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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0<strong>01</strong>21050416 APAP/CODEINE SOL 120-12/5 12/31/9999 2<strong>01</strong>2300603102058 APAP/CODEINE SOL 120-12/5 12/31/9999 2<strong>01</strong>2350383007916 APAP/CODEINE SOL 120-12/5 12/31/9999 2<strong>01</strong>2360432024504 APAP/CODEINE SOL 120-12/5 12/31/9999 2<strong>01</strong>2360432024516 APAP/CODEINE SOL 120-12/5 12/31/9999 2<strong>01</strong>23000930050<strong>01</strong> APAP/CODEINE TAB 300-15MG 12/31/9999 2<strong>01</strong>23004060483<strong>01</strong> APAP/CODEINE TAB 300-15MG 12/31/9999 2<strong>01</strong>2300603233721 APAP/CODEINE TAB 300-15MG 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>50<strong>01</strong> APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>5<strong>01</strong>0 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>23004060484<strong>01</strong> APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300406048403 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300406048410 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300406048420 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300406048450 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300406048462 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233802 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233804 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233816 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233820 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233821 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233822 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2300603233832 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>61<strong>01</strong> APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>6120 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>6121 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>6196 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>6199 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>2363739000410 APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>23680840372<strong>01</strong> APAP/CODEINE TAB 300-30MG 12/31/9999 2<strong>01</strong>23000930350<strong>01</strong> APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300093035005 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300093035<strong>01</strong>0 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300228302110 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300228302150 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>23004060485<strong>01</strong> APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300406048505 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300603233921 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2300603233928 APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>23680840373<strong>01</strong> APAP/CODEINE TAB 300-60MG 12/31/9999 2<strong>01</strong>2350844023508 APAP/DIPHEN TAB 500-25MG 12/31/9999 2<strong>01</strong>2350844023515 APAP/DIPHEN TAB 500-25MG 12/31/9999 2<strong>01</strong>2312939099831 APETIMAR SYP /IRON 12/31/9999 2<strong>01</strong>2300462039530 APEXICON E CRE 0.05% 12/31/9999 2<strong>01</strong>2300462039560 APEXICON E CRE 0.05% 12/31/9999 2<strong>01</strong>2300088250205 APIDRA INJ SOLOSTAR 12/31/9999 2<strong>01</strong>2300088250033 APIDRA INJ U-100 12/31/9999 2<strong>01</strong>2300024581030 APLENZIN TAB 174MG 12/31/9999 2<strong>01</strong>2300024581130 APLENZIN TAB 348MG 12/31/9999 2<strong>01</strong>2300024581230 APLENZIN TAB 522MG 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>04<strong>01</strong> APLISOL INJ 5/0.1ML 12/31/9999 2<strong>01</strong>2342023<strong>01</strong>0405 APLISOL INJ 5/0.1ML 12/31/9999 2<strong>01</strong>23150540211<strong>01</strong> APOKYN INJ 12/31/9999 2<strong>01</strong>2315054021105 APOKYN INJ 12/31/9999 2<strong>01</strong>23275050004<strong>01</strong> APOKYN INJ 10MG/ML 12/31/9999 2<strong>01</strong>2327505000405 APOKYN INJ 10MG/ML 12/31/9999 2<strong>01</strong>2368405802116 APPBUTAMONE PAK 12/31/9999 2<strong>01</strong>2368405800916 APPBUTAMONE PAK -D 12/31/9999 2<strong>01</strong>23684058<strong>01</strong>116 APPFORMIN PAK 12/31/9999 2<strong>01</strong>23684058<strong>01</strong>916 APPFORMIN-D PAK 12/31/9999 2<strong>01</strong>23

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