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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49908<strong>01</strong>3710 SALICYLIC AC LIQ 26% 12/31/9999 2<strong>01</strong>2349908023710 SALICYLIC AC LIQ 27.5% 12/31/9999 2<strong>01</strong>2345802081841 SALICYLIC AC LOT 6% 12/31/9999 2<strong>01</strong>2342546027906 SALICYLIC AC SHA 6% 12/31/9999 2<strong>01</strong>23458020237<strong>01</strong> SALICYLIC AC SHA 6% 12/31/9999 2<strong>01</strong>2300536250676 SALINE MIST SPR 0.65% 12/31/9999 2<strong>01</strong>2324385032558 SALINE NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2337205093<strong>01</strong>3 SALINE NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2337205093021 SALINE NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2349614031213 SALINE NASAL SPR 0.65% 12/31/9999 2<strong>01</strong>2316781<strong>01</strong>6760 SALKERA AER 6% 12/31/9999 2<strong>01</strong>2316781<strong>01</strong>6796 SALKERA AER 6% 12/31/9999 2<strong>01</strong>2300884519215 SAL-PLANT GEL 17% 12/31/9999 2<strong>01</strong>2300904125061 SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2300904562861 SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2351862<strong>01</strong>40<strong>01</strong> SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>23643760507<strong>01</strong> SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2364376050705 SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2365162051210 SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2365162051211 SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2365162051250 SALSALATE TAB 500MG 12/31/9999 2<strong>01</strong>2300904125161 SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>2351862<strong>01</strong>42<strong>01</strong> SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>23643760508<strong>01</strong> SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>2364376050805 SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>2365162051310 SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>2365162051311 SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>2365162051350 SALSALATE TAB 750MG 12/31/9999 2<strong>01</strong>2359148002050 SAMSCA TAB 15MG 12/31/9999 2<strong>01</strong>2359148002150 SAMSCA TAB 30MG 12/31/9999 2<strong>01</strong>2300023351360 SANCTURA TAB 20MG 12/31/9999 2<strong>01</strong>2315456098004 SANCTURA TAB 20MG 12/31/9999 2<strong>01</strong>2300023935030 SANCTURA XR CAP 60MG 12/31/9999 2<strong>01</strong>23427470726<strong>01</strong> SANCUSO DIS 3.1MG 12/31/9999 2<strong>01</strong>2300078024115 SANDIMMUNE CAP 100MG 12/31/9999 2<strong>01</strong>2300078024161 SANDIMMUNE CAP 100MG 12/31/9999 2<strong>01</strong>2300078024<strong>01</strong>5 SANDIMMUNE CAP 25MG 12/31/9999 2<strong>01</strong>2300078024061 SANDIMMUNE CAP 25MG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>09<strong>01</strong> SANDIMMUNE INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>0961 SANDIMMUNE INJ 50MG/ML 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>1022 SANDIMMUNE SOL 100MG/ML 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>8425 SANDOSTATIN INJ 1000MCG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>81<strong>01</strong> SANDOSTATIN INJ 100MCG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>8161 SANDOSTATIN INJ 100MCG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>8325 SANDOSTATIN INJ 200MCG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>82<strong>01</strong> SANDOSTATIN INJ 500MCG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>8261 SANDOSTATIN INJ 500MCG 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>80<strong>01</strong> SANDOSTATIN INJ 50MCG/ML 12/31/9999 2<strong>01</strong>2300078<strong>01</strong>8061 SANDOSTATIN INJ 50MCG/ML 12/31/9999 2<strong>01</strong>2300078034061 SANDOSTATIN KIT LAR 10MG 12/31/9999 2<strong>01</strong>2300078034161 SANDOSTATIN KIT LAR 20MG 12/31/9999 2<strong>01</strong>2300078034261 SANDOSTATIN KIT LAR 30MG 12/31/9999 2<strong>01</strong>2300713030898 SANI-PADS PAD 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>09 SANI-SUPP SUP ADULT 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>25 SANI-SUPP SUP ADULT 12/31/9999 2<strong>01</strong>2300713<strong>01</strong><strong>01</strong>50 SANI-SUPP SUP ADULT 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0209 SANI-SUPP SUP PEDIATRI 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0225 SANI-SUPP SUP PEDIATRI 12/31/9999 2<strong>01</strong>23000645<strong>01</strong><strong>01</strong>5 SANTYL OIN 250/GM 12/31/9999 2<strong>01</strong>23000645<strong>01</strong>030 SANTYL OIN 250/GM 12/31/9999 2<strong>01</strong>23

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