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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596760303<strong>01</strong> PROCRIT INJ 3000/ML 12/31/9999 2<strong>01</strong>2359676030302 PROCRIT INJ 3000/ML 12/31/9999 2<strong>01</strong>23596760304<strong>01</strong> PROCRIT INJ 4000/ML 12/31/9999 2<strong>01</strong>2359676030402 PROCRIT INJ 4000/ML 12/31/9999 2<strong>01</strong>23596760340<strong>01</strong> PROCRIT INJ 40000/ML 12/31/9999 2<strong>01</strong>236564905<strong>01</strong>30 PROCTOCORT CRE 1% 12/31/9999 2<strong>01</strong>2365649051112 PROCTOCORT SUP 30MG 12/31/9999 2<strong>01</strong>2368220<strong>01</strong>4130 PROCTOCREAM CRE HC 2.5% 12/31/9999 2<strong>01</strong>2300091464024 PROCTOCREAM CRE -HC 2.5% 12/31/9999 2<strong>01</strong>2368220<strong>01</strong>4210 PROCTOFOAM AER HC 1% 12/31/9999 2<strong>01</strong>2368220<strong>01</strong>4315 PROCTOFOAM AER NS 1% 12/31/9999 2<strong>01</strong>2364980030230 PROCTO-PAK CRE 1% 12/31/9999 2<strong>01</strong>2363304040812 PROCTOSOL SUP 25MG 12/31/9999 2<strong>01</strong>2363304040824 PROCTOSOL SUP 25MG 12/31/9999 2<strong>01</strong>23106310407<strong>01</strong> PROCTOSOL HC CRE 2.5% 12/31/9999 2<strong>01</strong>236498003<strong>01</strong>30 PROCTOZONE CRE -HC 2.5% 12/31/9999 2<strong>01</strong>2351079062282 PRODERM AER 12/31/9999 2<strong>01</strong>23665940777<strong>01</strong> PROFE CAP 180MG 12/31/9999 2<strong>01</strong>2366594078809 PROFE FORTE CAP 155-1MG 12/31/9999 2<strong>01</strong>2368516320202 PROFILNINE INJ 1000UNIT 12/31/9999 2<strong>01</strong>2368516320302 PROFILNINE INJ 1500UNIT 12/31/9999 2<strong>01</strong>236851632<strong>01</strong><strong>01</strong> PROFILNINE INJ 500UNIT 12/31/9999 2<strong>01</strong>23000935353<strong>01</strong> PROGESTERONE CAP 100MG 12/31/9999 2<strong>01</strong>23005913964<strong>01</strong> PROGESTERONE CAP 100MG 12/31/9999 2<strong>01</strong>23000935354<strong>01</strong> PROGESTERONE CAP 200MG 12/31/9999 2<strong>01</strong>23005913965<strong>01</strong> PROGESTERONE CAP 200MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>439725<strong>01</strong> PROGESTERONE INJ 50MG/ML 12/31/9999 2<strong>01</strong>23005170750<strong>01</strong> PROGESTERONE INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300591312879 PROGESTERONE INJ 50MG/ML 12/31/9999 2<strong>01</strong>2363323026110 PROGESTERONE INJ 50MG/ML 12/31/9999 2<strong>01</strong>23398226100<strong>01</strong> PROGESTERONE POW 06/30/2<strong>01</strong>3 2<strong>01</strong>2339822610003 PROGESTERONE POW 06/30/2<strong>01</strong>3 2<strong>01</strong>2339822610007 PROGESTERONE POW 06/30/2<strong>01</strong>3 2<strong>01</strong>23387790043<strong>01</strong> PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2338779004303 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2338779004304 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2338779004305 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2338779004308 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2338779004309 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>23398226000<strong>01</strong> PROGESTERONE POW MICRONIZ 02/28/2<strong>01</strong>3 2<strong>01</strong>2339822600003 PROGESTERONE POW MICRONIZ 02/28/2<strong>01</strong>3 2<strong>01</strong>2339822600007 PROGESTERONE POW MICRONIZ 02/28/2<strong>01</strong>3 2<strong>01</strong>2351552127903 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2351552127904 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2351552127905 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2351552127906 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2351552127907 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2351552127909 PROGESTERONE POW MICRONIZ 12/31/9999 2<strong>01</strong>2300575620030 PROGLYCEM SUS 50MG/ML 12/31/9999 2<strong>01</strong>2300469060773 PROGRAF CAP 0.5MG 12/31/9999 2<strong>01</strong>2300469061711 PROGRAF CAP 1MG 12/31/9999 2<strong>01</strong>2300469061773 PROGRAF CAP 1MG 12/31/9999 2<strong>01</strong>2300469065711 PROGRAF CAP 5MG 12/31/9999 2<strong>01</strong>2300469065773 PROGRAF CAP 5MG 12/31/9999 2<strong>01</strong>23004693<strong>01</strong>6<strong>01</strong> PROGRAF INJ 5MG/ML 12/31/9999 2<strong>01</strong>231353306<strong>01</strong>35 PROLASTIN INJ 1000MG 12/17/2<strong>01</strong>2 2<strong>01</strong>23135330700<strong>01</strong> PROLASTIN-C INJ 1000MG 12/31/9999 2<strong>01</strong>2365483<strong>01</strong>1607 PROLEUKIN INJ 22MU 12/31/9999 2<strong>01</strong>23555130710<strong>01</strong> PROLIA SOL 60MG/ML 12/31/9999 2<strong>01</strong>23586050524<strong>01</strong> PROMACET TAB 50-650MG 12/31/9999 2<strong>01</strong>23

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