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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5155213<strong>01</strong>06 PHARMABASE CRE LIGHT 12/31/9999 2<strong>01</strong>235155213<strong>01</strong>08 PHARMABASE CRE LIGHT 12/31/9999 2<strong>01</strong>235155213<strong>01</strong>09 PHARMABASE CRE LIGHT 12/31/9999 2<strong>01</strong>2300813006512 PHARMAFLUR CHW 0.5MG 12/31/9999 2<strong>01</strong>2300813006612 PHARMAFLUR CHW 2.2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35042900 PHAZYME CAP 180MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35042909 PHAZYME CAP 180MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35042912 PHAZYME CAP 180MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>58042908 PHAZYME CAP 180MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>58040580 PHAZYME CHW 125MG 12/31/9999 2<strong>01</strong>2300472114231 PHENADEX DRO PED 12/31/9999 2<strong>01</strong>2300574723612 PHENADOZ SUP 12.5MG 12/31/9999 2<strong>01</strong>2300574723412 PHENADOZ SUP 25MG 12/31/9999 2<strong>01</strong>2358809<strong>01</strong>12<strong>01</strong> PHENA-S LIQ 03/31/2<strong>01</strong>3 2<strong>01</strong>2300536242558 PHENASEPTIC LIQ 1.4% 12/31/9999 2<strong>01</strong>23102670860<strong>01</strong> PHENAZO TAB 200MG 12/31/9999 2<strong>01</strong>2310267086<strong>01</strong>0 PHENAZO TAB 200MG 12/31/9999 2<strong>01</strong>23102670025<strong>01</strong> PHENAZOPYRID TAB 100MG 12/31/9999 2<strong>01</strong>23643760811<strong>01</strong> PHENAZOPYRID TAB 100MG 12/31/9999 2<strong>01</strong>2365162051710 PHENAZOPYRID TAB 100MG 12/31/9999 2<strong>01</strong>23664240043<strong>01</strong> PHENAZOPYRID TAB 100MG 12/31/9999 2<strong>01</strong>23680840292<strong>01</strong> PHENAZOPYRID TAB 100MG 12/31/9999 2<strong>01</strong>2300472<strong>01</strong>9710 PHENAZOPYRID TAB 200MG 12/31/9999 2<strong>01</strong>23643760812<strong>01</strong> PHENAZOPYRID TAB 200MG 12/31/9999 2<strong>01</strong>2365162052<strong>01</strong>0 PHENAZOPYRID TAB 200MG 12/31/9999 2<strong>01</strong>23664240045<strong>01</strong> PHENAZOPYRID TAB 200MG 12/31/9999 2<strong>01</strong>23680840293<strong>01</strong> PHENAZOPYRID TAB 200MG 12/31/9999 2<strong>01</strong>2310267292903 PHENAZOPYRID TAB PLUS 12/31/9999 2<strong>01</strong>2310267292905 PHENAZOPYRID TAB PLUS 12/31/9999 2<strong>01</strong>230<strong>01</strong>855254<strong>01</strong> PHENDIMETRAZ CAP 105MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>85525410 PHENDIMETRAZ CAP 105MG ER 12/31/9999 2<strong>01</strong>230<strong>01</strong>854057<strong>01</strong> PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85405710 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>23107020045<strong>01</strong> PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2310702004503 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2310702004510 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>23107020077<strong>01</strong> PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2310702007703 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2310702007710 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>23107020078<strong>01</strong> PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2310702007803 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2310702007810 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2352152032702 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2352152032705 PHENDIMETRAZ TAB 35MG 12/31/9999 2<strong>01</strong>2343386036021 PHENELZINE TAB 15MG 12/31/9999 2<strong>01</strong>2359762<strong>01</strong>19<strong>01</strong> PHENELZINE TAB 15MG 12/31/9999 2<strong>01</strong>23006416082<strong>01</strong> PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>2300641608225 PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>23006416084<strong>01</strong> PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>2300641608425 PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>236097700<strong>01</strong><strong>01</strong> PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>236097700<strong>01</strong>03 PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>236097700<strong>01</strong>43 PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>236097700<strong>01</strong>44 PHENERGAN INJ 25MG/ML 12/31/9999 2<strong>01</strong>23006416083<strong>01</strong> PHENERGAN INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300641608325 PHENERGAN INJ 50MG/ML 12/31/9999 2<strong>01</strong>2360977000202 PHENERGAN INJ 50MG/ML 12/31/9999 2<strong>01</strong>2360977000204 PHENERGAN INJ 50MG/ML 12/31/9999 2<strong>01</strong>2360977000243 PHENERGAN INJ 50MG/ML 12/31/9999 2<strong>01</strong>2360977000244 PHENERGAN INJ 50MG/ML 12/31/9999 2<strong>01</strong>23

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