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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24090041008 NITROMIST AER 400MCG 12/31/9999 2<strong>01</strong>23004093024<strong>01</strong> NITROPRESS INJ 25MG/ML 12/31/9999 2<strong>01</strong>2300071041724 NITROSTAT SUB 0.3MG 12/31/9999 2<strong>01</strong>2300071041813 NITROSTAT SUB 0.4MG 12/31/9999 2<strong>01</strong>2300071041824 NITROSTAT SUB 0.4MG 12/31/9999 2<strong>01</strong>2300071041924 NITROSTAT SUB 0.6MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>5005 NIZATIDINE CAP 150MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>5060 NIZATIDINE CAP 150MG 12/31/9999 2<strong>01</strong>2300378515005 NIZATIDINE CAP 150MG 08/31/2<strong>01</strong>3 2<strong>01</strong>2300378515091 NIZATIDINE CAP 150MG 12/31/9999 2<strong>01</strong>2300591313760 NIZATIDINE CAP 150MG 12/31/9999 2<strong>01</strong>2355111031005 NIZATIDINE CAP 150MG 09/30/2<strong>01</strong>4 2<strong>01</strong>2355111031060 NIZATIDINE CAP 150MG <strong>01</strong>/13/2<strong>01</strong>4 2<strong>01</strong>2360505023004 NIZATIDINE CAP 150MG 12/31/9999 2<strong>01</strong>2368462042560 NIZATIDINE CAP 150MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850300<strong>01</strong> NIZATIDINE CAP 300MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85030030 NIZATIDINE CAP 300MG 12/31/9999 2<strong>01</strong>2300378530093 NIZATIDINE CAP 300MG 12/31/9999 2<strong>01</strong>2300591313830 NIZATIDINE CAP 300MG 12/31/9999 2<strong>01</strong>2355111031130 NIZATIDINE CAP 300MG 07/31/2<strong>01</strong>3 2<strong>01</strong>23605050231<strong>01</strong> NIZATIDINE CAP 300MG 12/31/9999 2<strong>01</strong>2368462042630 NIZATIDINE CAP 300MG 12/31/9999 2<strong>01</strong>2310572<strong>01</strong>4762 NIZATIDINE SOL 15MG/ML 12/31/9999 2<strong>01</strong>2365162065990 NIZATIDINE SOL 15MG/ML 12/31/9999 2<strong>01</strong>2350458068008 NIZORAL SHA 2% 12/31/9999 2<strong>01</strong>2351552115806 N-JELLY GEL 12/31/9999 2<strong>01</strong>2300067207<strong>01</strong>6 NO DOZ TAB 200MG 12/31/9999 2<strong>01</strong>2300067207036 NO DOZ TAB 200MG 12/31/9999 2<strong>01</strong>2300067207060 NO DOZ TAB 200MG 12/31/9999 2<strong>01</strong>2336800038810 NO DRIP NASL SPR 0.05% 12/31/9999 2<strong>01</strong>2337205033610 NO DRIP NASL SPR 0.05% 12/31/9999 2<strong>01</strong>2368047<strong>01</strong>73<strong>01</strong> NOHIST TAB 3-10MG 12/31/9999 2<strong>01</strong>2368047<strong>01</strong>8616 NOHIST-DM LIQ 12/31/9999 2<strong>01</strong>2368047<strong>01</strong>8516 NOHIST-LQ LIQ 4-10/5ML 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>5824 NON-ASA JR TAB 160MG 12/31/9999 2<strong>01</strong>2363868099030 NON-ASPIRIN CHW 80MG 12/31/9999 2<strong>01</strong>2363868099130 NON-ASPIRIN CHW 80MG 12/31/9999 2<strong>01</strong>23638680837<strong>01</strong> NON-ASPIRIN DRO 80/0.8ML 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>7526 NON-ASPIRIN SUS 160/5ML 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>7626 NON-ASPIRIN SUS 160/5ML 12/31/9999 2<strong>01</strong>2363868009050 NON-ASPIRIN TAB 25-500MG 12/31/9999 2<strong>01</strong>2315127007208 NON-ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2315127007224 NON-ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2363868031410 NON-ASPIRIN TAB 325MG 12/31/9999 2<strong>01</strong>2315127072<strong>01</strong>3 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2315127073006 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2315127073021 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2315127073508 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2315127073509 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2315127073516 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>23638680088<strong>01</strong> NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868008803 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868008824 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868008850 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868031510 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868031560 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868050350 NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>23638680507<strong>01</strong> NON-ASPIRIN TAB 500MG 12/31/9999 2<strong>01</strong>2363868098750 NON-ASPIRIN TAB 500MG/RR 12/31/9999 2<strong>01</strong>2363868008905 NON-ASPIRIN TAB 650MG 12/31/9999 2<strong>01</strong>23

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