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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003781650<strong>01</strong> NITROFUR MAC CAP 50MG 12/31/9999 2<strong>01</strong>2300378165005 NITROFUR MAC CAP 50MG 12/31/9999 2<strong>01</strong>23477810307<strong>01</strong> NITROFUR MAC CAP 50MG 12/31/9999 2<strong>01</strong>23510790584<strong>01</strong> NITROFUR MAC CAP 50MG 12/31/9999 2<strong>01</strong>2351079058420 NITROFUR MAC CAP 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>22<strong>01</strong> NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>2210 NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>23003783422<strong>01</strong> NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>23477810303<strong>01</strong> NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>23510790348<strong>01</strong> NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>2351079034820 NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>23633040518<strong>01</strong> NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>23680840446<strong>01</strong> NITROFURANTN CAP 100MG 12/31/9999 2<strong>01</strong>2365162068988 NITROFURANTN SUS 25MG/5ML 12/31/9999 2<strong>01</strong>2366993047173 NITROFURANTN SUS 25MG/5ML 12/31/9999 2<strong>01</strong>2300409148302 NITROGLY/D5W INJ 12/31/9999 2<strong>01</strong>2300409148303 NITROGLY/D5W INJ 12/31/9999 2<strong>01</strong>2300338105102 NITROGLY/D5W INJ 100MG 12/31/9999 2<strong>01</strong>2300409148402 NITROGLY/D5W INJ 100MG 12/31/9999 2<strong>01</strong>2300338104702 NITROGLY/D5W INJ 25MG 12/31/9999 2<strong>01</strong>2300338104902 NITROGLY/D5W INJ 50MG 12/31/9999 2<strong>01</strong>2300409148202 NITROGLY/D5W INJ 50MG 12/31/9999 2<strong>01</strong>2300904064360 NITROGLYCER CAP 2.5MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>855174<strong>01</strong> NITROGLYCER CAP 2.5MG SR 12/31/9999 2<strong>01</strong>230<strong>01</strong>85517460 NITROGLYCER CAP 2.5MG SR 12/31/9999 2<strong>01</strong>230<strong>01</strong>851235<strong>01</strong> NITROGLYCER CAP 6.5MG CR 12/31/9999 2<strong>01</strong>230<strong>01</strong>85123560 NITROGLYCER CAP 6.5MG CR 12/31/9999 2<strong>01</strong>2300904064460 NITROGLYCER CAP 6.5MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>851217<strong>01</strong> NITROGLYCER CAP 9MG CR 12/31/9999 2<strong>01</strong>230<strong>01</strong>85121760 NITROGLYCER CAP 9MG CR 12/31/9999 2<strong>01</strong>2300904064752 NITROGLYCER CAP 9MG ER 12/31/9999 2<strong>01</strong>2300378910293 NITROGLYCER DIS 0.1MG/HR 12/31/9999 2<strong>01</strong>2347781029603 NITROGLYCER DIS 0.1MG/HR 12/31/9999 2<strong>01</strong>2300378910493 NITROGLYCER DIS 0.2MG/HR 12/31/9999 2<strong>01</strong>2300904549546 NITROGLYCER DIS 0.2MG/HR 12/31/9999 2<strong>01</strong>2347781029703 NITROGLYCER DIS 0.2MG/HR 12/31/9999 2<strong>01</strong>2349730<strong>01</strong>1130 NITROGLYCER DIS 0.2MG/HR 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>23<strong>01</strong> NITROGLYCER DIS 0.2MG/HR 12/31/9999 2<strong>01</strong>2300378911293 NITROGLYCER DIS 0.4MG/HR 12/31/9999 2<strong>01</strong>2300904549646 NITROGLYCER DIS 0.4MG/HR 12/31/9999 2<strong>01</strong>2347781029803 NITROGLYCER DIS 0.4MG/HR 12/31/9999 2<strong>01</strong>2349730<strong>01</strong>1230 NITROGLYCER DIS 0.4MG/HR 12/31/9999 2<strong>01</strong>2362175<strong>01</strong>24<strong>01</strong> NITROGLYCER DIS 0.4MG/HR 12/31/9999 2<strong>01</strong>2300378911693 NITROGLYCER DIS 0.6MG/HR 12/31/9999 2<strong>01</strong>2300904549746 NITROGLYCER DIS 0.6MG/HR 12/31/9999 2<strong>01</strong>2347781029903 NITROGLYCER DIS 0.6MG/HR 12/31/9999 2<strong>01</strong>2300517481025 NITROGLYCER INJ 5MG/ML 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>45<strong>01</strong> NITROGLYCER SUB 0.3MG 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>46<strong>01</strong> NITROGLYCER SUB 0.4MG 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>4625 NITROGLYCER SUB 0.4MG 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>4645 NITROGLYCER SUB 0.4MG 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>47<strong>01</strong> NITROGLYCER SUB 0.6MG 12/31/9999 2<strong>01</strong>2349730<strong>01</strong>1330 NITROGLYCERI DIS 0.6MG/HR 12/31/9999 2<strong>01</strong>2352536030020 NITROGLYCRN SPR LINGUAL 12/31/9999 2<strong>01</strong>2352536030065 NITROGLYCRN SPR LINGUAL 12/31/9999 2<strong>01</strong>2324338030020 NITROLINGUAL SPR PUMPSPRA 12/31/9999 2<strong>01</strong>2324338030065 NITROLINGUAL SPR PUMPSPRA 12/31/9999 2<strong>01</strong>2359630030020 NITROLINGUAL SPR PUMPSPRA 12/31/2<strong>01</strong>2 2<strong>01</strong>2359630030065 NITROLINGUAL SPR PUMPSPRA 12/31/2<strong>01</strong>2 2<strong>01</strong>2324090041004 NITROMIST AER 400MCG 12/31/9999 2<strong>01</strong>23

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