Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

00168008160 NYSTAT/TRIAM CRE 12/31/9999 2012351672126301 NYSTAT/TRIAM CRE 12/31/9999 2012351672126302 NYSTAT/TRIAM CRE 12/31/9999 2012351672126303 NYSTAT/TRIAM CRE 12/31/9999 2012300168008915 NYSTAT/TRIAM OIN 12/31/9999 2012300168008930 NYSTAT/TRIAM OIN 12/31/9999 2012300168008960 NYSTAT/TRIAM OIN 12/31/9999 2012351672127201 NYSTAT/TRIAM OIN 12/31/9999 2012351672127202 NYSTAT/TRIAM OIN 12/31/9999 2012351672127203 NYSTAT/TRIAM OIN 12/31/9999 2012300168005415 NYSTATIN CRE 100000 12/31/9999 2012300168005430 NYSTATIN CRE 100000 12/31/9999 2012300472016315 NYSTATIN CRE 100000 12/31/9999 2012300472016330 NYSTATIN CRE 100000 12/31/9999 2012300603781874 NYSTATIN CRE 100000 12/31/9999 2012300603781878 NYSTATIN CRE 100000 12/31/9999 2012345802005911 NYSTATIN CRE 100000 12/31/9999 2012345802005935 NYSTATIN CRE 100000 12/31/9999 2012351672128901 NYSTATIN CRE 100000 12/31/9999 2012351672128902 NYSTATIN CRE 100000 12/31/9999 2012300168000715 NYSTATIN OIN 100000 12/31/9999 2012300168000730 NYSTATIN OIN 100000 12/31/9999 2012300472016615 NYSTATIN OIN 100000 12/31/9999 2012300472016630 NYSTATIN OIN 100000 12/31/9999 2012345802004811 NYSTATIN OIN 100000 12/31/9999 2012345802004835 NYSTATIN OIN 100000 12/31/9999 2012300574040405 NYSTATIN POW 12/31/9999 2012300574040415 NYSTATIN POW 12/31/9999 2012300574040450 NYSTATIN POW 12/31/9999 2012368308015215 NYSTATIN POW 100000 12/31/9999 2012368308015230 NYSTATIN POW 100000 12/31/9999 2012368308015260 NYSTATIN POW 100000 12/31/9999 2012300121478505 NYSTATIN SUS 100000 12/31/9999 2012300603148149 NYSTATIN SUS 100000 12/31/9999 2012300603148158 NYSTATIN SUS 100000 12/31/9999 2012350383058716 NYSTATIN SUS 100000 12/31/9999 2012350383058766 NYSTATIN SUS 100000 12/31/9999 2012351672411704 NYSTATIN SUS 100000 12/31/9999 2012351672411709 NYSTATIN SUS 100000 12/31/9999 2012360432053716 NYSTATIN SUS 100000 12/31/9999 2012360432053760 NYSTATIN SUS 100000 12/31/9999 2012366689003701 NYSTATIN SUS 100000 12/31/9999 2012366689003750 NYSTATIN SUS 100000 12/31/9999 2012366689003799 NYSTATIN SUS 100000 12/31/9999 2012368094059958 NYSTATIN SUS 100000 12/31/9999 2012368094059959 NYSTATIN SUS 100000 12/31/9999 2012368094059961 NYSTATIN SUS 100000 12/31/9999 2012368094059962 NYSTATIN SUS 100000 12/31/9999 2012300093098301 NYSTATIN TAB 500000 12/31/9999 2012323155005101 NYSTATIN TAB 500000 12/31/9999 2012353489040001 NYSTATIN TAB 500000 12/31/9999 2012351285053422 NYSTATIN VAG TAB 100000 12/31/9999 2012300574200802 NYSTOP POW 100000 12/31/9999 2012300574200815 NYSTOP POW 100000 12/31/9999 2012300574200830 NYSTOP POW 100000 12/31/9999 2012310158004302 NYTOL TAB 25MG 12/31/9999 2012310158004304 NYTOL TAB 25MG 12/31/9999 2012310158004306 NYTOL TAB 25MG 12/31/9999 2012310158004201 NYTOL MX-STR TAB 50MG 12/31/9999 2012300135044501 OASIS SPR 12/31/9999 20123