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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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586050433<strong>01</strong> PHENFLU CD TAB 12/31/9999 2<strong>01</strong>23586050434<strong>01</strong> PHENFLU CDX TAB 12/31/9999 2<strong>01</strong>23586050435<strong>01</strong> PHENFLU DM TAB 12/31/9999 2<strong>01</strong>23004721<strong>01</strong>516 PHENOBARB ELX 20MG/5ML 12/31/9999 2<strong>01</strong>23004721<strong>01</strong>528 PHENOBARB ELX 20MG/5ML 12/31/9999 2<strong>01</strong>2300603150858 PHENOBARB ELX 20MG/5ML 12/31/9999 2<strong>01</strong>2300641047721 PHENOBARB INJ 130MG/ML 12/31/9999 2<strong>01</strong>2300641047725 PHENOBARB INJ 130MG/ML 12/31/9999 2<strong>01</strong>2300641047621 PHENOBARB INJ 65MG/ML 12/31/9999 2<strong>01</strong>2300641047625 PHENOBARB INJ 65MG/ML 12/31/9999 2<strong>01</strong>2338779085204 PHENOBARB POW 12/31/9999 2<strong>01</strong>2338779085205 PHENOBARB POW 12/31/9999 2<strong>01</strong>2316571033<strong>01</strong>6 PHENOBARB SOL 20MG/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>431458<strong>01</strong> PHENOBARB TAB 100MG 08/25/2<strong>01</strong>6 2<strong>01</strong>230<strong>01</strong>43145805 PHENOBARB TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43145810 PHENOBARB TAB 100MG 08/26/2<strong>01</strong>6 2<strong>01</strong>23641250903<strong>01</strong> PHENOBARB TAB 100MG 12/31/9999 2<strong>01</strong>2364125090310 PHENOBARB TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43144505 PHENOBARB TAB 15MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43144510 PHENOBARB TAB 15MG 05/02/2<strong>01</strong>6 2<strong>01</strong>230<strong>01</strong>43144525 PHENOBARB TAB 15MG 05/02/2<strong>01</strong>6 2<strong>01</strong>230<strong>01</strong>43144552 PHENOBARB TAB 15MG 05/02/2<strong>01</strong>6 2<strong>01</strong>23641250915<strong>01</strong> PHENOBARB TAB 15MG 12/31/9999 2<strong>01</strong>2364125091510 PHENOBARB TAB 15MG 12/31/9999 2<strong>01</strong>2300603516521 PHENOBARB TAB 16.2MG 12/31/9999 2<strong>01</strong>2300603516532 PHENOBARB TAB 16.2MG 12/31/9999 2<strong>01</strong>2363739020<strong>01</strong>0 PHENOBARB TAB 16.2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43145005 PHENOBARB TAB 30MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43145<strong>01</strong>0 PHENOBARB TAB 30MG 05/02/2<strong>01</strong>6 2<strong>01</strong>230<strong>01</strong>43145025 PHENOBARB TAB 30MG 05/02/2<strong>01</strong>6 2<strong>01</strong>230<strong>01</strong>43145052 PHENOBARB TAB 30MG 05/02/2<strong>01</strong>6 2<strong>01</strong>23510790095<strong>01</strong> PHENOBARB TAB 30MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2351079009520 PHENOBARB TAB 30MG 02/28/2<strong>01</strong>3 2<strong>01</strong>236412509<strong>01</strong><strong>01</strong> PHENOBARB TAB 30MG 12/31/9999 2<strong>01</strong>236412509<strong>01</strong>10 PHENOBARB TAB 30MG 12/31/9999 2<strong>01</strong>2300603516602 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>2300603516616 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>2300603516620 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>2300603516621 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>2300603516622 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>2300603516632 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>236373902<strong>01</strong>10 PHENOBARB TAB 32.4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43145505 PHENOBARB TAB 60MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43145510 PHENOBARB TAB 60MG 05/18/2<strong>01</strong>6 2<strong>01</strong>23641250902<strong>01</strong> PHENOBARB TAB 60MG 12/31/9999 2<strong>01</strong>2364125090210 PHENOBARB TAB 60MG 12/31/9999 2<strong>01</strong>2300603516721 PHENOBARB TAB 64.8MG 12/31/9999 2<strong>01</strong>2300603516732 PHENOBARB TAB 64.8MG 12/31/9999 2<strong>01</strong>2300603516821 PHENOBARB TAB 97.2MG 12/31/9999 2<strong>01</strong>2300603516832 PHENOBARB TAB 97.2MG 12/31/9999 2<strong>01</strong>23000932110<strong>01</strong> PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850644<strong>01</strong> PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85064410 PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>23005271742<strong>01</strong> PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>2300527174210 PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>23107020026<strong>01</strong> PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>2310702002610 PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>7002 PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>2352152<strong>01</strong>7005 PHENTERMINE CAP 15MG 12/31/9999 2<strong>01</strong>23000932109<strong>01</strong> PHENTERMINE CAP 30MG 12/31/9999 2<strong>01</strong>23

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