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 ...

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42023<strong>01</strong>1625 PITOCIN INJ 10UNT/ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>1725 PITRESSIN INJ 20UNT/ML 12/31/9999 2<strong>01</strong>2351285076993 PLAN B TAB 0.75MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2351285094288 PLAN B TAB 1.5MG 12/31/9999 2<strong>01</strong>2300024156210 PLAQUENIL TAB 200MG 12/31/9999 2<strong>01</strong>2313533068416 PLASBUMIN-25 INJ 25% 12/31/9999 2<strong>01</strong>2313533068420 PLASBUMIN-25 INJ 25% 12/31/9999 2<strong>01</strong>2313533068471 PLASBUMIN-25 INJ 25% 12/31/9999 2<strong>01</strong>2313533069216 PLASBUMIN-25 INJ 25% 12/31/9999 2<strong>01</strong>2313533069220 PLASBUMIN-25 INJ 25% 12/31/9999 2<strong>01</strong>2313533069271 PLASBUMIN-25 INJ 25% 12/31/9999 2<strong>01</strong>2313533068520 PLASBUMIN-5 INJ 5% 12/31/9999 2<strong>01</strong>2313533068525 PLASBUMIN-5 INJ 5% 12/31/9999 2<strong>01</strong>2313533069020 PLASBUMIN-5 INJ 5% 12/31/9999 2<strong>01</strong>2313533069025 PLASBUMIN-5 INJ 5% 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>7903 PLASMA-LYTE INJ -148 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>7904 PLASMA-LYTE INJ -148 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>4703 PLASMA-LYTE INJ 56/D5W 12/31/9999 2<strong>01</strong>2300338<strong>01</strong>4704 PLASMA-LYTE INJ 56/D5W 12/31/9999 2<strong>01</strong>2300338022103 PLASMA-LYTE INJ -A 12/31/9999 2<strong>01</strong>2300338022104 PLASMA-LYTE INJ -A 12/31/9999 2<strong>01</strong>2313533061320 PLASMANATE INJ 5% 12/31/9999 2<strong>01</strong>2313533061325 PLASMANATE INJ 5% 12/31/9999 2<strong>01</strong>2351552024006 PLAST/PARIS POW DENTAL 12/31/9999 2<strong>01</strong>2363653133202 PLAVIX TAB 300MG 12/31/9999 2<strong>01</strong>23636531171<strong>01</strong> PLAVIX TAB 75MG 12/31/9999 2<strong>01</strong>2363653117103 PLAVIX TAB 75MG 12/31/9999 2<strong>01</strong>2363653117105 PLAVIX TAB 75MG 12/31/9999 2<strong>01</strong>2363653117106 PLAVIX TAB 75MG 12/31/9999 2<strong>01</strong>2300409796905 PLEGISOL SOL 12/31/9999 2<strong>01</strong>2359148000216 PLETAL TAB 100MG 12/31/9999 2<strong>01</strong>2359148000316 PLETAL TAB 50MG 12/31/9999 2<strong>01</strong>2359088<strong>01</strong>1560 PNV OB+DHA PAK 12/31/9999 2<strong>01</strong>2342192032130 PNV-DHA CAP 12/31/9999 2<strong>01</strong>2342192032090 PNV-SELECT TAB 12/31/9999 2<strong>01</strong>230057406<strong>01</strong>15 PODOCON SOL 25% 12/31/9999 2<strong>01</strong>2300574061105 PODOFILOX SOL 0.5% 12/31/9999 2<strong>01</strong>2300591320413 PODOFILOX SOL 0.5% 12/31/9999 2<strong>01</strong>2300904598931 POISON IVY MIS WASH 12/31/9999 2<strong>01</strong>23243850<strong>01</strong>803 POISON IVY MIS WASH 12/31/9999 2<strong>01</strong>2337205060810 POISON IVY MIS WASH 12/31/9999 2<strong>01</strong>2363323028350 POLOCAINE INJ 1% 12/31/9999 2<strong>01</strong>2363323029650 POLOCAINE INJ 2% 12/31/9999 2<strong>01</strong>2363323026030 POLOCAINE INJ -MPF 1% 12/31/9999 2<strong>01</strong>2363323029330 POLOCAINE INJ MPF 1.5% 12/31/9999 2<strong>01</strong>2363323029420 POLOCAINE INJ -MPF 2% 12/31/9999 2<strong>01</strong>23387790834<strong>01</strong> POLOXAMER POW 407 12/31/9999 2<strong>01</strong>2338779083403 POLOXAMER POW 407 12/31/9999 2<strong>01</strong>2338779083408 POLOXAMER POW 407 12/31/9999 2<strong>01</strong>2351552035506 POLOXAMER POW 407 12/31/9999 2<strong>01</strong>2351552035508 POLOXAMER POW 407 12/31/9999 2<strong>01</strong>2351552035509 POLOXAMER POW 407 12/31/9999 2<strong>01</strong>23515520<strong>01</strong>902 POLY GLYCOL LIQ 1450 12/31/9999 2<strong>01</strong>23515520<strong>01</strong>904 POLY GLYCOL LIQ 1450 12/31/9999 2<strong>01</strong>23515520<strong>01</strong>906 POLY GLYCOL LIQ 1450 12/31/9999 2<strong>01</strong>23387790290<strong>01</strong> POLY GLYCOL POW 8000 12/31/9999 2<strong>01</strong>2338779029008 POLY GLYCOL POW 8000 12/31/9999 2<strong>01</strong>2351552044006 POLY GLYCOL POW 8000 12/31/9999 2<strong>01</strong>2351552044008 POLY GLYCOL POW 8000 12/31/9999 2<strong>01</strong>2350991052116 POLY HIST LIQ DHC 12/31/9999 2<strong>01</strong>23

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