Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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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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00228306111 AMPHETAMINE CAP 30MG ER 12/31/9999 2<strong>01</strong>2300555078902 AMPHETAMINE CAP 30MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>151328<strong>01</strong> AMPHETAMINE CAP 5MG ER 12/31/9999 2<strong>01</strong>2300228306211 AMPHETAMINE CAP 5MG ER 12/31/9999 2<strong>01</strong>2300555079002 AMPHETAMINE CAP 5MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>11<strong>01</strong> AMPHETAMINE TAB 10MG 12/31/9999 2<strong>01</strong>2300555097202 AMPHETAMINE TAB 10MG 12/31/9999 2<strong>01</strong>2364720<strong>01</strong>3210 AMPHETAMINE TAB 10MG 12/31/9999 2<strong>01</strong>2300555077602 AMPHETAMINE TAB 12.5MG 12/31/9999 2<strong>01</strong>2300555077702 AMPHETAMINE TAB 15MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>8504<strong>01</strong><strong>01</strong> AMPHETAMINE TAB 20MG 12/31/9999 2<strong>01</strong>2300555097302 AMPHETAMINE TAB 20MG 12/31/9999 2<strong>01</strong>2364720<strong>01</strong>3510 AMPHETAMINE TAB 20MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850404<strong>01</strong> AMPHETAMINE TAB 30MG 12/31/9999 2<strong>01</strong>2300555097402 AMPHETAMINE TAB 30MG 12/31/9999 2<strong>01</strong>2364720<strong>01</strong>3610 AMPHETAMINE TAB 30MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850084<strong>01</strong> AMPHETAMINE TAB 5MG 12/31/9999 2<strong>01</strong>2300555097102 AMPHETAMINE TAB 5MG 12/31/9999 2<strong>01</strong>2364720<strong>01</strong>3<strong>01</strong>0 AMPHETAMINE TAB 5MG 12/31/9999 2<strong>01</strong>2300555077502 AMPHETAMINE TAB 7.5MG 12/31/9999 2<strong>01</strong>23664350302<strong>01</strong> AMPHOTEC INJ 100MG 12/31/9999 2<strong>01</strong>236643503<strong>01</strong>51 AMPHOTEC INJ 50MG 12/31/9999 2<strong>01</strong>2339822105505 AMPHOTERICIN INJ 50MG 12/31/9999 2<strong>01</strong>2339822105507 AMPHOTERICIN INJ 50MG 12/31/9999 2<strong>01</strong>23007812144<strong>01</strong> AMPICILLIN CAP 250MG 12/31/9999 2<strong>01</strong>2300781214405 AMPICILLIN CAP 250MG 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8<strong>01</strong>0 AMPICILLIN CAP 250MG 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8050 AMPICILLIN CAP 250MG 12/31/9999 2<strong>01</strong>23007812145<strong>01</strong> AMPICILLIN CAP 500MG 12/31/9999 2<strong>01</strong>2300781214505 AMPICILLIN CAP 500MG 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8110 AMPICILLIN CAP 500MG 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8150 AMPICILLIN CAP 500MG 12/31/9999 2<strong>01</strong>23000690026<strong>01</strong> AMPICILLIN INJ 10GM 10/31/2<strong>01</strong>3 2<strong>01</strong>2300069002605 AMPICILLIN INJ 10GM 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781340995 AMPICILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2300781940995 AMPICILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3899 AMPICILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2300069002710 AMPICILLIN INJ 125MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300069002712 AMPICILLIN INJ 125MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781340078 AMPICILLIN INJ 125MG 12/31/9999 2<strong>01</strong>2300781340095 AMPICILLIN INJ 125MG 12/31/9999 2<strong>01</strong>230078194<strong>01</strong>78 AMPICILLIN INJ 125MG 12/31/9999 2<strong>01</strong>230078194<strong>01</strong>95 AMPICILLIN INJ 125MG 12/31/9999 2<strong>01</strong>2300069002918 AMPICILLIN INJ 1GM 10/31/2<strong>01</strong>3 2<strong>01</strong>2300069002920 AMPICILLIN INJ 1GM 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781340485 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781340495 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781341215 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781341292 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781940485 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781940495 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781941215 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781941292 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3610 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2363323038910 AMPICILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300069004631 AMPICILLIN INJ 250MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300069004637 AMPICILLIN INJ 250MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781340278 AMPICILLIN INJ 250MG 12/31/9999 2<strong>01</strong>2300781340295 AMPICILLIN INJ 250MG 12/31/9999 2<strong>01</strong>2300781940278 AMPICILLIN INJ 250MG 12/31/9999 2<strong>01</strong>23

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