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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00904198359 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904198380 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904198394 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904198859 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904198860 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904198861 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904198880 MAPAP TAB 500MG 12/31/9999 2<strong>01</strong>2300904581651 MAPAP TAB 500MG/RR 12/31/9999 2<strong>01</strong>2300904581660 MAPAP TAB 500MG/RR 12/31/9999 2<strong>01</strong>2300904584709 MAPAP APAP LIQ 500/15ML 12/31/9999 2<strong>01</strong>2300904576960 MAPAP ARTHRI TAB 650MG 12/31/9999 2<strong>01</strong>2300904511620 MAPAP CHILD SUS 160/5ML 12/31/9999 2<strong>01</strong>2300904587420 MAPAP CHILD SUS CGH/SINU 12/31/9999 2<strong>01</strong>2300904579146 MAPAP CHILD TAB 80MG RT 12/31/9999 2<strong>01</strong>2300904578624 MAPAP COLD TAB FORMULA 12/31/9999 2<strong>01</strong>2300904624403 MAPAP INFANT SUS 160/5ML 12/31/9999 2<strong>01</strong>2300904765151 MAPAP PM TAB 25-500MG 12/31/9999 2<strong>01</strong>2300904578324 MAPAP SINUS TAB MAX ST 12/31/9999 2<strong>01</strong>23003780060<strong>01</strong> MAPROTILINE TAB 25MG 12/31/9999 2<strong>01</strong>23003780087<strong>01</strong> MAPROTILINE TAB 50MG 12/31/9999 2<strong>01</strong>23003780092<strong>01</strong> MAPROTILINE TAB 75MG 12/31/9999 2<strong>01</strong>2300409155910 MARCAINE INJ 0.25% 12/31/9999 2<strong>01</strong>2300409155930 MARCAINE INJ 0.25% 12/31/9999 2<strong>01</strong>2300409158750 MARCAINE INJ 0.25% 12/31/9999 2<strong>01</strong>2300409156<strong>01</strong>0 MARCAINE INJ 0.5% 12/31/9999 2<strong>01</strong>2300409156029 MARCAINE INJ 0.5% 12/31/9999 2<strong>01</strong>2300409161050 MARCAINE INJ 0.5% 12/31/9999 2<strong>01</strong>2300409158210 MARCAINE INJ 0.75% 12/31/9999 2<strong>01</strong>2300409158229 MARCAINE INJ 0.75% 12/31/9999 2<strong>01</strong>2300409176102 MARCAINE INJ SPINAL 12/31/9999 2<strong>01</strong>2300409174610 MARCAINE/EPI INJ 0.25% 12/31/9999 2<strong>01</strong>2300409174630 MARCAINE/EPI INJ 0.25% 12/31/9999 2<strong>01</strong>2300409175250 MARCAINE/EPI INJ 0.25% 12/31/9999 2<strong>01</strong>2300409174910 MARCAINE/EPI INJ 0.5% 12/31/9999 2<strong>01</strong>2300409174929 MARCAINE/EPI INJ 0.5% 12/31/9999 2<strong>01</strong>2300409175550 MARCAINE/EPI INJ 0.5% 12/31/9999 2<strong>01</strong>2300682048<strong>01</strong>6 MAR-COF BP LIQ 12/31/9999 2<strong>01</strong>2300682047516 MAR-COF CG LIQ EXPECT 12/31/9999 2<strong>01</strong>23006820804<strong>01</strong> MARGESIC CAP 12/31/9999 2<strong>01</strong>2300051002321 MARINOL CAP 10MG 12/31/9999 2<strong>01</strong>2300051002121 MARINOL CAP 2.5MG 12/31/9999 2<strong>01</strong>2300051002221 MARINOL CAP 5MG 12/31/9999 2<strong>01</strong>2368462038829 MARLISSA TAB 0.15/30 12/31/9999 2<strong>01</strong>23006821570<strong>01</strong> MARNATAL-F CAP 12/31/9999 2<strong>01</strong>23306980032<strong>01</strong> MARPLAN TAB 10MG 12/31/9999 2<strong>01</strong>23006821400<strong>01</strong> MARTEN-TAB TAB 50-325MG 12/31/9999 2<strong>01</strong>2312939030541 MARTINIC CAP 12/31/9999 2<strong>01</strong>23544820053<strong>01</strong> MATULANE CAP 50MG 12/31/9999 2<strong>01</strong>2352544069119 MATZIM LA TAB 180MG/24 12/31/9999 2<strong>01</strong>2352544069130 MATZIM LA TAB 180MG/24 12/31/9999 2<strong>01</strong>2352544069219 MATZIM LA TAB 240MG/24 12/31/9999 2<strong>01</strong>2352544069230 MATZIM LA TAB 240MG/24 12/31/9999 2<strong>01</strong>2352544069319 MATZIM LA TAB 300MG/24 12/31/9999 2<strong>01</strong>2352544069330 MATZIM LA TAB 300MG/24 12/31/9999 2<strong>01</strong>2362037069390 MATZIM LA TAB 300MG/24 02/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2352544069419 MATZIM LA TAB 360MG/24 12/31/9999 2<strong>01</strong>2352544069430 MATZIM LA TAB 360MG/24 12/31/9999 2<strong>01</strong>2362037069430 MATZIM LA TAB 360MG/24 <strong>01</strong>/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2362037069490 MATZIM LA TAB 360MG/24 <strong>01</strong>/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2352544069519 MATZIM LA TAB 420MG/24 12/31/9999 2<strong>01</strong>23

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