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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62756051344 LEVETIRACETM INJ 500/5ML 12/31/9999 2<strong>01</strong>230008519<strong>01</strong><strong>01</strong> LEVITRA TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73083<strong>01</strong>3 LEVITRA TAB 10MG 12/31/9999 2<strong>01</strong>23000851923<strong>01</strong> LEVITRA TAB 2.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73082813 LEVITRA TAB 2.5MG 12/31/9999 2<strong>01</strong>23000851934<strong>01</strong> LEVITRA TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73083113 LEVITRA TAB 20MG 12/31/9999 2<strong>01</strong>23000851945<strong>01</strong> LEVITRA TAB 5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73082913 LEVITRA TAB 5MG 12/31/9999 2<strong>01</strong>2360758006305 LEVOBUNOLOL SOL 0.25% OP 12/31/9999 2<strong>01</strong>2360758006310 LEVOBUNOLOL SOL 0.25% OP 12/31/9999 2<strong>01</strong>2324208050505 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2324208050510 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2324208050515 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2360758006005 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2360758006<strong>01</strong>0 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2360758006<strong>01</strong>5 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2361314022905 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2361314022910 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2361314022915 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 2<strong>01</strong>2300517104525 LEVOCARNITIN INJ 200MG/ML 12/31/9999 2<strong>01</strong>23007030404<strong>01</strong> LEVOCARNITIN INJ 200MG/ML 12/31/9999 2<strong>01</strong>2300703040402 LEVOCARNITIN INJ 200MG/ML 12/31/9999 2<strong>01</strong>23007030405<strong>01</strong> LEVOCARNITIN INJ 200MG/ML 12/31/9999 2<strong>01</strong>2300703040502 LEVOCARNITIN INJ 200MG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>3605 LEVOCARNITIN INJ 200MG/ML 12/31/9999 2<strong>01</strong>2350383<strong>01</strong>7104 LEVOCARNITIN SOL 1GM/10ML 12/31/9999 2<strong>01</strong>2364980050312 LEVOCARNITIN SOL 1GM/10ML 12/31/9999 2<strong>01</strong>2350383<strong>01</strong>7290 LEVOCARNITIN TAB 330MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>3009 LEVOCARNITIN TAB 330MG 12/31/9999 2<strong>01</strong>2300955102621 LEVOCETIRIZI SOL 2.5/5ML 12/31/9999 2<strong>01</strong>2345802068028 LEVOCETIRIZI SOL 2.5/5ML 12/31/9999 2<strong>01</strong>230009377<strong>01</strong>98 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2300955102590 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2331722055190 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>23458020594<strong>01</strong> LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2345802059465 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2345802059475 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2345802059487 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2355111028290 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>2368462034690 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>439722<strong>01</strong> LEVOFLOX/D5W INJ 250/50ML 12/31/9999 2<strong>01</strong>2300781334109 LEVOFLOX/D5W INJ 250/50ML 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3281 LEVOFLOX/D5W INJ 250/50ML 12/31/9999 2<strong>01</strong>2325021082581 LEVOFLOX/D5W INJ 250/50ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>439721<strong>01</strong> LEVOFLOX/D5W INJ 500/100M 12/31/9999 2<strong>01</strong>2300781334209 LEVOFLOX/D5W INJ 500/100M 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3282 LEVOFLOX/D5W INJ 500/100M 12/31/9999 2<strong>01</strong>2325021082582 LEVOFLOX/D5W INJ 500/100M 12/31/9999 2<strong>01</strong>230<strong>01</strong>439720<strong>01</strong> LEVOFLOX/D5W INJ 750/150 12/31/9999 2<strong>01</strong>2300781334309 LEVOFLOX/D5W INJ 750/150 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3283 LEVOFLOX/D5W INJ 750/150 12/31/9999 2<strong>01</strong>2325021082583 LEVOFLOX/D5W INJ 750/150 12/31/9999 2<strong>01</strong>2317478<strong>01</strong>0720 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 2<strong>01</strong>2317478<strong>01</strong>0730 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3020 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3030 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 2<strong>01</strong>2316571<strong>01</strong>5050 LEVOFLOXACIN SOL 0.5% 12/31/9999 2<strong>01</strong>2317478<strong>01</strong>0610 LEVOFLOXACIN SOL 0.5% 12/31/9999 2<strong>01</strong>2350383028305 LEVOFLOXACIN SOL 0.5% 12/31/9999 2<strong>01</strong>23

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