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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66479058<strong>01</strong>0 ROXICODONE TAB 5MG 12/31/9999 2<strong>01</strong>2366479058025 ROXICODONE TAB 5MG 12/31/9999 2<strong>01</strong>2364764080510 ROZEREM TAB 8MG 12/31/9999 2<strong>01</strong>2364764080530 ROZEREM TAB 8MG 12/31/9999 2<strong>01</strong>2349348000338 RUB ALCOHOL SOL 70% ETHY 12/31/9999 2<strong>01</strong>2315370000810 RU-HIST TAB FORTE 12/31/9999 2<strong>01</strong>2315370003110 RU-HIST-D TAB 30-10MG 12/31/9999 2<strong>01</strong>2300536194583 RULOX SUS 12/31/9999 2<strong>01</strong>2315370002710 RU-TUSS TAB 12/31/9999 2<strong>01</strong>23153700<strong>01</strong>210 RU-TUSS DM TAB 60-800MG 12/31/9999 2<strong>01</strong>23153700<strong>01</strong>710 RU-TUSS JR TAB 45-600MG 12/31/9999 2<strong>01</strong>2368453082503 RYBIX ODT TAB 50MG 06/30/2<strong>01</strong>4 2<strong>01</strong>2323359002316 RYDEX LIQ 12/31/9999 2<strong>01</strong>2323359002410 RYDEX G TAB 38.5-398 12/31/9999 2<strong>01</strong>23004850080<strong>01</strong> RYMED TAB 2-10MG 12/31/9999 2<strong>01</strong>2300485020416 RYNEX DM LIQ 12/31/9999 2<strong>01</strong>2300485020216 RYNEX PE ELX 12/31/9999 2<strong>01</strong>2300485020616 RYNEX PSE LIQ 12/31/9999 2<strong>01</strong>230<strong>01</strong>73079220 RYTHMOL TAB 150MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73079420 RYTHMOL TAB 225MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730786<strong>01</strong> RYTHMOL SR CAP 225MG 03/28/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>73082318 RYTHMOL SR CAP 225MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730788<strong>01</strong> RYTHMOL SR CAP 325MG 05/03/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>73082418 RYTHMOL SR CAP 325MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>730789<strong>01</strong> RYTHMOL SR CAP 425MG 05/03/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>73082618 RYTHMOL SR CAP 425MG 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1033430 RYZOLT TAB 100MG 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1033530 RYZOLT TAB 200MG 12/31/9999 2<strong>01</strong>2359<strong>01</strong>1033630 RYZOLT TAB 300MG 12/31/9999 2<strong>01</strong>230048759<strong>01</strong>02 S2 NEB 2.25% 12/31/9999 2<strong>01</strong>230048759<strong>01</strong>10 S2 NEB 2.25% 12/31/9999 2<strong>01</strong>230048759<strong>01</strong>99 S2 NEB 2.25% 12/31/9999 2<strong>01</strong>2367386021165 SABRIL POW 500MG 12/31/9999 2<strong>01</strong>2367386<strong>01</strong>11<strong>01</strong> SABRIL TAB 500MG 12/31/9999 2<strong>01</strong>2351552035604 SACCHARIN POW 12/31/9999 2<strong>01</strong>2351552035606 SACCHARIN POW 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>8704 SACCHARIN POW SODIUM 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>8706 SACCHARIN POW SODIUM 12/31/9999 2<strong>01</strong>2351552062606 SAFFLOWER OIL 12/31/9999 2<strong>01</strong>2351552062608 SAFFLOWER OIL 12/31/9999 2<strong>01</strong>2350419040303 SAFYRAL TAB 12/31/9999 2<strong>01</strong>2344087100502 SAIZEN INJ 5MG 12/31/9999 2<strong>01</strong>23440871080<strong>01</strong> SAIZEN INJ 8.8MG 12/31/9999 2<strong>01</strong>23440871088<strong>01</strong> SAIZEN INJ 8.8MG 12/31/9999 2<strong>01</strong>2300884259215 SALACTIC FIL SOL 17% 12/31/9999 2<strong>01</strong>2358980063190 SALACYN CRE 6% 12/31/9999 2<strong>01</strong>2358980063<strong>01</strong>4 SALACYN LOT 6% 12/31/9999 2<strong>01</strong>2358063070510 SALAGEN TAB 5MG 04/30/2<strong>01</strong>4 2<strong>01</strong>2362856070510 SALAGEN TAB 5MG 12/31/9999 2<strong>01</strong>2362856077510 SALAGEN TAB 7.5MG 12/31/9999 2<strong>01</strong>23135480<strong>01</strong>206 SALEX SHA 6% 12/31/9999 2<strong>01</strong>23135480<strong>01</strong><strong>01</strong>7 SALEX CREAM KIT 6% 12/31/9999 2<strong>01</strong>23135480<strong>01</strong>109 SALEX LOTION KIT 6% 12/31/9999 2<strong>01</strong>2342192<strong>01</strong>1270 SALICYLIC AER 6% 12/31/9999 2<strong>01</strong>2351552026406 SALICYLIC CRY ACID 12/31/9999 2<strong>01</strong>2351552026409 SALICYLIC CRY ACID 12/31/9999 2<strong>01</strong>23458020806<strong>01</strong> SALICYLIC AC CRE 6% 12/31/9999 2<strong>01</strong>23425460270<strong>01</strong> SALICYLIC AC KIT 6% 12/31/9999 2<strong>01</strong>2313925004<strong>01</strong>0 SALICYLIC AC KIT 6% CREAM 12/31/9999 2<strong>01</strong>2313925005<strong>01</strong>0 SALICYLIC AC KIT 6% LOTN 12/31/9999 2<strong>01</strong>23

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