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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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000081222<strong>01</strong> PRISTIQ TAB 100MG 12/31/9999 2<strong>01</strong>2300008122214 PRISTIQ TAB 100MG 12/31/9999 2<strong>01</strong>2300008122230 PRISTIQ TAB 100MG 12/31/9999 2<strong>01</strong>2300008122250 PRISTIQ TAB 100MG 12/31/9999 2<strong>01</strong>23000081211<strong>01</strong> PRISTIQ TAB 50MG 12/31/9999 2<strong>01</strong>2300008121114 PRISTIQ TAB 50MG 12/31/9999 2<strong>01</strong>2300008121130 PRISTIQ TAB 50MG 12/31/9999 2<strong>01</strong>2300008121150 PRISTIQ TAB 50MG 12/31/9999 2<strong>01</strong>2344206043710 PRIVIGEN INJ 10GRAMS 12/31/9999 2<strong>01</strong>2344206043820 PRIVIGEN INJ 20GRAMS 12/31/9999 2<strong>01</strong>2344206043605 PRIVIGEN INJ 5 GRAMS 12/31/9999 2<strong>01</strong>2359310057920 PROAIR HFA AER 12/31/9999 2<strong>01</strong>230<strong>01</strong>875270<strong>01</strong> PROBARIMIN CHW QT 12/31/9999 2<strong>01</strong>23002560218<strong>01</strong> PROBARIMIN CHW QT 03/31/2<strong>01</strong>4 2<strong>01</strong>23005915325<strong>01</strong> PROBEN/COLCH TAB 500-0.5 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>49<strong>01</strong> PROBEN/COLCH TAB 500-0.5 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>56<strong>01</strong> PROBENECID TAB 500MG 12/31/9999 2<strong>01</strong>23005271367<strong>01</strong> PROBENECID TAB 500MG 12/31/9999 2<strong>01</strong>2300527136710 PROBENECID TAB 500MG 12/31/9999 2<strong>01</strong>23005915347<strong>01</strong> PROBENECID TAB 500MG 12/31/9999 2<strong>01</strong>2300591534710 PROBENECID TAB 500MG 12/31/9999 2<strong>01</strong>23004091902<strong>01</strong> PROCAINAMIDE INJ 100MG/ML 12/31/9999 2<strong>01</strong>23004091903<strong>01</strong> PROCAINAMIDE INJ 500MG/ML 12/31/9999 2<strong>01</strong>2300264191507 PROCALAMINE INJ 3% 12/31/9999 2<strong>01</strong>2300069260066 PROCARDIA CAP 10MG 12/31/9999 2<strong>01</strong>2300069265041 PROCARDIA XL TAB 30MG CR 05/31/2<strong>01</strong>3 2<strong>01</strong>2300069265066 PROCARDIA XL TAB 30MG CR 12/31/9999 2<strong>01</strong>2300069265072 PROCARDIA XL TAB 30MG CR 12/31/9999 2<strong>01</strong>2300069266066 PROCARDIA XL TAB 60MG CR 12/31/9999 2<strong>01</strong>2300069266072 PROCARDIA XL TAB 60MG CR 12/31/9999 2<strong>01</strong>2300069267066 PROCARDIA XL TAB 90MG CR 12/31/9999 2<strong>01</strong>231355107<strong>01</strong>05 PROCENTRA SOL 5MG/5ML 12/31/9999 2<strong>01</strong>2366594032116 PRO-CHLO LIQ 12/31/9999 2<strong>01</strong>23553900077<strong>01</strong> PROCHLORPER INJ 5MG/ML 12/31/9999 2<strong>01</strong>2355390007710 PROCHLORPER INJ 5MG/ML 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>3512 PROCHLORPER SUP 25MG 12/31/9999 2<strong>01</strong>23000939652<strong>01</strong> PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>23003785110<strong>01</strong> PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>23007815021<strong>01</strong> PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>2349884055<strong>01</strong>0 PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>23510790542<strong>01</strong> PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>2351079054220 PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>2359746<strong>01</strong>1506 PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>2359746<strong>01</strong>1510 PROCHLORPER TAB 10MG 12/31/9999 2<strong>01</strong>23000939643<strong>01</strong> PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>23003785105<strong>01</strong> PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>23007815020<strong>01</strong> PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>23510790541<strong>01</strong> PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>2351079054120 PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>2359746<strong>01</strong>1306 PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>2359746<strong>01</strong>1310 PROCHLORPER TAB 5MG 12/31/9999 2<strong>01</strong>2366594<strong>01</strong>22<strong>01</strong> PRO-CLEAR CAP 200-9MG 12/31/9999 2<strong>01</strong>2366594033316 PRO-CLEAR AC SYP 12/31/9999 2<strong>01</strong>2350967035760 PROCORT CRE 12/31/9999 2<strong>01</strong>23596760310<strong>01</strong> PROCRIT INJ 10000/ML 12/31/9999 2<strong>01</strong>2359676031002 PROCRIT INJ 10000/ML 12/31/9999 2<strong>01</strong>2359676031204 PROCRIT INJ 10000/ML 12/31/9999 2<strong>01</strong>23596760302<strong>01</strong> PROCRIT INJ 2000/ML 12/31/9999 2<strong>01</strong>2359676030202 PROCRIT INJ 2000/ML 12/31/9999 2<strong>01</strong>2359676032004 PROCRIT INJ 20000/ML 12/31/9999 2<strong>01</strong>23

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