>2300904575424 JUNIOR MAPAP TAB 160MG RT 12/31/9999 2<strong>01</strong>2351552036305 JUNIPER TAR OIL 12/31/9999 2<strong>01</strong>2351552036306 JUNIPER TAR OIL 12/31/9999 2<strong>01</strong>2300006075331 JUVISYNC TAB 100-10MG 12/31/9999 2<strong>01</strong>2300006075354 JUVISYNC TAB 100-10MG 12/31/9999 2<strong>01</strong>2300006075382 JUVISYNC TAB 100-10MG 12/31/9999 2<strong>01</strong>2300006075731 JUVISYNC TAB 100-20MG 12/31/9999 2<strong>01</strong>2300006075754 JUVISYNC TAB 100-20MG 12/31/9999 2<strong>01</strong>2300006075782 JUVISYNC TAB 100-20MG 12/31/9999 2<strong>01</strong>2300006077331 JUVISYNC TAB 100-40MG 12/31/9999 2<strong>01</strong>2300006077354 JUVISYNC TAB 100-40MG 12/31/9999 2<strong>01</strong>2300006077382 JUVISYNC TAB 100-40MG 12/31/9999 2<strong>01</strong>2346987032411 KADIAN CAP 100MG CR 12/31/9999 2<strong>01</strong>2346987041<strong>01</strong>1 KADIAN CAP 10MG CR 12/31/9999 2<strong>01</strong>2346987032911 KADIAN CAP 130MG CR 12/31/9999 2<strong>01</strong>2346987033<strong>01</strong>1 KADIAN CAP 150MG CR 12/31/9999 2<strong>01</strong>2346987037711 KADIAN CAP 200MG CR 12/31/9999 2<strong>01</strong>2346987032211 KADIAN CAP 20MG CR 12/31/9999 2<strong>01</strong>2346987032511 KADIAN CAP 30MG CR 12/31/9999 2<strong>01</strong>2346987032711 KADIAN CAP 40MG CR 12/31/9999 2<strong>01</strong>2346987032311 KADIAN CAP 50MG CR 12/31/9999 2<strong>01</strong>2346987032611 KADIAN CAP 60MG CR 12/31/9999 2<strong>01</strong>2346987032811 KADIAN CAP 70MG CR 12/31/9999 2<strong>01</strong>2346987041211 KADIAN CAP 80MG CR 12/31/9999 2<strong>01</strong>2347783<strong>01</strong><strong>01</strong><strong>01</strong> KALBITOR INJ 10MG/ML 12/31/9999 2<strong>01</strong>2300074395646 KALETRA SOL 12/31/9999 2<strong>01</strong>2300074052260 KALETRA TAB 100-25MG 12/31/9999 2<strong>01</strong>2300074679922 KALETRA TAB 200-50MG 12/31/9999 2<strong>01</strong>2310702003645 KALEXATE POW 12/31/9999 2<strong>01</strong>2351167020002 KALYDECO TAB 150MG 12/31/9999 2<strong>01</strong>2363323035903 KANAMYCIN INJ 333MG/ML 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>9506 KAOLIN POW COLLOID 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>9509 KAOLIN POW COLLOID 12/31/9999 2<strong>01</strong>2300904577940 KAO-TIN CAP 240MG 12/31/9999 2<strong>01</strong>2300904577960 KAO-TIN CAP 240MG 12/31/9999 2<strong>01</strong>2300904570909 KAO-TIN SUS 262/15ML 12/31/9999 2<strong>01</strong>2300904570916 KAO-TIN SUS 262/15ML 12/31/9999 2<strong>01</strong>2359630067060 KAPVAY MIS 0.1&0.2 12/31/9999 2<strong>01</strong>2359630065860 KAPVAY TAB 0.1 MG 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>5206 KARAYA GUM 12/31/9999 2<strong>01</strong>2300555905058 KARIVA TAB 28 DAY 12/31/9999 2<strong>01</strong>23

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