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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1198008<strong>01</strong>03 OCUFEN SOL 0.03% OP 12/31/9999 2<strong>01</strong>2311980077905 OCUFLOX DRO 0.3% OP 12/31/9999 2<strong>01</strong>2316571<strong>01</strong>3<strong>01</strong>1 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2316571<strong>01</strong>3050 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2317478071310 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2317478071311 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2324208043405 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2324208043410 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2350383002405 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2350383002410 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2360505056000 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>23605050560<strong>01</strong> OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>23613140<strong>01</strong>205 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>23613140<strong>01</strong>210 OFLOXACIN DRO 0.3% OP 12/31/9999 2<strong>01</strong>2324208041005 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>2324208041<strong>01</strong>0 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>2350383002505 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>2350383002510 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>23605050363<strong>01</strong> OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>2360505036302 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>23613140<strong>01</strong>505 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>23613140<strong>01</strong>510 OFLOXACIN DRO 0.3%OTIC 12/31/9999 2<strong>01</strong>23000937180<strong>01</strong> OFLOXACIN TAB 200MG 12/31/9999 2<strong>01</strong>23000937181<strong>01</strong> OFLOXACIN TAB 300MG 12/31/9999 2<strong>01</strong>23000937182<strong>01</strong> OFLOXACIN TAB 400MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>62<strong>01</strong> OFLOXACIN TAB 400MG 07/31/2<strong>01</strong>3 2<strong>01</strong>2352544084828 OGESTREL TAB 12/31/9999 2<strong>01</strong>2300093550656 OLANZA/FLUOX CAP 12-25MG 12/31/9999 2<strong>01</strong>2300093550756 OLANZA/FLUOX CAP 12-50MG 12/31/9999 2<strong>01</strong>2300093550456 OLANZA/FLUOX CAP 6-25MG 12/31/9999 2<strong>01</strong>2300093550556 OLANZA/FLUOX CAP 6-50MG 12/31/9999 2<strong>01</strong>23005170955<strong>01</strong> OLANZAPINE INJ 10MG 12/31/9999 2<strong>01</strong>2300781315972 OLANZAPINE INJ 10MG 12/31/9999 2<strong>01</strong>23000935770<strong>01</strong> OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2300093577<strong>01</strong>0 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2300093577056 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2300378545491 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2300904628561 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>54<strong>01</strong> OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>5420 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>6605 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>6630 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2359762<strong>01</strong>08<strong>01</strong> OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2360505311303 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2362756055418 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2362756055483 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2362756055488 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2365862056430 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2365862056499 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2366993005005 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2366993005030 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2366993046330 OLANZAPINE TAB 10MG 12/31/9999 2<strong>01</strong>2300093524665 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2313668008830 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2349884032155 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2355111026381 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2360505327600 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2360505327603 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2362756075464 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>2366993005430 OLANZAPINE TAB 10MG ODT 12/31/9999 2<strong>01</strong>23

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