Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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0<strong>01</strong>35<strong>01</strong>5705 NICORETTE GUM 2MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5706 NICORETTE GUM 2MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5708 NICORETTE GUM 2MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>97<strong>01</strong> NICORETTE GUM 2MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>350241<strong>01</strong> NICORETTE GUM 2MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024102 NICORETTE GUM 2MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024103 NICORETTE GUM 2MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024106 NICORETTE GUM 2MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024108 NICORETTE GUM 2MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35046702 NICORETTE GUM 4MG CINN 12/31/9999 2<strong>01</strong>230<strong>01</strong>35046703 NICORETTE GUM 4MG CINN 12/31/9999 2<strong>01</strong>230<strong>01</strong>35046705 NICORETTE GUM 4MG CINN 12/31/9999 2<strong>01</strong>230<strong>01</strong>350226<strong>01</strong> NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35022602 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35022603 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35023004 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35023005 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35047502 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35047503 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35047507 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35047508 NICORETTE GUM 4MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5802 NICORETTE GUM 4MG ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5803 NICORETTE GUM 4MG ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5809 NICORETTE GUM 4MG ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5810 NICORETTE GUM 4MG ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5811 NICORETTE GUM 4MG ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>58<strong>01</strong> NICORETTE GUM 4MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5805 NICORETTE GUM 4MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5806 NICORETTE GUM 4MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5808 NICORETTE GUM 4MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>98<strong>01</strong> NICORETTE GUM 4MG REF 12/31/9999 2<strong>01</strong>230<strong>01</strong>350242<strong>01</strong> NICORETTE GUM 4MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024202 NICORETTE GUM 4MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024203 NICORETTE GUM 4MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024206 NICORETTE GUM 4MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024208 NICORETTE GUM 4MGFRUIT 12/31/9999 2<strong>01</strong>230<strong>01</strong>350510<strong>01</strong> NICORETTE LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051002 NICORETTE LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051005 NICORETTE LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350512<strong>01</strong> NICORETTE LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051205 NICORETTE LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051403 NICORETTE LOZ 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350511<strong>01</strong> NICORETTE LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051102 NICORETTE LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051105 NICORETTE LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350513<strong>01</strong> NICORETTE LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051305 NICORETTE LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35051503 NICORETTE LOZ 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050802 NICORETTE LOZ MINI 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050803 NICORETTE LOZ MINI 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050902 NICORETTE LOZ MINI 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050903 NICORETTE LOZ MINI 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35022502 NICORETTE ST GUM 2MG MINT 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5707 NICORETTE ST GUM 2MG ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>9802 NICORETTE ST GUM 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5807 NICORETTE ST GUM 4MG ORIG 12/31/9999 2<strong>01</strong>2342192030860 NICOTINAMIDE TAB ZN/CU/FA 12/31/9999 2<strong>01</strong>2342546091760 NICOTINAMIDE TAB ZN/CU/FA 10/31/2<strong>01</strong>4 2<strong>01</strong>2300067021407 NICOTINE DIS 14MG/24H 12/31/9999 2<strong>01</strong>2300067489007 NICOTINE DIS 14MG/24H 12/31/9999 2<strong>01</strong>23
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