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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51552077206 APPLE FLAVOR LIQ 12/31/9999 2<strong>01</strong>2351552088506 APPLE FLAVOR POW 12/31/9999 2<strong>01</strong>236840510<strong>01</strong><strong>01</strong> APPTRIM CAP 12/31/9999 2<strong>01</strong>23684051<strong>01</strong>4<strong>01</strong> APPTRIM LIFE CAP BARIATRC 12/31/9999 2<strong>01</strong>23684051<strong>01</strong>5<strong>01</strong> APPTRIM LIFE CAP BARIATRC 12/31/9999 2<strong>01</strong>23684051<strong>01</strong>3<strong>01</strong> APPTRIM LIFE CAP OBESITY 12/31/9999 2<strong>01</strong>23684051009<strong>01</strong> APPTRIM-D CAP 12/31/9999 2<strong>01</strong>2317478071610 APRACLONIDIN SOL 0.5% OP 12/31/9999 2<strong>01</strong>2317478071611 APRACLONIDIN SOL 0.5% OP 12/31/9999 2<strong>01</strong>2361314066505 APRACLONIDIN SOL 0.5% OP 12/31/9999 2<strong>01</strong>2361314066510 APRACLONIDIN SOL 0.5% OP 12/31/9999 2<strong>01</strong>2300555904358 APRI TAB 12/31/9999 2<strong>01</strong>2365649<strong>01</strong>0302 APRISO CAP 0.375GM 12/31/9999 2<strong>01</strong>2300904025024 APRODINE TAB 2.5-60MG 12/31/9999 2<strong>01</strong>2300904025059 APRODINE TAB 2.5-60MG 12/31/9999 2<strong>01</strong>2300597000302 APTIVUS CAP 250MG 12/31/9999 2<strong>01</strong>23005970002<strong>01</strong> APTIVUS SOL 12/31/9999 2<strong>01</strong>2300574003<strong>01</strong>6 AQUABASE OIN 12/31/9999 2<strong>01</strong>230<strong>01</strong>350504<strong>01</strong> AQUAFRESH GEL WHITENIN 12/31/9999 2<strong>01</strong>230<strong>01</strong>350505<strong>01</strong> AQUAFRESH GEL WHITENIN 12/31/9999 2<strong>01</strong>230<strong>01</strong>350506<strong>01</strong> AQUAFRESH GEL WHITENIN 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>29<strong>01</strong> AQUAFRESH PST 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>2902 AQUAFRESH PST 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>2903 AQUAFRESH PST 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>2904 AQUAFRESH PST 12/31/9999 2<strong>01</strong>230<strong>01</strong>35046802 AQUAFRESH PST ADVANCED 12/31/9999 2<strong>01</strong>230<strong>01</strong>35021906 AQUAFRESH PST CAV PROT 12/31/9999 2<strong>01</strong>230<strong>01</strong>350442<strong>01</strong> AQUAFRESH PST DR SEUSS 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>2502 AQUAFRESH PST EX FRESH 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>2503 AQUAFRESH PST EX FRESH 12/31/9999 2<strong>01</strong>230<strong>01</strong>35043205 AQUAFRESH PST EXTREME 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>2602 AQUAFRESH PST FOR KIDS 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>3202 AQUAFRESH PST SENSITIV 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>3203 AQUAFRESH PST SENSITIV 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>7903 AQUAFRESH PST TART CNT 12/31/9999 2<strong>01</strong>230<strong>01</strong>3502<strong>01</strong><strong>01</strong> AQUAFRESH PST WHITENG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350464<strong>01</strong> AQUAFRESH PST WHT&SHIN 12/31/9999 2<strong>01</strong>2300096073204 AQUANIL HC LOT 1% 12/31/9999 2<strong>01</strong>2300096072408 AQUANIL SKIN LOT CLEANSER 12/31/9999 2<strong>01</strong>2300096072416 AQUANIL SKIN LOT CLEANSER 12/31/9999 2<strong>01</strong>2351552114306 AQUAPHIL OIN BASE 12/31/9999 2<strong>01</strong>2351552114506 AQUASOL OIN 12/31/9999 2<strong>01</strong>2361703041807 AQUASOL A INJ 50000/ML 12/31/9999 2<strong>01</strong>2354838000530 AQUEOUS E DRO 15/0.3ML 12/31/9999 2<strong>01</strong>2300944282202 ARALAST NP INJ 1000MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23009442802<strong>01</strong> ARALAST NP INJ 400MG 12/31/9999 2<strong>01</strong>2300944280202 ARALAST NP INJ 800MG 12/31/9999 2<strong>01</strong>23000240084<strong>01</strong> ARALEN TAB 500MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2300555906667 ARANELLE TAB 12/31/9999 2<strong>01</strong>23555130005<strong>01</strong> ARANESP INJ 100MCG 12/31/9999 2<strong>01</strong>2355513000504 ARANESP INJ 100MCG 12/31/9999 2<strong>01</strong>23555130025<strong>01</strong> ARANESP INJ 100MCG 12/31/9999 2<strong>01</strong>2355513002504 ARANESP INJ 100MCG 12/31/9999 2<strong>01</strong>23555130027<strong>01</strong> ARANESP INJ 150MCG 12/31/9999 2<strong>01</strong>2355513002704 ARANESP INJ 150MCG 12/31/9999 2<strong>01</strong>23555130053<strong>01</strong> ARANESP INJ 150MCG 12/31/9999 2<strong>01</strong>2355513005304 ARANESP INJ 150MCG 12/31/9999 2<strong>01</strong>23555130006<strong>01</strong> ARANESP INJ 200MCG 12/31/9999 2<strong>01</strong>23555130028<strong>01</strong> ARANESP INJ 200MCG 12/31/9999 2<strong>01</strong>23555130002<strong>01</strong> ARANESP INJ 25MCG 12/31/9999 2<strong>01</strong>23

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