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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55513000204 ARANESP INJ 25MCG 12/31/9999 2<strong>01</strong>23555130057<strong>01</strong> ARANESP INJ 25MCG 12/31/9999 2<strong>01</strong>2355513005704 ARANESP INJ 25MCG 12/31/9999 2<strong>01</strong>2355513<strong>01</strong>10<strong>01</strong> ARANESP INJ 300MCG 12/31/9999 2<strong>01</strong>2355513<strong>01</strong>11<strong>01</strong> ARANESP INJ 300MCG 12/31/9999 2<strong>01</strong>23555130003<strong>01</strong> ARANESP INJ 40MCG 12/31/9999 2<strong>01</strong>2355513000304 ARANESP INJ 40MCG 12/31/9999 2<strong>01</strong>23555130021<strong>01</strong> ARANESP INJ 40MCG 12/31/9999 2<strong>01</strong>2355513002104 ARANESP INJ 40MCG 12/31/9999 2<strong>01</strong>23555130032<strong>01</strong> ARANESP INJ 500MCG 12/31/9999 2<strong>01</strong>23555130004<strong>01</strong> ARANESP INJ 60MCG 12/31/9999 2<strong>01</strong>2355513000404 ARANESP INJ 60MCG 12/31/9999 2<strong>01</strong>23555130023<strong>01</strong> ARANESP INJ 60MCG 12/31/9999 2<strong>01</strong>2355513002304 ARANESP INJ 60MCG 12/31/9999 2<strong>01</strong>2300088216030 ARAVA TAB 10MG 12/31/9999 2<strong>01</strong>2300088216130 ARAVA TAB 20MG 12/31/9999 2<strong>01</strong>2363717087116 ARBINOXA LIQ 4MG/5ML 12/31/9999 2<strong>01</strong>23637170870<strong>01</strong> ARBINOXA TAB 4MG 12/31/9999 2<strong>01</strong>236175500<strong>01</strong><strong>01</strong> ARCALYST INJ 220MG 12/31/9999 2<strong>01</strong>2300078061915 ARCAPTA CAP 75MCG 12/31/9999 2<strong>01</strong>2300078061961 ARCAPTA CAP 75MCG 12/31/9999 2<strong>01</strong>23000074407<strong>01</strong> ARGATROBAN INJ 100MG/ML 12/31/9999 2<strong>01</strong>2300007440754 ARGATROBAN INJ 100MG/ML 12/31/9999 2<strong>01</strong>2300781328512 ARGATROBAN INJ 125/125 12/31/9999 2<strong>01</strong>2351552102404 ARGININE HCL POW 12/31/9999 2<strong>01</strong>2351552102405 ARGININE HCL POW 12/31/9999 2<strong>01</strong>2362856024611 ARICEPT TAB 10MG 12/31/9999 2<strong>01</strong>2362856024630 ARICEPT TAB 10MG 12/31/9999 2<strong>01</strong>2362856024641 ARICEPT TAB 10MG 12/31/9999 2<strong>01</strong>2362856024690 ARICEPT TAB 10MG 12/31/9999 2<strong>01</strong>2362856024730 ARICEPT TAB 23MG 12/31/9999 2<strong>01</strong>2362856024790 ARICEPT TAB 23MG 12/31/9999 2<strong>01</strong>2362856024511 ARICEPT TAB 5MG 12/31/9999 2<strong>01</strong>2362856024530 ARICEPT TAB 5MG 12/31/9999 2<strong>01</strong>2362856024541 ARICEPT TAB 5MG 12/31/9999 2<strong>01</strong>2362856024590 ARICEPT TAB 5MG 12/31/9999 2<strong>01</strong>2362856083230 ARICEPT ODT TAB 10MG 12/31/9999 2<strong>01</strong>2362856083130 ARICEPT ODT TAB 5MG 12/31/9999 2<strong>01</strong>23441780552<strong>01</strong> ARIDOL KIT 12/31/9999 2<strong>01</strong>230031002<strong>01</strong>30 ARIMIDEX TAB 1MG 12/31/9999 2<strong>01</strong>2300781308571 ARISTOSPAN INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300781308575 ARISTOSPAN INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300781308475 ARISTOSPAN INJ 5MG/ML 12/31/9999 2<strong>01</strong>23000073236<strong>01</strong> ARIXTRA SOL 10/0.8 12/31/9999 2<strong>01</strong>2300007323602 ARIXTRA SOL 10/0.8 04/30/2<strong>01</strong>4 2<strong>01</strong>2300007323611 ARIXTRA SOL 10/0.8 12/31/9999 2<strong>01</strong>23000073230<strong>01</strong> ARIXTRA SOL 2.5/0.5 12/31/9999 2<strong>01</strong>2300007323002 ARIXTRA SOL 2.5/0.5 12/31/9999 2<strong>01</strong>2300007323<strong>01</strong>1 ARIXTRA SOL 2.5/0.5 12/31/9999 2<strong>01</strong>23000073232<strong>01</strong> ARIXTRA SOL 5.0/0.4 12/31/9999 2<strong>01</strong>2300007323202 ARIXTRA SOL 5.0/0.4 08/31/2<strong>01</strong>3 2<strong>01</strong>2300007323211 ARIXTRA SOL 5.0/0.4 12/31/9999 2<strong>01</strong>23000073234<strong>01</strong> ARIXTRA SOL 7.5/0.6 12/31/9999 2<strong>01</strong>2300007323402 ARIXTRA SOL 7.5/0.6 03/31/2<strong>01</strong>4 2<strong>01</strong>2300007323411 ARIXTRA SOL 7.5/0.6 12/31/9999 2<strong>01</strong>23004560461<strong>01</strong> ARMOUR THYRO TAB 120MG 12/31/9999 2<strong>01</strong>23004560457<strong>01</strong> ARMOUR THYRO TAB 15MG 12/31/9999 2<strong>01</strong>23004560462<strong>01</strong> ARMOUR THYRO TAB 180MG 12/31/9999 2<strong>01</strong>23004560463<strong>01</strong> ARMOUR THYRO TAB 240MG 12/31/9999 2<strong>01</strong>23004560464<strong>01</strong> ARMOUR THYRO TAB 300MG 12/31/9999 2<strong>01</strong>23

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