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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00781940295 AMPICILLIN INJ 250MG 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3410 AMPICILLIN INJ 250MG 12/31/9999 2<strong>01</strong>2363323038710 AMPICILLIN INJ 250MG 12/31/9999 2<strong>01</strong>2300069006525 AMPICILLIN INJ 2GM 10/31/2<strong>01</strong>3 2<strong>01</strong>2300069006530 AMPICILLIN INJ 2GM 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781340880 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781340895 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781341315 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781341392 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781940880 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781940895 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781941315 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781941392 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3720 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2363323039923 AMPICILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300069007128 AMPICILLIN INJ 500MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300069007135 AMPICILLIN INJ 500MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781340778 AMPICILLIN INJ 500MG 12/31/9999 2<strong>01</strong>2300781340795 AMPICILLIN INJ 500MG 12/31/9999 2<strong>01</strong>2300781940778 AMPICILLIN INJ 500MG 12/31/9999 2<strong>01</strong>2300781940795 AMPICILLIN INJ 500MG 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>3510 AMPICILLIN INJ 500MG 12/31/9999 2<strong>01</strong>2363323038810 AMPICILLIN INJ 500MG 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8210 AMPICILLIN SUS 125/5ML 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8220 AMPICILLIN SUS 125/5ML 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8310 AMPICILLIN SUS 250/5ML 12/31/9999 2<strong>01</strong>2367253<strong>01</strong>8320 AMPICILLIN SUS 250/5ML 12/31/9999 2<strong>01</strong>23004092689<strong>01</strong> AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>2300409268911 AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>23004092988<strong>01</strong> AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>23006416116<strong>01</strong> AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>2300641611610 AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>23006416119<strong>01</strong> AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>2300641611910 AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>2300781303295 AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>231<strong>01</strong>39007<strong>01</strong>1 AMP-SULBACTA INJ 1.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90631<strong>01</strong> AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063131 AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90634<strong>01</strong> AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063431 AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90636<strong>01</strong> AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063631 AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>4220 AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2363323036820 AMP-SULBACTA INJ 1-0.5GM 12/31/9999 2<strong>01</strong>2300409268715 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>23006416118<strong>01</strong> AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2300781303446 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063203 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063215 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063503 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063515 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063803 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063815 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>4499 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2363323037062 AMP-SULBACTA INJ 15GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063002 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063033 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063302 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063333 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9063702 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>23

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