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

00052011906 SAPHRIS SUB 10MG 12/31/9999 2012300052011990 SAPHRIS SUB 10MG 12/31/9999 2012300052214203 SAPHRIS SUB 10MG 12/31/9999 2012300052214204 SAPHRIS SUB 10MG 12/31/9999 2012300052011806 SAPHRIS SUB 5MG 12/31/9999 2012300052011890 SAPHRIS SUB 5MG 12/31/9999 2012300052213903 SAPHRIS SUB 5MG 12/31/9999 2012300052213904 SAPHRIS SUB 5MG 12/31/9999 2012300430021014 SARAFEM TAB 10MG 12/31/9999 2012300430022014 SARAFEM TAB 20MG 12/31/9999 2012351552063909 SARDINE LIQ FLAVOR 12/31/9999 2012300145062805 SARNA LOT 12/31/9999 2012300145063005 SARNA SENSIT LOT 1% 12/31/9999 2012300456150055 SAVELLA MIS TITR PAK 12/31/9999 2012300456151060 SAVELLA TAB 100MG 12/31/9999 2012300456151260 SAVELLA TAB 12.5MG 12/31/9999 2012300456152560 SAVELLA TAB 25MG 12/31/9999 2012300456155060 SAVELLA TAB 50MG 12/31/9999 2012351552106206 SAW PALMETTO EXT 12/31/9999 2012351552108506 SAW PALMETTO POW 12/31/9999 2012315127028336 SB ALLERGY CAP 25MG 12/31/9999 2012315127020524 SB ALLERGY TAB 25MG MED 12/31/9999 2012315127097324 SB ALLERGY/ TAB COLD PE 12/31/9999 2012315127054073 SB ANTACID SUS MINT 12/31/9999 2012315127088352 SB ANTACID/ SUS ANTIGAS 12/31/9999 2012315127073801 SB ASPIRIN TAB 325MG 12/31/9999 2012315127073805 SB ASPIRIN TAB 325MG 12/31/9999 2012315127073809 SB ASPIRIN TAB 325MG 12/31/9999 2012315127073810 SB ASPIRIN TAB 325MG 12/31/9999 2012315127073816 SB ASPIRIN TAB 325MG 12/31/9999 2012315127073821 SB ASPIRIN TAB 325MG 12/31/9999 2012315127001105 SB ASPIRIN TAB 325MG EC 12/31/9999 2012315127076008 SB ASPIRIN TAB 325MG EC 12/31/9999 2012315127044824 SB BACKACHE TAB 500MG 12/31/9999 2012315127017807 SB BISACODYL TAB 5MG EC 12/31/9999 2012315127055068 SB BISMUTH SUS 262/15ML 12/31/9999 2012315127018008 SB BISMUTH TAB 262MG 12/31/9999 2012315127094044 SB CGH CONTR SYP 100/5ML 12/31/9999 2012315127094048 SB CGH CONTR SYP 100/5ML 12/31/9999 2012315127024136 SB CHILD ASA CHW 81MG 12/31/9999 2012315127080413 SB FIB LAX POW 33% 12/31/9999 2012315127080419 SB FIB LAX POW 33% 12/31/9999 2012315127021320 SB FIBER LAX TAB 625MG 12/31/9999 2012315127031201 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031207 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031211 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031224 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031250 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031301 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031324 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127031350 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127033501 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127033511 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127033524 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127033550 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127090550 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127090724 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127090750 SB IBUPROFEN TAB 200MG 12/31/9999 2012315127083373 SB MILK MAGN SUS 12/31/9999 2012315127083573 SB MILK MAGN SUS MINT 12/31/9999 20123