Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

00004035009 PEGASYS INJ 180MCG/M 12/31/9999 2012300004036030 PEGASYS INJ PROCLICK 12/31/9999 2012300004036530 PEGASYS INJ PROCLICK 12/31/9999 2012300004035239 PEGASYS KIT 07/13/2014 2012300085129701 PEG-INTRON KIT 120 RP 12/31/9999 2012300085129702 PEG-INTRON KIT 120 RP 12/31/9999 2012300085130401 PEG-INTRON KIT 120MCG 12/31/9999 2012300085137001 PEG-INTRON KIT 150 RP 12/31/9999 2012300085137002 PEG-INTRON KIT 150 RP 12/31/9999 2012300085127901 PEG-INTRON KIT 150MCG 12/31/9999 2012300085136801 PEG-INTRON KIT 50MCG 12/31/9999 2012300085132301 PEG-INTRON KIT 50MCG RP 12/31/9999 2012300085132302 PEG-INTRON KIT 50MCG RP 12/31/9999 2012300085129101 PEG-INTRON KIT 80MCG 12/31/9999 2012300085131601 PEG-INTRON KIT 80MCG RP 12/31/9999 2012300085131602 PEG-INTRON KIT 80MCG RP 12/31/9999 2012368047032116 PE-HIST DM SYP 5-2-15MG 12/31/9999 2012351552128605 PEMOLINE POW 12/31/9999 2012360793013010 PEN G PROC INJ 600000 12/31/9999 2012360793013110 PEN G PROC INJ 600000 12/31/9999 2012300781615394 PEN G SOD INJ 5000000 12/31/9999 2012300781615395 PEN G SOD INJ 5000000 12/31/9999 2012300338102141 PENICILL GK/ INJ DEX 1MU 12/31/9999 2012300338102341 PENICILL GK/ INJ DEX 2MU 12/31/9999 2012300338102541 PENICILL GK/ INJ DEX 3MU 12/31/9999 2012300781613694 PENICILLN GK INJ 20MU 12/31/9999 2012300781613594 PENICILLN GK INJ 5MU 12/31/9999 2012300781613595 PENICILLN GK INJ 5MU 12/31/9999 2012363323032320 PENICILLN GK INJ 5MU 12/31/9999 2012300093412573 PENICILLN VK SOL 125/5ML 12/31/9999 2012300093412574 PENICILLN VK SOL 125/5ML 12/31/9999 2012367253020210 PENICILLN VK SOL 125/5ML 12/31/9999 2012367253020220 PENICILLN VK SOL 125/5ML 12/31/9999 2012300093412773 PENICILLN VK SOL 250/5ML 12/31/9999 2012300093412774 PENICILLN VK SOL 250/5ML 12/31/9999 2012367253020310 PENICILLN VK SOL 250/5ML 12/31/9999 2012367253020320 PENICILLN VK SOL 250/5ML 12/31/9999 2012300093117201 PENICILLN VK TAB 250MG 12/31/9999 2012300093117210 PENICILLN VK TAB 250MG 12/31/9999 2012300781120501 PENICILLN VK TAB 250MG 12/31/9999 2012300781120510 PENICILLN VK TAB 250MG 12/31/9999 2012316714023401 PENICILLN VK TAB 250MG 12/31/2020 2012316714023402 PENICILLN VK TAB 250MG 12/31/2020 2012359762153401 PENICILLN VK TAB 250MG 12/31/9999 2012359762153402 PENICILLN VK TAB 250MG 12/31/9999 2012365862017501 PENICILLN VK TAB 250MG 12/31/9999 2012365862017599 PENICILLN VK TAB 250MG 12/31/9999 2012367253020010 PENICILLN VK TAB 250MG 12/31/9999 2012367253020011 PENICILLN VK TAB 250MG 12/31/9999 2012300093117401 PENICILLN VK TAB 500MG 12/31/9999 2012300093117410 PENICILLN VK TAB 500MG 12/31/9999 2012300781165501 PENICILLN VK TAB 500MG 12/31/9999 2012300781165510 PENICILLN VK TAB 500MG 12/31/9999 2012316714023501 PENICILLN VK TAB 500MG 12/31/2020 2012316714023502 PENICILLN VK TAB 500MG 12/31/2020 2012359762153701 PENICILLN VK TAB 500MG 12/31/9999 2012359762153702 PENICILLN VK TAB 500MG 12/31/9999 2012359762153703 PENICILLN VK TAB 500MG 12/31/9999 2012365862017601 PENICILLN VK TAB 500MG 12/31/9999 2012365862017605 PENICILLN VK TAB 500MG 12/31/9999 20123