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

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

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

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38779051008 PROPYLENE LIQ GLYCOL 12/31/9999 2<strong>01</strong>2338779051009 PROPYLENE LIQ GLYCOL 12/31/9999 2<strong>01</strong>2300574007216 PROPYLENE GL SOL 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>0306 PROPYLENE GL SOL 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>0308 PROPYLENE GL SOL 12/31/9999 2<strong>01</strong>230<strong>01</strong>431480<strong>01</strong> PROPYLTHIOUR TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43148<strong>01</strong>0 PROPYLTHIOUR TAB 50MG 12/31/9999 2<strong>01</strong>2300228234810 PROPYLTHIOUR TAB 50MG 12/31/9999 2<strong>01</strong>2366594044416 PRO-RED AC SYP 12/31/9999 2<strong>01</strong>2300006007231 PROSCAR TAB 5MG 12/31/9999 2<strong>01</strong>2300006007258 PROSCAR TAB 5MG 12/31/9999 2<strong>01</strong>235556681<strong>01</strong><strong>01</strong> PROSED/DS TAB 12/31/9999 2<strong>01</strong>2300064<strong>01</strong>5008 PROSHIELD AER FOAM/SPR 12/31/9999 2<strong>01</strong>2300064030004 PROSHIELD CRE PLUS 12/31/9999 2<strong>01</strong>2300064085006 PROSHIELD CRE PROTECT 12/31/9999 2<strong>01</strong>2300064030025 PROSHIELD KIT SKN CARE 12/31/9999 2<strong>01</strong>2300064070004 PROSHIELD SPR CLEANSER 12/31/9999 2<strong>01</strong>2300338049906 PROSOL INJ 20% 12/31/9999 2<strong>01</strong>230<strong>01</strong>87310<strong>01</strong>0 PROSTIGMIN TAB 15MG 12/31/9999 2<strong>01</strong>2300009082703 PROSTIN E2 SUP 20MG 12/31/9999 2<strong>01</strong>23000093169<strong>01</strong> PROSTIN VR INJ 500MCG 12/31/9999 2<strong>01</strong>2300009316906 PROSTIN VR INJ 500MCG 12/31/9999 2<strong>01</strong>2351552096002 PROTAMINE POW SULFATE 12/31/9999 2<strong>01</strong>2363323022905 PROTAMINE SU SOL 10MG/ML 12/31/9999 2<strong>01</strong>2363323022915 PROTAMINE SU SOL 10MG/ML 12/31/9999 2<strong>01</strong>2363323022930 PROTAMINE SU SOL 10MG/ML 12/31/9999 2<strong>01</strong>2363323022935 PROTAMINE SU SOL 10MG/ML 12/31/9999 2<strong>01</strong>2300008092351 PROTONIX INJ 40MG 12/31/9999 2<strong>01</strong>2300008092355 PROTONIX INJ 40MG 12/31/9999 2<strong>01</strong>2300008092360 PROTONIX INJ 40MG 12/31/9999 2<strong>01</strong>2300008094102 PROTONIX INJ 40MG 12/31/9999 2<strong>01</strong>23000080844<strong>01</strong> PROTONIX PAK 12/31/9999 2<strong>01</strong>2300008084402 PROTONIX PAK 12/31/9999 2<strong>01</strong>2300008084381 PROTONIX TAB 20MG 12/31/9999 2<strong>01</strong>2300008084181 PROTONIX TAB 40MG 12/31/9999 2<strong>01</strong>2300008084199 PROTONIX TAB 40MG 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>41<strong>01</strong> PROTOPAM CHL INJ 1GM 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>4127 PROTOPAM CHL INJ 1GM 12/31/9999 2<strong>01</strong>230046952<strong>01</strong>11 PROTOPIC OIN 0.03% 12/31/9999 2<strong>01</strong>230046952<strong>01</strong>30 PROTOPIC OIN 0.03% 12/31/9999 2<strong>01</strong>230046952<strong>01</strong>60 PROTOPIC OIN 0.03% 12/31/9999 2<strong>01</strong>2300469520211 PROTOPIC OIN 0.1% 12/31/9999 2<strong>01</strong>2300469520230 PROTOPIC OIN 0.1% 12/31/9999 2<strong>01</strong>2300469520260 PROTOPIC OIN 0.1% 12/31/9999 2<strong>01</strong>2300054021125 PROTRIPTYLIN TAB 10MG 12/31/9999 2<strong>01</strong>2300555059402 PROTRIPTYLIN TAB 10MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>59<strong>01</strong> PROTRIPTYLIN TAB 10MG 12/31/9999 2<strong>01</strong>2300054021025 PROTRIPTYLIN TAB 5MG 12/31/9999 2<strong>01</strong>2300555059502 PROTRIPTYLIN TAB 5MG 12/31/9999 2<strong>01</strong>2364980<strong>01</strong>58<strong>01</strong> PROTRIPTYLIN TAB 5MG 12/31/9999 2<strong>01</strong>2330237890006 PROVENGE INJ 12/31/9999 2<strong>01</strong>23000851132<strong>01</strong> PROVENTIL AER HFA 12/31/9999 2<strong>01</strong>2300009005002 PROVERA TAB 10MG 12/31/9999 2<strong>01</strong>2300009005<strong>01</strong>1 PROVERA TAB 10MG 12/31/9999 2<strong>01</strong>2300009006404 PROVERA TAB 2.5MG 12/31/9999 2<strong>01</strong>2300009028603 PROVERA TAB 5MG 12/31/9999 2<strong>01</strong>2363459<strong>01</strong><strong>01</strong><strong>01</strong> PROVIGIL TAB 100MG 12/31/9999 2<strong>01</strong>2363459<strong>01</strong><strong>01</strong>30 PROVIGIL TAB 100MG 12/31/9999 2<strong>01</strong>236345902<strong>01</strong><strong>01</strong> PROVIGIL TAB 200MG 12/31/9999 2<strong>01</strong>236345902<strong>01</strong>30 PROVIGIL TAB 200MG 12/31/9999 2<strong>01</strong>23

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