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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370000<strong>01</strong>903 PEPTO-BISMOL SUS 525/15ML 12/31/9999 2<strong>01</strong>2363481062970 PERCOCET TAB 10-325MG 12/31/9999 2<strong>01</strong>2363481062270 PERCOCET TAB 10-650MG 12/31/9999 2<strong>01</strong>2363481062770 PERCOCET TAB 2.5-325 12/31/9999 2<strong>01</strong>2363481062370 PERCOCET TAB 5-325MG 12/31/9999 2<strong>01</strong>2363481062375 PERCOCET TAB 5-325MG 12/31/9999 2<strong>01</strong>2363481062385 PERCOCET TAB 5-325MG 12/31/9999 2<strong>01</strong>2363481062870 PERCOCET TAB 7.5-325M 12/31/9999 2<strong>01</strong>2363481062170 PERCOCET TAB 7.5-500 12/31/9999 2<strong>01</strong>2363481<strong>01</strong>2170 PERCODAN TAB 12/31/9999 2<strong>01</strong>2300067602560 PERDIEM OVER TAB 15MG 12/31/9999 2<strong>01</strong>2349502060530 PERFOROMIST NEB 20MCG 12/31/9999 2<strong>01</strong>2349502060561 PERFOROMIST NEB 20MCG 12/31/9999 2<strong>01</strong>2367618<strong>01</strong>0610 PERI-COLACE TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2367618<strong>01</strong>0630 PERI-COLACE TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2367618<strong>01</strong>0660 PERI-COLACE TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2361924<strong>01</strong>98<strong>01</strong> PERIGIENE LIQ 12/31/9999 2<strong>01</strong>2361924<strong>01</strong>9808 PERIGIENE LIQ 12/31/9999 2<strong>01</strong>2361924020404 PERIGUARD OIN 12/31/9999 2<strong>01</strong>2361924020405 PERIGUARD OIN 12/31/9999 2<strong>01</strong>2361924020415 PERIGUARD OIN 12/31/9999 2<strong>01</strong>2361924020416 PERIGUARD OIN 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>1025 PERINDOPRIL TAB 2MG 12/31/9999 2<strong>01</strong>23658620286<strong>01</strong> PERINDOPRIL TAB 2MG 12/31/9999 2<strong>01</strong>23681800235<strong>01</strong> PERINDOPRIL TAB 2MG 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>1125 PERINDOPRIL TAB 4MG 12/31/9999 2<strong>01</strong>23658620287<strong>01</strong> PERINDOPRIL TAB 4MG 12/31/9999 2<strong>01</strong>23681800236<strong>01</strong> PERINDOPRIL TAB 4MG 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>1225 PERINDOPRIL TAB 8MG 12/31/9999 2<strong>01</strong>23658620288<strong>01</strong> PERINDOPRIL TAB 8MG 12/31/9999 2<strong>01</strong>23681800237<strong>01</strong> PERINDOPRIL TAB 8MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>26027116 PERIOGARD SOL 0.12% 12/31/9999 2<strong>01</strong>2363921050004 PERISHIELD OIN 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000904 PERI-WASH II LIQ 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000905 PERI-WASH II LIQ 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000909 PERI-WASH II LIQ 12/31/9999 2<strong>01</strong>2350242<strong>01</strong>45<strong>01</strong> PERJETA INJ 420/14ML 12/31/9999 2<strong>01</strong>2300472024260 PERMETHRIN CRE 5% 12/31/9999 2<strong>01</strong>2345802026937 PERMETHRIN CRE 5% 12/31/9999 2<strong>01</strong>2300472524267 PERMETHRIN LOT 1% 12/31/9999 2<strong>01</strong>2300472524269 PERMETHRIN LOT 1% 12/31/9999 2<strong>01</strong>2351552130806 PERMETHRIN POW 12/31/9999 2<strong>01</strong>2351552130807 PERMETHRIN POW 12/31/9999 2<strong>01</strong>230<strong>01</strong>26008008 PEROXYL SOL 12/31/9999 2<strong>01</strong>230<strong>01</strong>26008<strong>01</strong>6 PEROXYL SOL 12/31/9999 2<strong>01</strong>230<strong>01</strong>26008050 PEROXYL SOL 12/31/9999 2<strong>01</strong>23003780330<strong>01</strong> PERPHEN/AMIT TAB 2-10MG 12/31/9999 2<strong>01</strong>2300378033005 PERPHEN/AMIT TAB 2-10MG 12/31/9999 2<strong>01</strong>23003780442<strong>01</strong> PERPHEN/AMIT TAB 2-25MG 12/31/9999 2<strong>01</strong>2300378044205 PERPHEN/AMIT TAB 2-25MG 12/31/9999 2<strong>01</strong>23003780042<strong>01</strong> PERPHEN/AMIT TAB 4-10MG 12/31/9999 2<strong>01</strong>23003780574<strong>01</strong> PERPHEN/AMIT TAB 4-25MG 12/31/9999 2<strong>01</strong>2300378057405 PERPHEN/AMIT TAB 4-25MG 12/31/9999 2<strong>01</strong>23003780073<strong>01</strong> PERPHEN/AMIT TAB 4-50MG 12/31/9999 2<strong>01</strong>2300603509321 PERPHENAZINE TAB 16MG 12/31/9999 2<strong>01</strong>23007811049<strong>01</strong> PERPHENAZINE TAB 16MG 12/31/9999 2<strong>01</strong>2300603506021 PERPHENAZINE TAB 2MG 12/31/9999 2<strong>01</strong>2300603509021 PERPHENAZINE TAB 2MG 12/31/9999 2<strong>01</strong>2300603509028 PERPHENAZINE TAB 2MG 12/31/9999 2<strong>01</strong>23007811046<strong>01</strong> PERPHENAZINE TAB 2MG 12/31/9999 2<strong>01</strong>23

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