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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52544069530 MATZIM LA TAB 420MG/24 12/31/9999 2<strong>01</strong>2362037069530 MATZIM LA TAB 420MG/24 <strong>01</strong>/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2362037069590 MATZIM LA TAB 420MG/24 02/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2300074227813 MAVIK TAB 1MG 12/31/9999 2<strong>01</strong>2300074227913 MAVIK TAB 2MG 12/31/9999 2<strong>01</strong>2300074228<strong>01</strong>3 MAVIK TAB 4MG 12/31/9999 2<strong>01</strong>2399207028040 MAXAIR AUTOH AER 200MCG 12/31/9999 2<strong>01</strong>2300006026718 MAXALT TAB 10MG 12/31/9999 2<strong>01</strong>2300006026618 MAXALT TAB 5MG 12/31/9999 2<strong>01</strong>230000638<strong>01</strong>12 MAXALT-MLT TAB 10MG 12/31/9999 2<strong>01</strong>230000638<strong>01</strong>18 MAXALT-MLT TAB 10MG 12/31/9999 2<strong>01</strong>2300006380<strong>01</strong>2 MAXALT-MLT TAB 5MG 12/31/9999 2<strong>01</strong>2300006380<strong>01</strong>8 MAXALT-MLT TAB 5MG 12/31/9999 2<strong>01</strong>2311528<strong>01</strong>33<strong>01</strong> MAXARON TAB FORTE 12/31/9999 2<strong>01</strong>2311528<strong>01</strong>35<strong>01</strong> MAXARON FORT CAP 03/31/2<strong>01</strong>3 2<strong>01</strong>23586050444<strong>01</strong> MAXICHLOR TAB PEH 12/31/9999 2<strong>01</strong>23586050445<strong>01</strong> MAXICHLOR TAB PEH DM 12/31/9999 2<strong>01</strong>23586050442<strong>01</strong> MAXICHLOR TAB PSE 12/31/9999 2<strong>01</strong>2358605044228 MAXICHLOR TAB PSE 12/31/9999 2<strong>01</strong>23586050443<strong>01</strong> MAXICHLOR TAB PSE DM 12/31/9999 2<strong>01</strong>23586050448<strong>01</strong> MAXICHLOR DM TAB 4-20MG 12/31/9999 2<strong>01</strong>2300998061505 MAXIDEX SUS 0.1% OP 12/31/9999 2<strong>01</strong>23525440634<strong>01</strong> MAXIDONE TAB 10-750MG 12/31/9999 2<strong>01</strong>23586050406<strong>01</strong> MAXIFED TAB 60-400MG 12/31/9999 2<strong>01</strong>23586050410<strong>01</strong> MAXIFED CD TAB 12/31/9999 2<strong>01</strong>23586050411<strong>01</strong> MAXIFED CDX TAB 12/31/9999 2<strong>01</strong>2358605020916 MAXIFED DM LIQ 12/31/9999 2<strong>01</strong>23586050409<strong>01</strong> MAXIFED DM TAB 12/31/9999 2<strong>01</strong>23586050407<strong>01</strong> MAXIFED DMX TAB 12/31/9999 2<strong>01</strong>23586050408<strong>01</strong> MAXIFED-G TAB 40-400MG 12/31/9999 2<strong>01</strong>23586050413<strong>01</strong> MAXIFED-G TAB CDX 12/31/9999 2<strong>01</strong>23586050412<strong>01</strong> MAXIFED-G CD TAB 12/31/9999 2<strong>01</strong>23586050430<strong>01</strong> MAXIFLU CD TAB 12/31/9999 2<strong>01</strong>23586050431<strong>01</strong> MAXIFLU CDX TAB 12/31/9999 2<strong>01</strong>23586050432<strong>01</strong> MAXIFLU DM TAB 12/31/9999 2<strong>01</strong>2366594099905 MAXIMUM D3 CAP 12/31/9999 2<strong>01</strong>236687006<strong>01</strong><strong>01</strong> MAXINATE TAB 12/31/9999 2<strong>01</strong>23586050422<strong>01</strong> MAXIPHEN TAB 10-400MG 12/31/9999 2<strong>01</strong>23586050426<strong>01</strong> MAXIPHEN CD TAB 12/31/9999 2<strong>01</strong>23586050427<strong>01</strong> MAXIPHEN CDX TAB 12/31/9999 2<strong>01</strong>23586050423<strong>01</strong> MAXIPHEN DM TAB 12/31/9999 2<strong>01</strong>2351479005510 MAXIPIME INJ 2GM 11/30/2<strong>01</strong>2 2<strong>01</strong>2300065063136 MAXITROL OIN 0.1% OP 12/31/9999 2<strong>01</strong>2300998063006 MAXITROL SUS 0.1% OP 12/31/9999 2<strong>01</strong>23003780460<strong>01</strong> MAXZIDE TAB 75-50 12/31/9999 2<strong>01</strong>23003780464<strong>01</strong> MAXZIDE-25 TAB 12/31/9999 2<strong>01</strong>23128300714<strong>01</strong> M-CLEAR CAP 200-9MG 12/31/9999 2<strong>01</strong>2312830071716 M-CLEAR WC LIQ 12/31/9999 2<strong>01</strong>2300093910719 MEBENDAZOLE CHW 100MG 05/31/2<strong>01</strong>4 2<strong>01</strong>2300093910729 MEBENDAZOLE CHW 100MG 05/31/2<strong>01</strong>4 2<strong>01</strong>2300378548510 MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>2300378548577 MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>23005363985<strong>01</strong> MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>2300536398510 MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>23007811345<strong>01</strong> MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>23498840034<strong>01</strong> MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>2349884003410 MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>23510790089<strong>01</strong> MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>2351079008920 MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>2359746<strong>01</strong>2206 MECLIZINE TAB 12.5MG 12/31/9999 2<strong>01</strong>23

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