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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37205<strong>01</strong>1153 MOTION SICK TAB 50MG 12/31/9999 2<strong>01</strong>2349348007002 MOTION SICK TAB 50MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>9802 MOTION SICK TAB 50MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>9812 MOTION SICK TAB 50MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10036<strong>01</strong> MOTION SICK TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>87050002 MOTOFEN TAB 12/31/9999 2<strong>01</strong>236564902<strong>01</strong>75 MOVIPREP SOL 12/31/9999 2<strong>01</strong>2368453<strong>01</strong>4203 MOXATAG TAB 775MG <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2300065000603 MOXEZA SOL 0.5% 12/31/9999 2<strong>01</strong>2358468<strong>01</strong>40<strong>01</strong> MOZOBIL INJ 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026305 MS CONTIN TAB 100MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026310 MS CONTIN TAB 100MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026<strong>01</strong>0 MS CONTIN TAB 15MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026410 MS CONTIN TAB 200MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026105 MS CONTIN TAB 30MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026125 MS CONTIN TAB 30MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026205 MS CONTIN TAB 60MG CR 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1026210 MS CONTIN TAB 60MG CR 12/31/9999 2<strong>01</strong>23005271410<strong>01</strong> MTEST HS/EST TAB ESTROGEN 12/31/9999 2<strong>01</strong>23005271409<strong>01</strong> MTEST/EST TAB ESTROGEN 12/31/9999 2<strong>01</strong>23004850250<strong>01</strong> MUCAPHED TAB 10-400MG 12/31/9999 2<strong>01</strong>2363824002314 MUCINEX TAB 1200MG 12/31/9999 2<strong>01</strong>2363824002328 MUCINEX TAB 1200MG 12/31/9999 2<strong>01</strong>2363824002335 MUCINEX TAB 1200MG 12/31/9999 2<strong>01</strong>2363824000810 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824000820 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824000832 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824000834 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824000840 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824000850 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824000861 MUCINEX TAB 600MG ER 12/31/9999 2<strong>01</strong>2363824025612 MUCINEX CGH GRA 5-100MG 12/31/9999 2<strong>01</strong>2363824027464 MUCINEX CGH LIQ 5-100MG 12/31/9999 2<strong>01</strong>23638240<strong>01</strong>764 MUCINEX CHLD LIQ MULTISYM 12/31/9999 2<strong>01</strong>2363824027764 MUCINEX COLD LIQ /KIDS 12/31/9999 2<strong>01</strong>23638240<strong>01</strong>064 MUCINEX COLD LIQ CHILD 12/31/9999 2<strong>01</strong>23638240<strong>01</strong>566 MUCINEX COLD LIQ FLU&SORE 12/31/9999 2<strong>01</strong>23638240<strong>01</strong>666 MUCINEX COLD LIQ SINUS 12/31/9999 2<strong>01</strong>23638240<strong>01</strong>466 MUCINEX CONG LIQ COUGH 12/31/9999 2<strong>01</strong>2363824004124 MUCINEX D TAB 120-1200 12/31/9999 2<strong>01</strong>2363824005718 MUCINEX D TAB 60-600MG 12/31/9999 2<strong>01</strong>2363824005736 MUCINEX D TAB 60-600MG 12/31/9999 2<strong>01</strong>23638240<strong>01</strong>866 MUCINEX DM LIQ 20-400 12/31/9999 2<strong>01</strong>2363824005620 MUCINEX DM TAB 30-600ER 12/31/9999 2<strong>01</strong>2363824005632 MUCINEX DM TAB 30-600ER 12/31/9999 2<strong>01</strong>2363824005634 MUCINEX DM TAB 30-600ER 12/31/9999 2<strong>01</strong>2363824005640 MUCINEX DM TAB 30-600ER 12/31/9999 2<strong>01</strong>2363824007214 MUCINEX DM TAB 60-1200 12/31/9999 2<strong>01</strong>2363824007228 MUCINEX DM TAB 60-1200 12/31/9999 2<strong>01</strong>2363824007235 MUCINEX DM TAB 60-1200 12/31/9999 2<strong>01</strong>2363824007236 MUCINEX DM TAB 60-1200 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>2275 MUCINEX NASL SPR 0.05% 12/31/9999 2<strong>01</strong>2363824<strong>01</strong>2375 MUCINEX NASL SPR 0.05% 12/31/9999 2<strong>01</strong>2363824025412 MUCINEX/KIDS GRA 100MG 12/31/9999 2<strong>01</strong>2363824025312 MUCINEX/KIDS GRA 50MG 12/31/9999 2<strong>01</strong>2363824027364 MUCINEX/KIDS LIQ 100/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>13028826 MUCUS RELIEF LIQ 100/5ML 12/31/9999 2<strong>01</strong>2324385098226 MUCUS RELIEF LIQ 100/5ML 12/31/9999 2<strong>01</strong>2336800028826 MUCUS RELIEF LIQ 100/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>13041926 MUCUS RELIEF LIQ 5-100MG 12/31/9999 2<strong>01</strong>23

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