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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0<strong>01</strong>157<strong>01</strong>7<strong>01</strong> MINOCYCLINE CAP 50MG 12/31/9999 2<strong>01</strong>23005915694<strong>01</strong> MINOCYCLINE CAP 50MG 12/31/9999 2<strong>01</strong>2300591569460 MINOCYCLINE CAP 50MG 12/31/9999 2<strong>01</strong>23633040694<strong>01</strong> MINOCYCLINE CAP 50MG 12/31/9999 2<strong>01</strong>23658620209<strong>01</strong> MINOCYCLINE CAP 50MG 12/31/9999 2<strong>01</strong>23000937300<strong>01</strong> MINOCYCLINE CAP 75MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>157054<strong>01</strong> MINOCYCLINE CAP 75MG 12/31/9999 2<strong>01</strong>23005913153<strong>01</strong> MINOCYCLINE CAP 75MG 12/31/9999 2<strong>01</strong>23633040695<strong>01</strong> MINOCYCLINE CAP 75MG 12/31/9999 2<strong>01</strong>23658620210<strong>01</strong> MINOCYCLINE CAP 75MG 12/31/9999 2<strong>01</strong>2349884051303 MINOCYCLINE TAB 100MG 12/31/9999 2<strong>01</strong>2355111063960 MINOCYCLINE TAB 100MG 12/31/9999 2<strong>01</strong>2363304069950 MINOCYCLINE TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>151247<strong>01</strong> MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>15124708 MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>23003784298<strong>01</strong> MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>2300378429893 MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>23007815387<strong>01</strong> MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>2300781538731 MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>2368180038106 MINOCYCLINE TAB 135MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>151245<strong>01</strong> MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>15124508 MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>23003784296<strong>01</strong> MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>2300378429693 MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>23007815385<strong>01</strong> MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>2300781538531 MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>2368180037906 MINOCYCLINE TAB 45MG ER 12/31/9999 2<strong>01</strong>23498840511<strong>01</strong> MINOCYCLINE TAB 50MG 12/31/9999 2<strong>01</strong>23551110637<strong>01</strong> MINOCYCLINE TAB 50MG 12/31/9999 2<strong>01</strong>23633040697<strong>01</strong> MINOCYCLINE TAB 50MG 12/31/9999 2<strong>01</strong>23498840512<strong>01</strong> MINOCYCLINE TAB 75MG 12/31/9999 2<strong>01</strong>23551110638<strong>01</strong> MINOCYCLINE TAB 75MG 12/31/9999 2<strong>01</strong>23633040698<strong>01</strong> MINOCYCLINE TAB 75MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>151246<strong>01</strong> MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>15124608 MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>23003784297<strong>01</strong> MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>2300378429793 MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>23007815386<strong>01</strong> MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>2300781538631 MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>2368180038006 MINOCYCLINE TAB 90MG ER 12/31/9999 2<strong>01</strong>2300472006673 MINOXIDIL SOL 2% MEN 12/31/9999 2<strong>01</strong>2300472006675 MINOXIDIL SOL 2% MEN 12/31/9999 2<strong>01</strong>2300472009473 MINOXIDIL SOL 5% MEN 12/31/9999 2<strong>01</strong>2300472009475 MINOXIDIL SOL 5% MEN 12/31/9999 2<strong>01</strong>23005915643<strong>01</strong> MINOXIDIL TAB 10MG 12/31/9999 2<strong>01</strong>2300591564305 MINOXIDIL TAB 10MG 12/31/9999 2<strong>01</strong>23498840257<strong>01</strong> MINOXIDIL TAB 10MG 12/31/9999 2<strong>01</strong>2349884025705 MINOXIDIL TAB 10MG 12/31/9999 2<strong>01</strong>23534890387<strong>01</strong> MINOXIDIL TAB 10MG 12/31/9999 2<strong>01</strong>23680840205<strong>01</strong> MINOXIDIL TAB 10MG 12/31/9999 2<strong>01</strong>23005915642<strong>01</strong> MINOXIDIL TAB 2.5MG 12/31/9999 2<strong>01</strong>2300591564205 MINOXIDIL TAB 2.5MG 12/31/9999 2<strong>01</strong>23498840256<strong>01</strong> MINOXIDIL TAB 2.5MG 12/31/9999 2<strong>01</strong>23534890386<strong>01</strong> MINOXIDIL TAB 2.5MG 12/31/9999 2<strong>01</strong>23680840204<strong>01</strong> MINOXIDIL TAB 2.5MG 12/31/9999 2<strong>01</strong>2300904572114 MINTOX SUS 12/31/9999 2<strong>01</strong>2300904572514 MINTOX SUS MAX ST 12/31/9999 2<strong>01</strong>2300904047860 MINTOX PLUS CHW 12/31/9999 2<strong>01</strong>2300078047461 MIOCHOL-E SOL 1:100 09/30/2<strong>01</strong>3 2<strong>01</strong>2324208053920 MIOCHOL-E SOL 1:100 12/31/9999 2<strong>01</strong>23

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