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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68025004830 OB COMPLETE CAP 400 12/31/9999 2<strong>01</strong>2368025004430 OB COMPLETE CAP ONE 12/31/9999 2<strong>01</strong>2368025005930 OB COMPLETE CAP PETITE 12/31/9999 2<strong>01</strong>2368025003930 OB COMPLETE CHW 12/31/9999 2<strong>01</strong>23680250<strong>01</strong><strong>01</strong>0 OB COMPLETE TAB 12/31/9999 2<strong>01</strong>2368025004330 OB COMPLETE TAB PREMIER 12/31/9999 2<strong>01</strong>2368025004960 OB COMPLETE/ CAP DHA 12/31/9999 2<strong>01</strong>23008130202<strong>01</strong> O-CAL TAB PRENATAL 12/31/9999 2<strong>01</strong>23008139316<strong>01</strong> O-CAL FA TAB 12/31/9999 2<strong>01</strong>23002560211<strong>01</strong> OCEAN KIDS SPR 0.65% 12/31/9999 2<strong>01</strong>230<strong>01</strong>875260<strong>01</strong> OCEAN NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2300256<strong>01</strong>52<strong>01</strong> OCEAN NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2300256<strong>01</strong>5218 OCEAN NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2300256<strong>01</strong>5225 OCEAN NASAL SPR 0.65% 04/30/2<strong>01</strong>4 2<strong>01</strong>2300555913167 OCELLA TAB 3-0.03MG 12/31/9999 2<strong>01</strong>2300555913179 OCELLA TAB 3-0.03MG 12/31/9999 2<strong>01</strong>2367467084304 OCTAGAM INJ 10GM 12/31/9999 2<strong>01</strong>2368209084304 OCTAGAM INJ 10GM 12/31/9999 2<strong>01</strong>23674670843<strong>01</strong> OCTAGAM INJ 1GM 12/31/9999 2<strong>01</strong>23682090843<strong>01</strong> OCTAGAM INJ 1GM 12/31/9999 2<strong>01</strong>2367467084302 OCTAGAM INJ 2.5GM 12/31/9999 2<strong>01</strong>2368209084302 OCTAGAM INJ 2.5GM 12/31/9999 2<strong>01</strong>2367467084305 OCTAGAM INJ 25GM 12/31/9999 2<strong>01</strong>2367467084303 OCTAGAM INJ 5GM 12/31/9999 2<strong>01</strong>2368209084303 OCTAGAM INJ 5GM 12/31/9999 2<strong>01</strong>23007033343<strong>01</strong> OCTREOTIDE INJ 1000MCG 12/31/9999 2<strong>01</strong>2300781316475 OCTREOTIDE INJ 1000MCG 12/31/9999 2<strong>01</strong>2300781916475 OCTREOTIDE INJ 1000MCG 06/29/2<strong>01</strong>4 2<strong>01</strong>2355390<strong>01</strong>64<strong>01</strong> OCTREOTIDE INJ 1000MCG 12/31/9999 2<strong>01</strong>23553900377<strong>01</strong> OCTREOTIDE INJ 1000MCG 12/31/9999 2<strong>01</strong>2362756035240 OCTREOTIDE INJ 1000MCG 12/31/9999 2<strong>01</strong>2363323037905 OCTREOTIDE INJ 1000MCG 12/31/9999 2<strong>01</strong>23007033311<strong>01</strong> OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>2300703331104 OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>2300781916795 OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>6110 OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>2355390037510 OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>2362756034944 OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>23633230376<strong>01</strong> OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>23674570245<strong>01</strong> OCTREOTIDE INJ 100MCG 12/31/9999 2<strong>01</strong>23007033333<strong>01</strong> OCTREOTIDE INJ 200MCG 12/31/9999 2<strong>01</strong>2300781316575 OCTREOTIDE INJ 200MCG 12/31/9999 2<strong>01</strong>2300781916575 OCTREOTIDE INJ 200MCG 11/17/2<strong>01</strong>4 2<strong>01</strong>2355390<strong>01</strong>63<strong>01</strong> OCTREOTIDE INJ 200MCG 12/31/9999 2<strong>01</strong>2362756035040 OCTREOTIDE INJ 200MCG 12/31/9999 2<strong>01</strong>2363323037805 OCTREOTIDE INJ 200MCG 12/31/9999 2<strong>01</strong>23007033321<strong>01</strong> OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>2300703332104 OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>2300781916895 OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>6210 OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>2355390037610 OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>2362756035144 OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>23633230377<strong>01</strong> OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>23674570246<strong>01</strong> OCTREOTIDE INJ 500MCG 12/31/9999 2<strong>01</strong>230070333<strong>01</strong>04 OCTREOTIDE INJ 50MCG/ML 12/31/9999 2<strong>01</strong>2300781916695 OCTREOTIDE INJ 50MCG/ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>6<strong>01</strong>0 OCTREOTIDE INJ 50MCG/ML 12/31/9999 2<strong>01</strong>2362756034844 OCTREOTIDE INJ 50MCG/ML 12/31/9999 2<strong>01</strong>23633230365<strong>01</strong> OCTREOTIDE INJ 50MCG/ML 12/31/9999 2<strong>01</strong>23674570239<strong>01</strong> OCTREOTIDE INJ 50MCG/ML 12/31/9999 2<strong>01</strong>23

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