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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00378557505 MODAFINIL TAB 200MG 12/31/9999 2<strong>01</strong>2349884053511 MODAFINIL TAB 200MG 12/31/9999 2<strong>01</strong>23510790562<strong>01</strong> MODAFINIL TAB 200MG 12/31/9999 2<strong>01</strong>2351079056203 MODAFINIL TAB 200MG 12/31/9999 2<strong>01</strong>2355253080230 MODAFINIL TAB 200MG 12/31/9999 2<strong>01</strong>2355253080290 MODAFINIL TAB 200MG 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>7115 MODICON TAB 0.5/35 12/31/9999 2<strong>01</strong>23000935214<strong>01</strong> MOEXIPR/HCTZ TAB 15-12.5 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>34<strong>01</strong> MOEXIPR/HCTZ TAB 15-12.5 08/31/2<strong>01</strong>3 2<strong>01</strong>23162520613<strong>01</strong> MOEXIPR/HCTZ TAB 15-12.5 03/31/2<strong>01</strong>3 2<strong>01</strong>2362175072037 MOEXIPR/HCTZ TAB 15-12.5 12/31/9999 2<strong>01</strong>23684620206<strong>01</strong> MOEXIPR/HCTZ TAB 15-12.5 12/31/9999 2<strong>01</strong>23000935215<strong>01</strong> MOEXIPR/HCTZ TAB 15-25MG 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>35<strong>01</strong> MOEXIPR/HCTZ TAB 15-25MG 08/31/2<strong>01</strong>3 2<strong>01</strong>23162520614<strong>01</strong> MOEXIPR/HCTZ TAB 15-25MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2362175072537 MOEXIPR/HCTZ TAB 15-25MG 12/31/9999 2<strong>01</strong>23684620205<strong>01</strong> MOEXIPR/HCTZ TAB 15-25MG 12/31/9999 2<strong>01</strong>23000935213<strong>01</strong> MOEXIPR/HCTZ TAB 7.5-12.5 12/31/9999 2<strong>01</strong>23162520612<strong>01</strong> MOEXIPR/HCTZ TAB 7.5-12.5 03/31/2<strong>01</strong>3 2<strong>01</strong>2362175071237 MOEXIPR/HCTZ TAB 7.5-12.5 12/31/9999 2<strong>01</strong>23684620207<strong>01</strong> MOEXIPR/HCTZ TAB 7.5-12.5 12/31/9999 2<strong>01</strong>23000935150<strong>01</strong> MOEXIPRIL TAB 15MG 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>1215 MOEXIPRIL TAB 15MG 12/31/9999 2<strong>01</strong>23162520611<strong>01</strong> MOEXIPRIL TAB 15MG 05/31/2<strong>01</strong>3 2<strong>01</strong>23605050272<strong>01</strong> MOEXIPRIL TAB 15MG 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>7737 MOEXIPRIL TAB 15MG 12/31/9999 2<strong>01</strong>23684620208<strong>01</strong> MOEXIPRIL TAB 15MG 12/31/9999 2<strong>01</strong>23000930<strong>01</strong>7<strong>01</strong> MOEXIPRIL TAB 7.5MG 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>10<strong>01</strong> MOEXIPRIL TAB 7.5MG 12/31/9999 2<strong>01</strong>23162520610<strong>01</strong> MOEXIPRIL TAB 7.5MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23605050271<strong>01</strong> MOEXIPRIL TAB 7.5MG 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>7137 MOEXIPRIL TAB 7.5MG 12/31/9999 2<strong>01</strong>23684620209<strong>01</strong> MOEXIPRIL TAB 7.5MG 12/31/9999 2<strong>01</strong>2300430350008 MOISTUREL CRE 12/31/9999 2<strong>01</strong>2300430350<strong>01</strong>1 MOISTUREL CRE 12/31/9999 2<strong>01</strong>2300430310<strong>01</strong>0 MOISTUREL LOT 12/31/9999 2<strong>01</strong>2300430310<strong>01</strong>1 MOISTUREL LOT 12/31/9999 2<strong>01</strong>2345802061204 MOISTURIN CRE <strong>01</strong>/<strong>01</strong>/2<strong>01</strong>4 2<strong>01</strong>230<strong>01</strong>82507945 MOISTURIN CRE DRY SKIN 09/30/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>68027046 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2300713063415 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2300713063437 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2300781706619 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2300781706627 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2345802025735 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2345802025742 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2367405<strong>01</strong>0<strong>01</strong>5 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2367405<strong>01</strong>0045 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>9217 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>9255 MOMETASONE CRE 0.1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68027115 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68027146 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2300713063515 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2300713063537 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2300781706819 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2300781706827 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2345802<strong>01</strong>1937 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2345802<strong>01</strong>1942 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2367405030<strong>01</strong>5 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>2367405030045 MOMETASONE OIN 0.1% 12/31/9999 2<strong>01</strong>23

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