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

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42023011625 PITOCIN INJ 10UNT/ML 12/31/9999 2012342023011725 PITRESSIN INJ 20UNT/ML 12/31/9999 2012351285076993 PLAN B TAB 0.75MG 02/28/2013 2012351285094288 PLAN B TAB 1.5MG 12/31/9999 2012300024156210 PLAQUENIL TAB 200MG 12/31/9999 2012313533068416 PLASBUMIN-25 INJ 25% 12/31/9999 2012313533068420 PLASBUMIN-25 INJ 25% 12/31/9999 2012313533068471 PLASBUMIN-25 INJ 25% 12/31/9999 2012313533069216 PLASBUMIN-25 INJ 25% 12/31/9999 2012313533069220 PLASBUMIN-25 INJ 25% 12/31/9999 2012313533069271 PLASBUMIN-25 INJ 25% 12/31/9999 2012313533068520 PLASBUMIN-5 INJ 5% 12/31/9999 2012313533068525 PLASBUMIN-5 INJ 5% 12/31/9999 2012313533069020 PLASBUMIN-5 INJ 5% 12/31/9999 2012313533069025 PLASBUMIN-5 INJ 5% 12/31/9999 2012300338017903 PLASMA-LYTE INJ -148 12/31/9999 2012300338017904 PLASMA-LYTE INJ -148 12/31/9999 2012300338014703 PLASMA-LYTE INJ 56/D5W 12/31/9999 2012300338014704 PLASMA-LYTE INJ 56/D5W 12/31/9999 2012300338022103 PLASMA-LYTE INJ -A 12/31/9999 2012300338022104 PLASMA-LYTE INJ -A 12/31/9999 2012313533061320 PLASMANATE INJ 5% 12/31/9999 2012313533061325 PLASMANATE INJ 5% 12/31/9999 2012351552024006 PLAST/PARIS POW DENTAL 12/31/9999 2012363653133202 PLAVIX TAB 300MG 12/31/9999 2012363653117101 PLAVIX TAB 75MG 12/31/9999 2012363653117103 PLAVIX TAB 75MG 12/31/9999 2012363653117105 PLAVIX TAB 75MG 12/31/9999 2012363653117106 PLAVIX TAB 75MG 12/31/9999 2012300409796905 PLEGISOL SOL 12/31/9999 2012359148000216 PLETAL TAB 100MG 12/31/9999 2012359148000316 PLETAL TAB 50MG 12/31/9999 2012359088011560 PNV OB+DHA PAK 12/31/9999 2012342192032130 PNV-DHA CAP 12/31/9999 2012342192032090 PNV-SELECT TAB 12/31/9999 2012300574060115 PODOCON SOL 25% 12/31/9999 2012300574061105 PODOFILOX SOL 0.5% 12/31/9999 2012300591320413 PODOFILOX SOL 0.5% 12/31/9999 2012300904598931 POISON IVY MIS WASH 12/31/9999 2012324385001803 POISON IVY MIS WASH 12/31/9999 2012337205060810 POISON IVY MIS WASH 12/31/9999 2012363323028350 POLOCAINE INJ 1% 12/31/9999 2012363323029650 POLOCAINE INJ 2% 12/31/9999 2012363323026030 POLOCAINE INJ -MPF 1% 12/31/9999 2012363323029330 POLOCAINE INJ MPF 1.5% 12/31/9999 2012363323029420 POLOCAINE INJ -MPF 2% 12/31/9999 2012338779083401 POLOXAMER POW 407 12/31/9999 2012338779083403 POLOXAMER POW 407 12/31/9999 2012338779083408 POLOXAMER POW 407 12/31/9999 2012351552035506 POLOXAMER POW 407 12/31/9999 2012351552035508 POLOXAMER POW 407 12/31/9999 2012351552035509 POLOXAMER POW 407 12/31/9999 2012351552001902 POLY GLYCOL LIQ 1450 12/31/9999 2012351552001904 POLY GLYCOL LIQ 1450 12/31/9999 2012351552001906 POLY GLYCOL LIQ 1450 12/31/9999 2012338779029001 POLY GLYCOL POW 8000 12/31/9999 2012338779029008 POLY GLYCOL POW 8000 12/31/9999 2012351552044006 POLY GLYCOL POW 8000 12/31/9999 2012351552044008 POLY GLYCOL POW 8000 12/31/9999 2012350991052116 POLY HIST LIQ DHC 12/31/9999 20123
50991021001 POLY HIST TAB FORTE 12/31/9999 2012350991052816 POLY HIST NC LIQ 12/31/9999 2012310267146501 POLY IRON CAP 150MG 12/31/9999 2012310267210101 POLY IRON PN TAB FORTE 12/31/9999 2012300574030905 POLYBASE OIN 12/31/9999 2012300574030916 POLYBASE OIN 12/31/9999 2012300574041202 POLYETH GLYC POW 3350 NF 12/31/9999 2012300574041205 POLYETH GLYC POW 3350 NF 12/31/9999 2012300574041207 POLYETH GLYC POW 3350 NF 12/31/9999 2012345802086801 POLYETH GLYC POW 3350 NF 12/31/9999 2012345802086802 POLYETH GLYC POW 3350 NF 12/31/9999 2012345802086803 POLYETH GLYC POW 3350 NF 12/31/9999 2012351079030601 POLYETH GLYC POW 3350 NF 12/31/9999 2012351079030630 POLYETH GLYC POW 3350 NF 12/31/9999 2012351991045757 POLYETH GLYC POW 3350 NF 12/31/9999 2012351991045758 POLYETH GLYC POW 3350 NF 12/31/9999 2012362175019507 POLYETH GLYC POW 3350 NF 12/31/9999 2012362175019515 POLYETH GLYC POW 3350 NF 12/31/9999 2012362175019531 POLYETH GLYC POW 3350 NF 12/31/9999 2012362175044215 POLYETH GLYC POW 3350 NF 12/31/9999 2012362175044231 POLYETH GLYC POW 3350 NF 12/31/9999 2012325021011710 POLYMYXIN B INJ 500000 12/31/9999 2012339822016605 POLYMYXIN B INJ 500000 12/31/9999 2012339822016607 POLYMYXIN B INJ 500000 12/31/9999 2012355390013910 POLYMYXIN B INJ 500000 12/31/9999 2012363323032110 POLYMYXIN B INJ 500000 12/31/9999 2012351552094609 POLYMYXIN B POW SULFATE 12/31/9999 2012360758090810 POLYMYXIN B/ SOL TRIMETHP 12/31/9999 2012361314062810 POLYMYXIN B/ SOL TRIMETHP 12/31/9999 2012351552027906 POLYOXYL 40 POW STEARATE 12/31/9999 2012351552027909 POLYOXYL 40 POW STEARATE 12/31/9999 2012339822010001 POLY-RX POW 06/30/2013 2012310267210301 POLYSACCHARI CAP IRON 12/31/9999 2012351552011106 POLYSORBATE LIQ 60 12/31/9999 2012338779052601 POLYSORBATE LIQ 80 12/31/9999 2012338779052605 POLYSORBATE LIQ 80 12/31/9999 2012338779052608 POLYSORBATE LIQ 80 12/31/9999 2012338779052609 POLYSORBATE LIQ 80 12/31/9999 2012351552009205 POLYSORBATE LIQ 80 12/31/9999 2012351552009206 POLYSORBATE LIQ 80 12/31/9999 2012351552009207 POLYSORBATE LIQ 80 12/31/9999 2012351552009208 POLYSORBATE LIQ 80 12/31/9999 2012351552009209 POLYSORBATE LIQ 80 12/31/9999 2012300023782410 POLYTRIM SOL OP 12/31/9999 2012350991011916 POLY-TUSSIN LIQ 10-9.375 12/31/9999 2012350991071316 POLY-TUSSIN LIQ AC 12/31/9999 2012350991079016 POLY-TUSSIN LIQ DHC 12/31/9999 2012350991052916 POLY-TUSSIN SYP EX 12/31/9999 2012350991011416 POLY-TUSSIND LIQ 10-9.375 12/31/9999 2012350991050001 POLY-VENT TAB PLUS 12/31/9999 2012350991030960 POLY-VENT DM TAB 12/31/9999 2012350991056160 POLY-VENT IR TAB 45-400MG 12/31/9999 2012350383063450 POLY-VIT/FE DRO /FL 0.25 12/31/9999 2012350383063350 POLY-VIT/FE DRO /FL 0.5 12/31/9999 2012350383064150 POLYVIT/FL DRO 0.5MG/ML 12/31/9999 2012350383064250 POLY-VIT/FL DRO 0.25MG 12/31/9999 2012300536781601 POLYVITAMIN CHW /IRON 12/31/9999 2012300536845080 POLYVITAMIN DRO 12/31/9999 2012300536853080 POLYVITAMIN DRO /IRON 12/31/9999 2012300536430401 POLY-VITAMIN CHW 12/31/9999 20123
Page 1 and 2:
Rebatable Drug List for Iowa Medica
Page 3 and 4:
00713011801 ACEPHEN SUP 120MG 12/31
Page 5 and 6:
37205084462 ACID CONTROL TAB 150MG
Page 7 and 8:
00378220005 ACYCLOVIR CAP 200MG 02/
Page 9 and 10:
00173069604 ADVAIR DISKU AER 250/50
Page 11 and 12:
50991081416 ALAHIST DM LIQ 7.5-4-15
Page 13 and 14:
68462029965 ALCLOMETASON OIN 0.05%
Page 15 and 16:
00904582946 ALL DAY ALLG TAB 10MG 1
Page 17 and 18:
49348081812 ALLERGY RELF TAB 10MG 1
Page 19 and 20:
51552012808 ALMOND OIL SWEET 12/31/
Page 21 and 22:
67253090250 ALPRAZOLAM TAB 1MG 12/3
Page 23 and 24:
00168027860 AMCINONIDE CRE 0.1% 12/
Page 25 and 26:
00603221621 AMITRIPTYLIN TAB 100MG
Page 27 and 28:
00781227210 AMLOD/BENAZP CAP 5-10MG
Page 29 and 30:
67877019710 AMLODIPINE TAB 2.5MG 12
Page 31 and 32:
66685101101 AMOX/K CLAV SUS 200/5ML
Page 33 and 34:
65862001705 AMOXICILLIN CAP 500MG 1
Page 35 and 36:
00228306111 AMPHETAMINE CAP 30MG ER
Page 37 and 38:
10019063733 AMP-SULBACTA INJ 2-1GM
Page 39 and 40:
37205031440 ANTACID SUS REG ST 12/3
Page 41 and 42:
00121050416 APAP/CODEINE SOL 120-12
Page 43 and 44:
55513000204 ARANESP INJ 25MCG 12/31
Page 45 and 46:
00085134104 ASMANEX 14 AER 220MCG 1
Page 47 and 48:
63323029280 ASTRAMORPH INJ 2MG/2ML
Page 49 and 50:
60977011601 ATIVAN INJ 2MG/ML 12/31
Page 51 and 52:
00168026550 AUG BETAMET CRE 0.05% 1
Page 53 and 54:
60505057804 AZELASTINE DRO 0.05% 12
Page 55 and 56:
00472110556 BACITR ZINC OIN 500/GM
Page 57 and 58:
11701004814 BAZA CLEAR OIN 12/31/99
Page 59 and 60:
65597010630 BENICAR HCT TAB 40-12.5
Page 61 and 62:
00904105561 BENZTROPINE TAB 0.5MG 1
Page 63 and 64:
10702001401 BETAXOLOL TAB 20MG 12/3
Page 65 and 66:
00135048702 BIOTENE DRY PST MOUTH 1
Page 67 and 68:
51552028104 BORAX GRA 12/31/9999 20
Page 69 and 70:
00378715501 BUDESONIDE CAP 3MG/24HR
Page 71 and 72:
00591354060 BUPROPION TAB 100MG SR
Page 73 and 74:
51079099420 BUSPIRONE TAB 30MG 12/3
Page 75 and 76:
55390035803 CAFCIT SOL 60MG/3ML 12/
Page 77 and 78:
00517271025 CALCIUM CL INJ 10% 12/3
Page 80 and 81:
SNAM RETE GAS SUSTAINABILITY REPORT
Page 82:
44183060430 CARDEC DRO 12/31/9999 2
Page 85 and 86:
00093005101 CARVEDILOL TAB 3.125MG
Page 87 and 88:
00781293801 CEFADROXIL CAP 500MG 12
Page 89:
10019068115 CEFOTAXIME INJ 1GM 12/3
Page 92 and 93:
00409733649 CEFTRIAXONE INJ 2GM 12/
Page 94:
51285044202 CENESTIN TAB 0.625MG 12
Page 97 and 98:
51552056909 CHICKEN LIQ FLAVOR 12/3
Page 99 and 100:
00832030010 CHLORPROMAZ TAB 10MG 12
Page 101 and 102:
00185022305 CILOSTAZOL TAB 100MG 12
Page 103 and 104:
16252051501 CIPROFLOXACN TAB 500MG
Page 105 and 106:
57664050813 CITALOPRAM TAB 20MG 12/
Page 107 and 108:
00085132201 CLARINEX-D TAB 2.5-120
Page 109 and 110:
00009312401 CLEOCIN PHOS INJ 600MG
Page 111 and 112:
00338114703 CLINIMIX E INJ 5%/D15W
Page 113 and 114:
51672401201 CLOMIPRAMINE CAP 50MG 1
Page 115 and 116:
00517073001 CLONIDINE INJ 12/31/999
Page 117 and 118:
51672404301 CLORAZ DIPOT TAB 7.5MG
Page 119 and 120:
60575021216 CODAR AR LIQ 12/31/9999
Page 121 and 122:
62107004113 COMPLETE TAB 12/31/9999
Page 123 and 124:
00904572246 COUGH DROPS LOZ CHERRY
Page 125 and 126:
00603752517 CYCLAFEM TAB 7/7/7 12/3
Page 127 and 128:
00002327004 CYMBALTA CAP 60MG 12/31
Page 129 and 130:
51645074010 DAILY VITAMI TAB FORMUL
Page 131 and 132:
00037502001 DEMADEX TAB 20MG 12/31/
Page 133 and 134:
00067096946 DESENEX SPRY AER LIQUID
Page 135 and 136:
00069454101 DEXAMETH PHO INJ 10MG/M
Page 137 and 138:
00338001703 DEXTROSE INJ 5% 12/31/9
Page 139 and 140:
00941041146 DIANEAL PD-2 SOL 1.5% D
Page 141 and 142:
00781178501 DICLOFENAC TAB 25MG DR
Page 143 and 144:
00049350079 DIFLUCAN TAB 150MG 12/3
Page 145 and 146:
00093511798 DILTIAZEM CAP 180MG ER
Page 147 and 148:
60505021309 DILTZAC CAP 300MG/24 12
Page 149 and 150:
49483006101 DIPHENHYDRAM TAB 25MG 1
Page 151 and 152:
62756079613 DIVALPROEX TAB 125MG DR
Page 153 and 154:
00409020120 DOCETAXEL INJ 160/16ML
Page 155 and 156:
68382034706 DONEPEZIL TAB 10MG ODT
Page 157 and 158:
00093812193 DOXAZOSIN TAB 2MG 12/31
Page 159 and 160:
53489011805 DOXYCYCL HYC CAP 50MG 1
Page 161 and 162:
00310108730 DUTOPROL TAB 25-12.5 12
Page 163 and 164:
00008083721 EFFEXOR XR CAP 37.5MG 1
Page 165 and 166:
60505005107 ENALAPRIL TAB 10MG 12/3
Page 167 and 168:
62037086420 ENOXAPARIN INJ 120/0.8
Page 169 and 170:
55513028301 EPOGEN INJ 10000/ML 12/
Page 171 and 172:
00093585005 ESCITALOPRAM TAB 5MG 12
Page 173 and 174:
00185014001 ETODOLAC TAB 400MG 12/3
Page 175 and 176:
10631010030 EXELDERM SOL 1% 12/31/9
Page 177 and 178:
63323073804 FAMOTIDINE INJ 10MG/ML
Page 179 and 180:
65162073409 FELBAMATE TAB 400MG 12/
Page 181 and 182:
10019003725 FENTANYL CIT INJ 1000MC
Page 183 and 184:
66993010904 FEXOFENADINE TAB 180MG
Page 185 and 186:
00054001121 FLECAINIDE TAB 100MG 12
Page 187 and 188:
00703102030 FLUCONAZOLE/ INJ NACL 4
Page 189 and 190:
60258015520 FLUORIDE CHW 0.25MG F 0
Page 191 and 192:
00555087188 FLUOXETINE CAP 90MG DR
Page 193 and 194:
00378040701 FLUVOXAMINE TAB 25MG 12
Page 195 and 196:
51552020504 FORMALDEHYDE SOL 37% 12
Page 197 and 198:
00409163910 FUROSEMIDE INJ 10MG/ML
Page 199 and 200:
00378542605 GABAPENTIN CAP 100MG 12
Page 201 and 202:
00378542401 GABAPENTIN TAB 600MG 12
Page 203 and 204:
64208823403 GAMMAPLEX INJ 10GM 12/3
Page 205 and 206:
00904598861 GEMFIBROZIL TAB 600MG 1
Page 207 and 208:
58063010001 GLIADEL WAF 7.7MG 10/31
Page 209 and 210:
55390000401 GLUCAGEN INJ 1MG 12/31/
Page 211 and 212:
00781119110 GLYBURIDE TAB 5MG 11/30
Page 213 and 214:
24385026226 GNP CGH RELF LIQ 15MG/5
Page 215 and 216:
10158000103 GOODYS POW EX ST 12/31/
Page 217 and 218:
00168035650 HALOBETASOL OIN 0.05% 1
Page 219 and 220:
51672129006 HC VALERATE CRE 0.2% 12
Page 221 and 222:
25021040001 HEPARIN SOD INJ 1000/ML
Page 223 and 224:
00002879759 HUMALOG MIX INJ 75/25KW
Page 225 and 226:
00143312505 HYDROCHLOROT CAP 12.5MG
Page 227 and 228:
53746011005 HYDROCO/APAP TAB 10-325
Page 229 and 230:
51079077801 HYDROCO/APAP TAB 7.5-32
Page 231 and 232:
00603390021 HYDROCORT TAB 10MG 12/3
Page 233 and 234:
00555088202 HYDROXYUREA CAP 500MG 1
Page 235 and 236:
24486060110 HYOMAX-SL SUB 0.125MG 1
Page 237 and 238:
68094049458 IBUPROFEN SUS 100/5ML 1
Page 239 and 240:
53746046505 IBUPROFEN TAB 600MG 12/
Page 241 and 242:
49884005610 IMIPRAM HCL TAB 50MG 12
Page 243 and 244:
52544093102 INFED INJ 50MG/ML 12/31
Page 245 and 246:
00487980130 IPRATROPIUM SOL 0.02%IN
Page 247 and 248:
00998022515 ISO CARBACHO SOL 3% OP
Page 249 and 250:
62175012841 ISOSORB MONO TAB 30MG E
Page 251 and 252:
00597014760 JENTADUETO TAB 2.5-850
Page 253 and 254:
50474059540 KEPPRA TAB 500MG 12/31/
Page 255 and 256:
00245004115 KLOR-CON 10 TAB 10MEQ E
Page 257 and 258:
00904593061 LABETALOL TAB 300MG 12/
Page 259 and 260:
00067617185 LAMISIL AT CRE 1% 12/31
Page 261 and 262:
13668004505 LAMOTRIGINE TAB 25MG 12
Page 263 and 264:
66758000501 L-CYSTEINE INJ 50MG/ML
Page 265 and 266:
54838054880 LEVETIRACETA SOL 100MG/
Page 267 and 268:
68462054608 LEVETIRACETA TAB 500MG
Page 269 and 270:
50383028604 LEVOFLOXACIN SOL 25MG/M
Page 271 and 272:
00781518710 LEVOTHYROXIN TAB 150MCG
Page 273 and 274:
00409317803 LIDO/EPI 1%- INJ 1:1000
Page 275 and 276:
58281056002 LIORESAL INT INJ 10MG/2
Page 277 and 278:
00172375900 LISINOPRIL TAB 10MG 12/
Page 279 and 280:
24658024345 LISINOPRIL TAB 20MG 12/
Page 281 and 282:
00172375810 LISINOPRIL TAB 5MG 12/3
Page 283 and 284:
00056051168 LODOSYN TAB 25MG 10/31/
Page 285 and 286:
46122010952 LORATADINE-D TAB 5-120M
Page 287 and 288:
00785635001 LORCET TAB 10-650MG 12/
Page 289 and 290:
68084034701 LOSARTAN POT TAB 50MG 1
Page 291 and 292:
00093092619 LOVASTATIN TAB 10MG 12/
Page 293 and 294:
52152019302 LOXAPINE CAP 25MG 12/31
Page 295 and 296:
00067032844 MAALOX REG SUS STRENGTH
Page 297 and 298:
00904198359 MAPAP TAB 500MG 12/31/9
Page 299 and 300:
59746012210 MECLIZINE TAB 12.5MG 12
Page 301 and 302:
54458096405 MELOXICAM TAB 15MG 04/0
Page 303 and 304:
00703480503 MESNA INJ 1GM 12/31/999
Page 305 and 306:
00406202805 METFORMIN TAB 500MG 12/
Page 307 and 308:
43547024950 METFORMIN TAB 850MG 12/
Page 309 and 310:
00591538205 METHOCARBAM TAB 750MG 0
Page 311 and 312:
43386014001 METHYLERGON TAB 0.2MG 1
Page 313 and 314:
00591246810 METOCLOPRAM TAB 10MG 12
Page 315 and 316:
51079080117 METOPROL TAR TAB 50MG 1
Page 317 and 318:
00168038360 METRONIDAZOL LOT 0.75%
Page 319 and 320:
00409230662 MIDAZOLAM INJ 2MG/2ML 1
Page 321 and 322:
00641606701 MILRINONE INJ 1MG/ML 12
Page 323 and 324:
68308050260 MI-OMEGA NF CAP 12/31/9
Page 325 and 326:
60505024901 MIRTAZAPINE TAB 45MG 12
Page 327 and 328:
68462022517 MOMETASONE OIN 0.1% 12/
Page 329 and 330:
00641606801 MORPHINE SUL INJ 10MG/M
Page 331 and 332:
37205011153 MOTION SICK TAB 50MG 12
Page 333 and 334:
00603438121 MULTI-VIT/FL CHW 0.25MG
Page 335 and 336:
61748030113 MYORISAN CAP 10MG 12/31
Page 337 and 338:
00409146301 NALBUPHINE INJ 10MG/ML
Page 339 and 340:
68462019005 NAPROXEN TAB 500MG 12/3
Page 341 and 342: 62011008701 NASAL DECONG TAB 120MG
Page 343 and 344: 00517003425 NEOSTIG METH INJ 0.5MG/
Page 345 and 346: 00074308090 NIASPAN TAB 1000 ER 12/
Page 347 and 348: 00067512507 NICOTINE DIS 14MG/24H 1
Page 349 and 350: 59762669108 NIFEDIPINE TAB 60MG ER
Page 351 and 352: 00378165001 NITROFUR MAC CAP 50MG 1
Page 353 and 354: 63868008910 NON-ASPIRIN TAB 650MG 1
Page 355 and 356: 50458084002 NUCYNTA TAB 100MG 12/31
Page 357 and 358: 68025004830 OB COMPLETE CAP 400 12/
Page 359 and 360: 66993046730 OLANZAPINE TAB 10MG ODT
Page 361 and 362: 66993004905 OLANZAPINE TAB 7.5MG 12
Page 363 and 364: 00407141234 OMNIPAQUE INJ 240MG/ML
Page 365 and 366: 00641608001 ONDANSETRON INJ 4MG/2ML
Page 367 and 368: 63481044070 OPANA ER TAB 40MG 12/31
Page 369 and 370: 00781310195 OXACILLIN INJ 2GM 12/31
Page 371 and 372: 10337035960 OXISTAT LOT 1% 12/31/99
Page 373 and 374: 00603499128 OXYCODONE TAB 15MG 12/3
Page 375 and 376: 00536012297 PAIN & FEVER SOL 160/5M
Page 377 and 378: 00904513559 PAIN RELIEVR TAB PLUS 1
Page 379 and 380: 00378200593 PAROXETIN ER TAB 37.5MG
Page 381 and 382: 00029321113 PAXIL TAB 20MG 08/31/20
Page 383 and 384: 65862017699 PENICILLN VK TAB 500MG
Page 385 and 386: 00781104613 PERPHENAZINE TAB 2MG 12
Page 387 and 388: 58605043301 PHENFLU CD TAB 12/31/99
Page 389 and 390: 61314034201 PHENYLEPHRIN SOL 2.5% O
Page 391: 00378004893 PIOGLITAZONE TAB 15MG 1
Page 395 and 396: 00603153658 POT CHLORIDE LIQ 20% 12
Page 397 and 398: 68382019816 PRAMIPEXOLE TAB 0.5MG 1
Page 399 and 400: 68180048802 PRAVASTATIN TAB 80MG 12
Page 401 and 402: 63739052010 PREDNISONE TAB 20MG 12/
Page 403 and 404: 00186074331 PRILOSEC CAP 40MG 12/31
Page 405 and 406: 59676030301 PROCRIT INJ 3000/ML 12/
Page 407 and 408: 60432060804 PROMETHAZINE SYP 6.25/5
Page 409 and 410: 63323029750 PROPOVEN INJ 10MG/ML 12
Page 411 and 412: 38779051008 PROPYLENE LIQ GLYCOL 12
Page 413 and 414: 67253066010 PYRAZINAMIDE TAB 500MG
Page 415 and 416: 31722037590 QNAPRIL/HCTZ TAB 20-12.
Page 417 and 418: 16729014912 QUETIAPINE TAB 300MG 12
Page 419 and 420: 68180059109 RAMIPRIL CAP 10MG 12/31
Page 421 and 422: 64679074202 RANITIDINE TAB 300MG 12
Page 423 and 424: 53329015713 REMEDY NUTRA CRE 1% 12/
Page 425 and 426: 59572040200 REVLIMID CAP 2.5MG 12/3
Page 427 and 428: 00409614009 RINGERS IRR SOL 12/31/9
Page 429 and 430: 13668003701 RISPERIDONE TAB 1MG 12/
Page 431 and 432: 00603568820 RISPERIDONE TAB 4MG 12/
Page 433 and 434: 00031873612 ROBITUSSIN LIQ CGH/CONG
Page 435 and 436: 64679017402 ROPINIROLE TAB 3MG 12/3
Page 437 and 438: 49908013710 SALICYLIC AC LIQ 26% 12
Page 439 and 440: 15127080313 SB NAT FIBER POW 49% 12
Page 441 and 442: 55513007430 SENSIPAR TAB 60MG 12/31
Page 443 and 444:
60505018203 SERTRALINE TAB 100MG 12
Page 445 and 446:
51552012605 SILICA GEL 12/31/9999 2
Page 447 and 448:
51079045520 SIMVASTATIN TAB 20MG 01
Page 449 and 450:
24658021490 SIMVASTATIN TAB 80MG 12
Page 451 and 452:
49348087934 SM CHILDRENS SUS MS COL
Page 453 and 454:
00603578121 SMZ/TMP DS TAB 800-160
Page 455 and 456:
00409798325 SOD CHLORIDE INJ 0.9% 1
Page 457 and 458:
00338004746 SODIUM CHLOR SOL 0.9% I
Page 459 and 460:
00145213007 SORILUX AER 0.005% 12/3
Page 461 and 462:
53489032801 SPIRONOLACT TAB 50MG 12
Page 463 and 464:
00517301025 STERIL WATER INJ 12/31/
Page 465 and 466:
00591078005 SUCRALFATE TAB 1GM 12/3
Page 467 and 468:
49884048299 SUMATRIPTAN INJ 4MG/0.5
Page 469 and 470:
00085131201 SYLATRON KIT 888MCG 12/
Page 471 and 472:
00409194101 TALWIN INJ 30MG/ML 12/3
Page 473 and 474:
00065041625 TEARS NATURA SOL FREE O
Page 475 and 476:
59746038306 TERAZOSIN CAP 1MG 12/31
Page 477 and 478:
57844071319 TEV-TROPIN INJ 5MG 12/3
Page 479 and 480:
51552048105 THIABENDAZOL POW 12/31/
Page 481 and 482:
60505059702 TIMOLOL MAL SOL 0.25% O
Page 483 and 484:
13811006816 TL-HIST DM LIQ 12/31/99
Page 485 and 486:
13668003360 TOPIRAMATE TAB 100MG 12
Page 487 and 488:
65862012601 TORSEMIDE TAB 10MG 12/3
Page 489 and 490:
00378324201 TRANDOLAPRIL TAB 2MG 11
Page 491 and 492:
43478024445 TRETINOIN GEL 0.025% 12
Page 493 and 494:
00781112301 TRIAMT/HCTZ TAB 37.5-25
Page 495 and 496:
00555903270 TRI-LEGEST TAB FE 12/31
Page 497 and 498:
00135022301 TUMS CALCIUM CHW 750MG
Page 499 and 500:
66302020603 TYVASO SOL 0.6MG/ML 12/
Page 501 and 502:
42192010110 UREA EMU 50% 12/31/9999
Page 503 and 504:
00004003822 VALCYTE TAB 450MG 12/31
Page 505 and 506:
51552129409 VANIBASE CRE 12/31/9999
Page 507 and 508:
00378513205 VENLAFAXINE CAP 75MG ER
Page 509 and 510:
66215030300 VENTAVIS SOL 20MCG/ML 1
Page 511 and 512:
00469357550 VIBATIV INJ 750MG 12/31
Page 513 and 514:
00407222255 VISIPAQUE INJ 270MG/ML
Page 515 and 516:
00078034545 VIVELLE-DOT DIS 0.075MG
Page 517 and 518:
00406205510 WARFARIN TAB 4MG 12/31/
Page 519 and 520:
59630091310 XODOL TAB 7.5-300 12/31
Page 521 and 522:
52152003205 YOHIMBINE TAB 5.4MG 12/
Page 523 and 524:
00310013311 ZESTRIL TAB 30MG 12/31/
Page 525 and 526:
00069417034 ZMAX SUS 2GM 12/31/9999
Page 527 and 528:
00095067416 ZOLVIT SOL 10-300MG 12/
Page 529:
00002411230 ZYPREXA TAB 2.5MG 12/31
show all

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

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