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 ...

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0<strong>01</strong>85071405 ORPHEN CPD TAB DS 12/31/9999 2<strong>01</strong>230<strong>01</strong>85071410 ORPHEN CPD TAB DS 12/31/9999 2<strong>01</strong>2300591322247 ORPHENADRINE INJ 30MG/ML 12/31/9999 2<strong>01</strong>2317478053802 ORPHENADRINE INJ 30MG/ML 12/31/9999 2<strong>01</strong>2325021065102 ORPHENADRINE INJ 30MG/ML 12/31/9999 2<strong>01</strong>2355390005910 ORPHENADRINE INJ 30MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>152<strong>01</strong>1<strong>01</strong> ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>152<strong>01</strong>102 ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>850022<strong>01</strong> ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>85002210 ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>2343386048024 ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>2343386048026 ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>2343386048028 ORPHENADRINE TAB 100MG ER 12/31/9999 2<strong>01</strong>2300603763417 ORSYTHIA TAB 12/31/9999 2<strong>01</strong>2300603763449 ORSYTHIA TAB 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>92<strong>01</strong> ORTHO EVRA DIS WEEK 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>9215 ORTHO EVRA DIS WEEK 12/31/9999 2<strong>01</strong>2300062141116 ORTHO MICRON TAB 0.35MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2350458<strong>01</strong>9416 ORTHO MICRON TAB 0.35MG 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>9115 ORTHO TRI- TAB CYCLEN 12/31/9999 2<strong>01</strong>2300062125115 ORTHO TRI- TAB CYCLN LO 11/30/2<strong>01</strong>2 2<strong>01</strong>2350458025115 ORTHO TRI- TAB CYCLN LO 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>9615 ORTHO-CEPT TAB 28 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>9715 ORTHO-CYCLEN TAB 0.25/35 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>7615 ORTHO-NOVUM TAB 1/35-28 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>7815 ORTHO-NOVUM TAB 7/7/7-28 12/31/9999 2<strong>01</strong>2350458<strong>01</strong>7820 ORTHO-NOVUM TAB 7/7/7-28 12/31/9999 2<strong>01</strong>23680470253<strong>01</strong> OSCIMIN SUB 0.125MG 12/31/9999 2<strong>01</strong>23680470252<strong>01</strong> OSCIMIN TAB 0.125MG 12/31/9999 2<strong>01</strong>23680470254<strong>01</strong> OSCIMIN TAB 0.125MG 12/31/9999 2<strong>01</strong>23680470255<strong>01</strong> OSCIMIN SR TAB 0.375MG 12/31/9999 2<strong>01</strong>2300338035303 OSMITROL INJ 10% 12/31/9999 2<strong>01</strong>2300338035503 OSMITROL INJ 15% 12/31/9999 2<strong>01</strong>2300338035104 OSMITROL INJ 5% 12/31/9999 2<strong>01</strong>2300338035702 OSMITROL VFX INJ 20% 12/31/9999 2<strong>01</strong>2300338035703 OSMITROL VFX INJ 20% 12/31/9999 2<strong>01</strong>236564907<strong>01</strong>41 OSMOPREP TAB 1.5GM 12/31/9999 2<strong>01</strong>2368047005110 OTO-END 10 SOL 12/31/9999 2<strong>01</strong>2328595042020 OTOZIN DRO 12/31/9999 2<strong>01</strong>2300430058545 OVCON 50 TAB 28 12/31/2<strong>01</strong>2 2<strong>01</strong>2300430058045 OVCON-35 TAB 12/31/9999 2<strong>01</strong>2351672527604 OVIDE LOT 0.5% 12/31/9999 2<strong>01</strong>23440871150<strong>01</strong> OVIDREL INJ 12/31/9999 2<strong>01</strong>2324385047210 OVULATION PR KIT ONE STEP 12/31/9999 2<strong>01</strong>2300781310346 OXACILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2300781310395 OXACILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2300781911346 OXACILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2300781911395 OXACILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>6399 OXACILLIN INJ 10GM 12/31/9999 2<strong>01</strong>2300781309415 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781309492 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781309985 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781309995 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781910995 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781911<strong>01</strong>5 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781911092 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>4610 OXACILLIN INJ 1GM 12/31/9999 2<strong>01</strong>2300781309515 OXACILLIN INJ 2GM 12/31/9999 2<strong>01</strong>2300781309592 OXACILLIN INJ 2GM 12/31/9999 2<strong>01</strong>230078131<strong>01</strong>80 OXACILLIN INJ 2GM 12/31/9999 2<strong>01</strong>23

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