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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00407141490 OMNIPAQUE INJ 350MG/ML 12/31/9999 2<strong>01</strong>2300407141491 OMNIPAQUE INJ 350MG/ML 12/31/9999 2<strong>01</strong>2300407141493 OMNIPAQUE INJ 350MG/ML 12/31/9999 2<strong>01</strong>2300407141494 OMNIPAQUE INJ 350MG/ML 12/31/9999 2<strong>01</strong>2300407141498 OMNIPAQUE INJ 350MG/ML 12/31/9999 2<strong>01</strong>2300065063825 OMNIPRED SUS 1% OP 12/31/9999 2<strong>01</strong>2300065063827 OMNIPRED SUS 1% OP 12/31/9999 2<strong>01</strong>2300407069162 OMNISCAN INJ /NACL 12/31/9999 2<strong>01</strong>2300407069163 OMNISCAN INJ /NACL 12/31/9999 2<strong>01</strong>2300407069005 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069<strong>01</strong>0 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069<strong>01</strong>2 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069<strong>01</strong>5 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069<strong>01</strong>7 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069020 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069022 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069030 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069040 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069042 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069043 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069050 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300407069070 OMNISCAN INJ 287MG/ML 12/31/9999 2<strong>01</strong>2300781300407 OMNITROPE INJ 10/1.5ML 12/31/9999 2<strong>01</strong>2300781300426 OMNITROPE INJ 10/1.5ML 12/31/9999 2<strong>01</strong>2300781400436 OMNITROPE INJ 5.8MG 12/31/9999 2<strong>01</strong>230078130<strong>01</strong>07 OMNITROPE INJ 5/1.5ML 12/31/9999 2<strong>01</strong>230078130<strong>01</strong>26 OMNITROPE INJ 5/1.5ML 12/31/9999 2<strong>01</strong>2364764061<strong>01</strong>0 OMONTYS INJ 10MG/ML 12/31/9999 2<strong>01</strong>2364764062020 OMONTYS INJ 20MG/2ML 12/31/9999 2<strong>01</strong>235448203<strong>01</strong><strong>01</strong> ONCASPAR INJ 750/ML 12/31/9999 2<strong>01</strong>23621070039<strong>01</strong> ONCE DAILY TAB 12/31/9999 2<strong>01</strong>2362107003910 ONCE DAILY TAB 12/31/9999 2<strong>01</strong>23621070040<strong>01</strong> ONCE DAILY TAB IRON 12/31/9999 2<strong>01</strong>2362107004<strong>01</strong>0 ONCE DAILY TAB IRON 12/31/9999 2<strong>01</strong>230<strong>01</strong>43977106 ONDANSETRON INJ 32/50ML 12/31/9999 2<strong>01</strong>2300409476024 ONDANSETRON INJ 32/50ML 12/31/9999 2<strong>01</strong>2300703723939 ONDANSETRON INJ 32/50ML 12/31/9999 2<strong>01</strong>23553900234<strong>01</strong> ONDANSETRON INJ 32/50ML 12/31/9999 2<strong>01</strong>2300069134002 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>439890<strong>01</strong> ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>23004094759<strong>01</strong> ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>23006416079<strong>01</strong> ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>23007037226<strong>01</strong> ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2300703722603 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9090603 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9090605 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9090663 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2355390<strong>01</strong>21<strong>01</strong> ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2360505074406 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2363323037420 ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>23646790727<strong>01</strong> ONDANSETRON INJ 40/20ML 12/31/9999 2<strong>01</strong>2300069134005 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>2300069134<strong>01</strong>6 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>43989105 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>43989125 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>2300409112<strong>01</strong>2 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>2300409112062 ONDANSETRON INJ 4MG/2ML 03/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2300409475503 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>23006416078<strong>01</strong> ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>2300641607825 ONDANSETRON INJ 4MG/2ML 12/31/9999 2<strong>01</strong>23

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