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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5167220<strong>01</strong>02 MICONAZOLE CRE 2% 12/31/9999 2<strong>01</strong>2351672203506 MICONAZOLE CRE 2% 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>9757 MICONAZOLE SUP 100MG 12/31/9999 2<strong>01</strong>2336800073745 MICONAZOLE 1 KIT 12/31/9999 2<strong>01</strong>2346122002702 MICONAZOLE 1 KIT 12/31/9999 2<strong>01</strong>2336800098200 MICONAZOLE 3 KIT COMBINAT 12/31/9999 2<strong>01</strong>2337205058303 MICONAZOLE 3 KIT COMBINAT 12/31/9999 2<strong>01</strong>2349348064573 MICONAZOLE 3 KIT COMBINAT 12/31/9999 2<strong>01</strong>230<strong>01</strong>13008100 MICONAZOLE 3 KIT COMBO PK 12/31/9999 2<strong>01</strong>230<strong>01</strong>13060500 MICONAZOLE 3 KIT COMBO PK 12/31/9999 2<strong>01</strong>23009045415<strong>01</strong> MICONAZOLE 3 KIT COMBO PK 12/31/9999 2<strong>01</strong>2336800008100 MICONAZOLE 3 KIT COMBO PK 12/31/9999 2<strong>01</strong>2337205058903 MICONAZOLE 3 KIT COMBO PK 12/31/9999 2<strong>01</strong>2300472173803 MICONAZOLE 3 SUP 200MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13082529 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>2300536142326 MICONAZOLE 7 CRE 2% 03/31/2<strong>01</strong>3 2<strong>01</strong>2324385059029 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>2336800082529 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>2337205059029 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>2349348053077 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>2349348087277 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>2363868020046 MICONAZOLE 7 CRE 2% 12/31/9999 2<strong>01</strong>230<strong>01</strong>13021429 MICONAZOLE 7 CRE TUBE/KIT 12/31/9999 2<strong>01</strong>2300472173607 MICONAZOLE 7 SUP 100MG 12/31/9999 2<strong>01</strong>2337205065318 MICONAZORB POW AF 2% 12/31/9999 2<strong>01</strong>2346122003927 MICONAZORB POW AF 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>003816 MICRO GUARD POW 2% 12/31/9999 2<strong>01</strong>2352544095121 MICROGESTIN TAB 1.5/30 12/31/9999 2<strong>01</strong>2352544095021 MICROGESTIN TAB 1/20 12/31/9999 2<strong>01</strong>2352544063028 MICROGESTIN TAB FE 1/20 12/31/9999 2<strong>01</strong>2352544063128 MICROGESTIN TAB FE1.5/30 12/31/9999 2<strong>01</strong>2364<strong>01</strong>1000904 MICRO-K CAP 10MEQ CR 05/31/2<strong>01</strong>5 2<strong>01</strong>2364<strong>01</strong>10<strong>01</strong>004 MICRO-K CAP 8MEQ CR 07/31/2<strong>01</strong>5 2<strong>01</strong>23525440622<strong>01</strong> MICROZIDE CAP 12.5MG 12/31/9999 2<strong>01</strong>23006416056<strong>01</strong> MIDAZOLAM INJ 10MG/10 12/31/9999 2<strong>01</strong>2300641605610 MIDAZOLAM INJ 10MG/10 12/31/9999 2<strong>01</strong>2325021066<strong>01</strong>0 MIDAZOLAM INJ 10MG/10 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>2510 MIDAZOLAM INJ 10MG/10 12/31/9999 2<strong>01</strong>2363323041110 MIDAZOLAM INJ 10MG/10 12/31/9999 2<strong>01</strong>2300409230802 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2300409230850 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2300641606310 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2300641606325 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9002707 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9002708 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9002759 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2325021065602 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>3802 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2363323041202 MIDAZOLAM INJ 10MG/2ML 12/31/9999 2<strong>01</strong>2300409230517 MIDAZOLAM INJ 1MG/ML 12/31/9999 2<strong>01</strong>2300409230521 MIDAZOLAM INJ 1MG/ML 12/31/9999 2<strong>01</strong>2300409258705 MIDAZOLAM INJ 1MG/ML 12/31/9999 2<strong>01</strong>2300409258753 MIDAZOLAM INJ 1MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9002810 MIDAZOLAM INJ 1MG/ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9002839 MIDAZOLAM INJ 1MG/ML 12/31/9999 2<strong>01</strong>2325021066105 MIDAZOLAM INJ 25MG/5ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>2605 MIDAZOLAM INJ 25MG/5ML 12/31/9999 2<strong>01</strong>2357664063444 MIDAZOLAM INJ 25MG/5ML 12/31/9999 2<strong>01</strong>2363323041205 MIDAZOLAM INJ 25MG/5ML 12/31/9999 2<strong>01</strong>2300409230612 MIDAZOLAM INJ 2MG/2ML 12/31/9999 2<strong>01</strong>23

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