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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007030045<strong>01</strong> METHYLPR ACE INJ 40MG/ML 12/31/9999 2<strong>01</strong>2300781313171 METHYLPR ACE INJ 40MG/ML 12/31/9999 2<strong>01</strong>2300781313195 METHYLPR ACE INJ 40MG/ML 12/31/9999 2<strong>01</strong>2300781313670 METHYLPR ACE INJ 40MG/ML 12/31/9999 2<strong>01</strong>23007030051<strong>01</strong> METHYLPR ACE INJ 80MG/ML 12/31/9999 2<strong>01</strong>2300703005104 METHYLPR ACE INJ 80MG/ML 12/31/9999 2<strong>01</strong>23007030063<strong>01</strong> METHYLPR ACE INJ 80MG/ML 12/31/9999 2<strong>01</strong>2300781313271 METHYLPR ACE INJ 80MG/ML 12/31/9999 2<strong>01</strong>2300781313295 METHYLPR ACE INJ 80MG/ML 12/31/9999 2<strong>01</strong>2300781313775 METHYLPR ACE INJ 80MG/ML 12/31/9999 2<strong>01</strong>2363323026530 METHYLPR SS INJ 1000MG 12/31/9999 2<strong>01</strong>2363323025803 METHYLPR SS INJ 125MG 12/31/9999 2<strong>01</strong>2363323025503 METHYLPR SS INJ 40MG 12/31/9999 2<strong>01</strong>2300603459315 METHYLPRED PAK 4MG 12/31/9999 2<strong>01</strong>2300781502207 METHYLPRED PAK 4MG 12/31/9999 2<strong>01</strong>2351991<strong>01</strong>8831 METHYLPRED PAK 4MG 12/31/9999 2<strong>01</strong>235974600<strong>01</strong>03 METHYLPRED PAK 4MG 12/31/9999 2<strong>01</strong>235974600<strong>01</strong>09 METHYLPRED PAK 4MG 12/31/9999 2<strong>01</strong>2359762444002 METHYLPRED PAK 4MG 12/31/9999 2<strong>01</strong>2351552095802 METHYLPRED POW ACETATE 12/31/9999 2<strong>01</strong>2351552095804 METHYLPRED POW ACETATE 12/31/9999 2<strong>01</strong>2351552095805 METHYLPRED POW ACETATE 12/31/9999 2<strong>01</strong>2351552095806 METHYLPRED POW ACETATE 12/31/9999 2<strong>01</strong>2359746000314 METHYLPRED TAB 16MG 12/31/9999 2<strong>01</strong>23597460<strong>01</strong>504 METHYLPRED TAB 32MG 12/31/9999 2<strong>01</strong>2300603459321 METHYLPRED TAB 4MG 12/31/9999 2<strong>01</strong>23007815022<strong>01</strong> METHYLPRED TAB 4MG 12/31/9999 2<strong>01</strong>235974600<strong>01</strong>06 METHYLPRED TAB 4MG 12/31/9999 2<strong>01</strong>2359762444003 METHYLPRED TAB 4MG 12/31/9999 2<strong>01</strong>2359746000204 METHYLPRED TAB 8MG 12/31/9999 2<strong>01</strong>2359746000206 METHYLPRED TAB 8MG 12/31/9999 2<strong>01</strong>2324208040205 METIPRANOLOL SOL 0.3% 07/18/2<strong>01</strong>3 2<strong>01</strong>2324208040210 METIPRANOLOL SOL 0.3% 07/18/2<strong>01</strong>3 2<strong>01</strong>2361314044705 METIPRANOLOL SOL 0.3% OPH 12/31/9999 2<strong>01</strong>2361314044710 METIPRANOLOL SOL 0.3% OPH 12/31/9999 2<strong>01</strong>23004093414<strong>01</strong> METOCLOPRAM INJ 5MG/ML 12/31/9999 2<strong>01</strong>23007034502<strong>01</strong> METOCLOPRAM INJ 5MG/ML 03/31/2<strong>01</strong>3 2<strong>01</strong>2300703450204 METOCLOPRAM INJ 5MG/ML 03/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>21157610 METOCLOPRAM SOL 10/10ML 12/31/9999 2<strong>01</strong>2368094067659 METOCLOPRAM SOL 10/10ML 12/31/9999 2<strong>01</strong>2368094067662 METOCLOPRAM SOL 10/10ML 12/31/9999 2<strong>01</strong>2368094068058 METOCLOPRAM SOL 1MG/1ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21057616 METOCLOPRAM SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2354838050880 METOCLOPRAM SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2360432062216 METOCLOPRAM SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2362559<strong>01</strong>1<strong>01</strong>6 METOCLOPRAM SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2362559110606 METOCLOPRAM SOL 5MG/5ML 03/31/2<strong>01</strong>4 2<strong>01</strong>23666890031<strong>01</strong> METOCLOPRAM SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2366689003150 METOCLOPRAM SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2300472045416 METOCLOPRAM SYP 5MG/5ML 12/31/9999 2<strong>01</strong>23000932203<strong>01</strong> METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>2300093220305 METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>2300093220310 METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>2300228226910 METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>2300228226950 METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>23005912229<strong>01</strong> METOCLOPRAM TAB 10MG 03/31/2<strong>01</strong>3 2<strong>01</strong>2300591222905 METOCLOPRAM TAB 10MG 11/30/2<strong>01</strong>3 2<strong>01</strong>2300591222910 METOCLOPRAM TAB 10MG 03/31/2<strong>01</strong>3 2<strong>01</strong>23005912468<strong>01</strong> METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>2300591246805 METOCLOPRAM TAB 10MG 12/31/9999 2<strong>01</strong>23

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