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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00713<strong>01</strong>18<strong>01</strong> ACEPHEN SUP 120MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>1811 ACEPHEN SUP 120MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>1812 ACEPHEN SUP 120MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>1850 ACEPHEN SUP 120MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>1866 ACEPHEN SUP 120MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>64<strong>01</strong> ACEPHEN SUP 325MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6411 ACEPHEN SUP 325MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6412 ACEPHEN SUP 325MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6450 ACEPHEN SUP 325MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6466 ACEPHEN SUP 325MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>65<strong>01</strong> ACEPHEN SUP 650MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6505 ACEPHEN SUP 650MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6510 ACEPHEN SUP 650MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6512 ACEPHEN SUP 650MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>6550 ACEPHEN SUP 650MG 12/31/9999 2<strong>01</strong>2351552127704 ACESULFAME POW POTASSIU 12/31/9999 2<strong>01</strong>2351552127705 ACESULFAME POW POTASSIU 12/31/9999 2<strong>01</strong>23005363605<strong>01</strong> ACETA-GESIC TAB 12.5-325 12/31/9999 2<strong>01</strong>23005363<strong>01</strong>4<strong>01</strong> ACETA-GESIC TAB 30-325MG 12/31/2<strong>01</strong>3 2<strong>01</strong>2300536323307 ACETAMIN CHW 80MG 12/31/9999 2<strong>01</strong>2350383<strong>01</strong>0004 ACETAMIN ELX 160/5ML 12/31/9999 2<strong>01</strong>2350383<strong>01</strong>0<strong>01</strong>6 ACETAMIN ELX 160/5ML 12/31/9999 2<strong>01</strong>2350383<strong>01</strong>0028 ACETAMIN ELX 160/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21065705 ACETAMIN SOL 160/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21065711 ACETAMIN SOL 160/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21065721 ACETAMIN SOL 160/5ML 12/31/9999 2<strong>01</strong>2300536125512 ACETAMIN SUP 120MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2345802073230 ACETAMIN SUP 120MG 12/31/9999 2<strong>01</strong>2345802073233 ACETAMIN SUP 120MG 12/31/9999 2<strong>01</strong>2300536132<strong>01</strong>2 ACETAMIN SUP 325MG 03/31/2<strong>01</strong>5 2<strong>01</strong>2300536126<strong>01</strong>2 ACETAMIN SUP 650MG 04/30/2<strong>01</strong>4 2<strong>01</strong>2345802073030 ACETAMIN SUP 650MG 12/31/9999 2<strong>01</strong>2345802073032 ACETAMIN SUP 650MG 12/31/9999 2<strong>01</strong>2345802073033 ACETAMIN SUP 650MG 12/31/9999 2<strong>01</strong>23005363222<strong>01</strong> ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2300536322210 ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2300615059163 ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>0412 ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>23516450703<strong>01</strong> ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2351645070310 ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2351645070399 ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>23637390440<strong>01</strong> ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2363739044004 ACETAMIN TAB 325MG 12/31/9999 2<strong>01</strong>2365162035005 ACETAMIN TAB 325MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2365162035<strong>01</strong>0 ACETAMIN TAB 325MG 11/30/2<strong>01</strong>2 2<strong>01</strong>230<strong>01</strong>13<strong>01</strong>8771 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13<strong>01</strong>8778 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>23005363218<strong>01</strong> ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2300536321810 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>23005363231<strong>01</strong> ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2300536323110 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>4811 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>4812 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>7508 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>7512 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>7514 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>7515 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>7516 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>23516450705<strong>01</strong> ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>2351645070510 ACETAMIN TAB 500MG 12/31/9999 2<strong>01</strong>23

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