Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

66685101101 AMOX/K CLAV SUS 200/5ML 12/31/9999 2012366685101102 AMOX/K CLAV SUS 200/5ML 12/31/9999 2012343598020451 AMOX/K CLAV SUS 250/5ML 12/31/9999 2012343598020452 AMOX/K CLAV SUS 250/5ML 12/31/9999 2012343598020453 AMOX/K CLAV SUS 250/5ML 12/31/9999 2012360432006500 AMOX/K CLAV SUS 250/5ML 12/31/9999 2012360432006547 AMOX/K CLAV SUS 250/5ML 12/31/9999 2012360432006575 AMOX/K CLAV SUS 250/5ML 12/31/9999 2012300093227973 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012300143998201 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012300143998250 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012300143998275 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012300781610446 AMOX/K CLAV SUS 400/5ML 07/31/2013 2012343598020850 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012343598020851 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012343598020852 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012363304097901 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012363304097903 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012363304097904 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012365862053401 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012365862053450 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012365862053475 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012366685101200 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012366685101201 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012366685101202 AMOX/K CLAV SUS 400/5ML 12/31/9999 2012300093867574 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300093867575 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300093867578 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300143985316 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300143985324 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300143985375 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300781613948 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300781613954 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300781613957 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012343598020351 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012343598020354 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012343598020369 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012363304076801 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012363304076802 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012363304076807 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012365862053502 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012365862053513 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012365862053575 AMOX/K CLAV SUS 600/5ML 12/31/9999 2012300781187431 AMOX/K CLAV TAB 250MG 12/31/9999 2012316714029501 AMOX/K CLAV TAB 250MG 12/31/2020 2012343598021830 AMOX/K CLAV TAB 250MG 12/31/9999 2012360505253903 AMOX/K CLAV TAB 250MG 12/31/9999 2012365862050130 AMOX/K CLAV TAB 250MG 12/31/9999 2012300093227434 AMOX/K CLAV TAB 500MG 12/31/9999 2012300781183120 AMOX/K CLAV TAB 500MG 08/31/2013 2012316714029601 AMOX/K CLAV TAB 500MG 12/31/2020 2012343598020614 AMOX/K CLAV TAB 500MG 12/31/9999 2012360505254002 AMOX/K CLAV TAB 500MG 12/31/9999 2012363304071320 AMOX/K CLAV TAB 500MG 12/31/9999 2012365862050220 AMOX/K CLAV TAB 500MG 12/31/9999 2012366685100200 AMOX/K CLAV TAB 500MG 12/31/9999 2012366685100202 AMOX/K CLAV TAB 500MG 12/31/9999 2012300093227534 AMOX/K CLAV TAB 875MG 12/31/9999 2012300781185220 AMOX/K CLAV TAB 875MG 12/31/9999 2012316714029701 AMOX/K CLAV TAB 875MG 12/31/2020 20123