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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10<strong>01</strong>9063733 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>4330 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2363323036920 AMP-SULBACTA INJ 2-1GM 12/31/9999 2<strong>01</strong>2300409298703 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>2300409298713 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>2300409299803 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>23006416117<strong>01</strong> AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>2300641611710 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>23006416120<strong>01</strong> AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>2300641612<strong>01</strong>0 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>2300781303370 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>2300781303395 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>231<strong>01</strong>39007110 AMP-SULBACTA INJ 3GM 12/31/9999 2<strong>01</strong>231<strong>01</strong>44042760 AMPYRA TAB 10MG 12/31/9999 2<strong>01</strong>2363459070060 AMRIX CAP 15MG 12/31/9999 2<strong>01</strong>236345907<strong>01</strong>60 AMRIX CAP 30MG 12/31/9999 2<strong>01</strong>2300078061<strong>01</strong>5 AMTURNIDE150 TAB -5-12.5 12/31/9999 2<strong>01</strong>2300078061315 AMTURNIDE300 TAB -10-12.5 12/31/9999 2<strong>01</strong>2300078061415 AMTURNIDE300 TAB -10-25MG 12/31/9999 2<strong>01</strong>2300078061115 AMTURNIDE300 TAB -5-12.5 12/31/9999 2<strong>01</strong>2300078061215 AMTURNIDE300 TAB -5-25MG 12/31/9999 2<strong>01</strong>2339822995002 AMYL NITRITE INH 0.3ML 12/31/9999 2<strong>01</strong>2351552074805 AMYLASE-A POW 12/31/9999 2<strong>01</strong>23429980303<strong>01</strong> AMYTAL SOD INJ 500MG 12/31/9999 2<strong>01</strong>23000021200<strong>01</strong> AMYVID INJ 12/31/9999 2<strong>01</strong>2310892<strong>01</strong>5310 ANABAR TAB 12/31/9999 2<strong>01</strong>2368220005510 ANADROL-50 TAB 50MG 12/31/9999 2<strong>01</strong>2300406990603 ANAFRANIL CAP 25MG 12/31/9999 2<strong>01</strong>2300406990703 ANAFRANIL CAP 50MG 12/31/9999 2<strong>01</strong>2300406990803 ANAFRANIL CAP 75MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72524160 ANAGRELIDE CAP 0.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>72524060 ANAGRELIDE CAP 1MG 12/31/9999 2<strong>01</strong>2300904585756 ANALGESIC CRE /ALOE 12/31/9999 2<strong>01</strong>230<strong>01</strong>68003631 ANALGESIC OIN BALM 12/31/9999 2<strong>01</strong>2300482480<strong>01</strong>4 ANAMANTLE HC CRE 12/31/9999 2<strong>01</strong>2300482480020 ANAMANTLE HC KIT 12/31/9999 2<strong>01</strong>23000046202<strong>01</strong> ANAPROX TAB 275MG 12/31/9999 2<strong>01</strong>23000046203<strong>01</strong> ANAPROX DS TAB 550MG 12/31/9999 2<strong>01</strong>2366621<strong>01</strong>50<strong>01</strong> ANASCORP INJ 12/31/9999 2<strong>01</strong>2300225029515 ANASPAZ TAB 0.125MG 12/31/9999 2<strong>01</strong>2300225029520 ANASPAZ TAB 0.125MG 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>6413 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2300093753656 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2300378603405 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2300378603477 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2300781535631 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2300904619546 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2316571042103 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2316729003510 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2316729003515 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2316729003516 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2342043<strong>01</strong>8003 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>23510790323<strong>01</strong> ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2351079032306 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2351991062<strong>01</strong>0 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2351991062033 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2355111064730 ANASTROZOLE TAB 1MG 02/28/2<strong>01</strong>4 2<strong>01</strong>2360505298503 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2362756025<strong>01</strong>3 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>2362756025083 ANASTROZOLE TAB 1MG 12/31/9999 2<strong>01</strong>23

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