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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68382<strong>01</strong>9816 PRAMIPEXOLE TAB 0.5MG 12/31/9999 2<strong>01</strong>2368462033290 PRAMIPEXOLE TAB 0.5MG 12/31/9999 2<strong>01</strong>23000938<strong>01</strong>998 PRAMIPEXOLE TAB 0.75MG 04/30/2<strong>01</strong>4 2<strong>01</strong>2300378171377 PRAMIPEXOLE TAB 0.75MG 12/31/9999 2<strong>01</strong>2300781528192 PRAMIPEXOLE TAB 0.75MG 12/31/9999 2<strong>01</strong>2313668<strong>01</strong>8405 PRAMIPEXOLE TAB 0.75MG 12/31/9999 2<strong>01</strong>2313668<strong>01</strong>8490 PRAMIPEXOLE TAB 0.75MG 12/31/9999 2<strong>01</strong>23167140589<strong>01</strong> PRAMIPEXOLE TAB 0.75MG 12/31/2020 2<strong>01</strong>2300555061514 PRAMIPEXOLE TAB 1.5MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781525292 PRAMIPEXOLE TAB 1.5MG 12/31/9999 2<strong>01</strong>2313668009505 PRAMIPEXOLE TAB 1.5MG 12/31/9999 2<strong>01</strong>2313668009590 PRAMIPEXOLE TAB 1.5MG 12/31/9999 2<strong>01</strong>23167140588<strong>01</strong> PRAMIPEXOLE TAB 1.5MG 12/31/2020 2<strong>01</strong>2351991063290 PRAMIPEXOLE TAB 1.5MG 12/31/9999 2<strong>01</strong>2368382020<strong>01</strong>6 PRAMIPEXOLE TAB 1.5MG 12/31/9999 2<strong>01</strong>2368462033490 PRAMIPEXOLE TAB 1.5MG 12/31/9999 2<strong>01</strong>2300555061414 PRAMIPEXOLE TAB 1MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300781525192 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>2313668009405 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>2313668009490 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>23167140587<strong>01</strong> PRAMIPEXOLE TAB 1MG 12/31/2020 2<strong>01</strong>2351991063190 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>2363739053610 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>2368382<strong>01</strong>9916 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>2368462033390 PRAMIPEXOLE TAB 1MG 12/31/9999 2<strong>01</strong>2300677196579 PRAMOXINE AER 1% 06/30/2<strong>01</strong>3 2<strong>01</strong>2351862<strong>01</strong>8<strong>01</strong>5 PRAMOXINE AER 1% 12/31/9999 2<strong>01</strong>230<strong>01</strong>690093<strong>01</strong> PRANDIMET TAB 1-500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>690092<strong>01</strong> PRANDIMET TAB 2-500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69008181 PRANDIN TAB 0.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69008281 PRANDIN TAB 1MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69008481 PRANDIN TAB 2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69008483 PRANDIN TAB 2MG 03/31/2<strong>01</strong>3 2<strong>01</strong>2366993090206 PRASCION EMU 09/30/2<strong>01</strong>3 2<strong>01</strong>2366993090212 PRASCION EMU 09/30/2<strong>01</strong>3 2<strong>01</strong>2366993090530 PRASCION FC PAD 10-5% 08/31/2<strong>01</strong>3 2<strong>01</strong>2366993090560 PRASCION FC PAD 10-5% 09/30/2<strong>01</strong>3 2<strong>01</strong>2366993090445 PRASCION RA CRE 10-5% 04/30/2<strong>01</strong>3 2<strong>01</strong>2300003517805 PRAVACHOL TAB 20MG 12/31/9999 2<strong>01</strong>2300003519410 PRAVACHOL TAB 40MG 12/31/9999 2<strong>01</strong>2300003519510 PRAVACHOL TAB 80MG 12/31/9999 2<strong>01</strong>2300093077110 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300093077198 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300378055277 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300904611361 PRAVASTATIN TAB 10MG 02/28/2<strong>01</strong>4 2<strong>01</strong>2316252052690 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2354458092710 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2354458098709 PRAVASTATIN TAB 10MG 12/<strong>01</strong>/2<strong>01</strong>2 2<strong>01</strong>2355111022905 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2355111022990 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2360505<strong>01</strong>6805 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2360505<strong>01</strong>6809 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2363304059590 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2368084<strong>01</strong>86<strong>01</strong> PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>23680840500<strong>01</strong> PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2368180048502 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2368180048509 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2368382007005 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2368382007<strong>01</strong>6 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2368462<strong>01</strong>9505 PRAVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>23

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