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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00056051168 LODOSYN TAB 25MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2325<strong>01</strong>0071115 LODOSYN TAB 25MG 12/31/9999 2<strong>01</strong>2300095086006 LODRANE D CAP 4-60MG 12/31/9999 2<strong>01</strong>2351285007997 LOESTRIN TAB 1/20-21 12/31/9999 2<strong>01</strong>2351285008297 LOESTRIN 21 TAB 1.5/30 12/31/9999 2<strong>01</strong>2300430053<strong>01</strong>4 LOESTRIN 24 TAB FE 12/31/9999 2<strong>01</strong>2351285008370 LOESTRIN FE TAB 1.5/30 12/31/9999 2<strong>01</strong>2351285008498 LOESTRIN FE TAB 1.5/30 12/31/9999 2<strong>01</strong>2351285008070 LOESTRIN FE TAB 1/20 12/31/9999 2<strong>01</strong>2351285008198 LOESTRIN FE TAB 1/20 12/31/9999 2<strong>01</strong>23578440323<strong>01</strong> LOFIBRA CAP 134MG 12/31/9999 2<strong>01</strong>23578440324<strong>01</strong> LOFIBRA CAP 200MG 12/31/9999 2<strong>01</strong>23578440322<strong>01</strong> LOFIBRA CAP 67MG 12/31/9999 2<strong>01</strong>2357844069298 LOFIBRA TAB 160MG 12/31/9999 2<strong>01</strong>2357844069198 LOFIBRA TAB 54MG 12/31/9999 2<strong>01</strong>2368047003202 LOHIST DRO 1-2.5MG 12/31/9999 2<strong>01</strong>2368047<strong>01</strong>2<strong>01</strong>6 LOHIST-D LIQ 12/31/9999 2<strong>01</strong>2368047<strong>01</strong>2916 LOHIST-DM SYP 5-2-10MG 12/31/9999 2<strong>01</strong>2368047034004 LOHIST-PEB LIQ 4-10/5ML 12/31/9999 2<strong>01</strong>2368047034<strong>01</strong>6 LOHIST-PEB LIQ 4-10/5ML 12/31/9999 2<strong>01</strong>2368047034116 LOHIST-PEB- LIQ DM 12/31/9999 2<strong>01</strong>2368047034216 LOHIST-PSB LIQ 4-20/5ML 12/31/9999 2<strong>01</strong>2368047034316 LOHIST-PSB- LIQ DM 12/31/9999 2<strong>01</strong>2351552128706 LOLLIBASE POW 12/31/9999 2<strong>01</strong>2361480021505 LOMA ASTHMA TAB 12/31/9999 2<strong>01</strong>2361480<strong>01</strong>1505 LOMA ECZEMA TAB 12/31/9999 2<strong>01</strong>2361480<strong>01</strong>2503 LOMA LUX LIQ PSORIASI 12/31/9999 2<strong>01</strong>2361480<strong>01</strong>3505 LOMA LUX TAB ACNEPILL 12/31/9999 2<strong>01</strong>2361480023505 LOMA SINUS/ TAB ALLERGY 12/31/9999 2<strong>01</strong>2300025006131 LOMOTIL TAB 2.5MG 12/31/9999 2<strong>01</strong>2363868005630 LONG ACTING SPR 0.05% 12/31/9999 2<strong>01</strong>23007811262<strong>01</strong> LONOX TAB 2.5MG 12/31/9999 2<strong>01</strong>23000930311<strong>01</strong> LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2300093031105 LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>23003782100<strong>01</strong> LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2300378210005 LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>23510790690<strong>01</strong> LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2351079069<strong>01</strong>7 LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2351079069<strong>01</strong>9 LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2351079069020 LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>58<strong>01</strong> LOPERAMIDE CAP 2MG 12/31/9999 2<strong>01</strong>2337205037726 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 2<strong>01</strong>2350383061804 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>0659 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>0662 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 2<strong>01</strong>2368094021759 LOPERAMIDE LIQ 2MG/10ML 12/31/9999 2<strong>01</strong>2368094021762 LOPERAMIDE LIQ 2MG/10ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>13064526 LOPERAMIDE SUS 1MG/7.5 12/31/9999 2<strong>01</strong>2300904625620 LOPERAMIDE SUS 1MG/7.5 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>51<strong>01</strong> LOPERAMIDE SUS 1MG/7.5 12/31/9999 2<strong>01</strong>2300071073720 LOPID TAB 600MG 12/31/9999 2<strong>01</strong>2300071073730 LOPID TAB 600MG 12/31/9999 2<strong>01</strong>2300078046105 LOPRESS HCT TAB 100-25MG 12/31/9999 2<strong>01</strong>2300078046005 LOPRESS HCT TAB 50-25MG 12/31/9999 2<strong>01</strong>23000780400<strong>01</strong> LOPRESSOR INJ 5MG/5ML 12/31/9999 2<strong>01</strong>2300078045905 LOPRESSOR TAB 100MG 12/31/9999 2<strong>01</strong>2300078045805 LOPRESSOR TAB 50MG 12/31/9999 2<strong>01</strong>23992070<strong>01</strong>3<strong>01</strong> LOPROX GEL 0.77% 12/31/9999 2<strong>01</strong>23992070<strong>01</strong>330 LOPROX GEL 0.77% 12/31/9999 2<strong>01</strong>23992070<strong>01</strong>345 LOPROX GEL 0.77% 12/31/9999 2<strong>01</strong>23

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