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

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

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004560458<strong>01</strong> ARMOUR THYRO TAB 30MG 12/31/9999 2<strong>01</strong>23004560459<strong>01</strong> ARMOUR THYRO TAB 60MG 12/31/9999 2<strong>01</strong>23004560460<strong>01</strong> ARMOUR THYRO TAB 90MG 12/31/9999 2<strong>01</strong>2300009766304 AROMASIN TAB 25MG 12/31/9999 2<strong>01</strong>230000744<strong>01</strong><strong>01</strong> ARRANON INJ 5MG/ML 12/31/9999 2<strong>01</strong>230000744<strong>01</strong>06 ARRANON INJ 5MG/ML 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>6553 ARTHRICREAM CRE 10% 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>9821 ARTHRICREAM CRE 10% 12/31/9999 2<strong>01</strong>2345802035653 ARTHRICREAM CRE 10% 12/31/9999 2<strong>01</strong>2349348088384 ARTHRICREAM CRE 10% 12/31/9999 2<strong>01</strong>2300025141134 ARTHROTEC 50 TAB 12/31/9999 2<strong>01</strong>2300025141160 ARTHROTEC 50 TAB 12/31/9999 2<strong>01</strong>2300025141190 ARTHROTEC 50 TAB 12/31/9999 2<strong>01</strong>2300025142134 ARTHROTEC 75 TAB 12/31/9999 2<strong>01</strong>2300025142160 ARTHROTEC 75 TAB 12/31/9999 2<strong>01</strong>2324385062971 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2324385062978 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2324385062981 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2336800054462 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2336800054471 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2336800054478 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2336800096647 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2337205003471 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2337205003478 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2349614047378 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>23516600333<strong>01</strong> ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2351660033350 ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10026<strong>01</strong> ARTHRTS PAIN TAB 650MG 12/31/9999 2<strong>01</strong>2300536655091 ARTIFI TEARS OIN OP 12/31/9999 2<strong>01</strong>2300536197072 ARTIFI TEARS SOL OP 12/31/9999 2<strong>01</strong>2324385000605 ARTIFICIAL SOL TEARS 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>3705 ARTIFICIAL SOL TEARS 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong><strong>01</strong><strong>01</strong> ARTIFICIAL SOL TEARS 12/31/9999 2<strong>01</strong>2368<strong>01</strong>6032211 ARTIFICIAL SOL TEARS OP 12/31/9999 2<strong>01</strong>2300944850310 ARTISS SOL 10ML 12/31/9999 2<strong>01</strong>2300944850302 ARTISS SOL 2ML 12/31/9999 2<strong>01</strong>2300944850304 ARTISS SOL 4ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>730821<strong>01</strong> ARZERRA CON 100/50ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>73082133 ARZERRA CON 100/5ML 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>6412 ASA/CAFF TAB 400-32MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>49075215 ASACOL TAB 400MG DR 03/31/2<strong>01</strong>3 2<strong>01</strong>2300430075227 ASACOL TAB 400MG DR 12/31/9999 2<strong>01</strong>230<strong>01</strong>490783<strong>01</strong> ASACOL HD TAB 800MG 05/31/2<strong>01</strong>3 2<strong>01</strong>2300430078327 ASACOL HD TAB 800MG 12/31/9999 2<strong>01</strong>23519910074<strong>01</strong> ASCOMP/COD CAP 30MG 12/31/9999 2<strong>01</strong>2351991007405 ASCOMP/COD CAP 30MG 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6404 ASCORBIC ACD GRA 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6406 ASCORBIC ACD GRA 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6407 ASCORBIC ACD GRA 12/31/9999 2<strong>01</strong>23005175050<strong>01</strong> ASCORBIC ACD INJ 500MG/ML 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>1850 ASCORBIC ACD INJ 500MG/ML 12/31/9999 2<strong>01</strong>2338779090804 ASCORBYL POW PALMITAT 12/31/9999 2<strong>01</strong>2338779090805 ASCORBYL POW PALMITAT 12/31/9999 2<strong>01</strong>2338779090808 ASCORBYL POW PALMITAT 12/31/9999 2<strong>01</strong>2351552125304 ASCORBYL POW PALMITAT 12/31/9999 2<strong>01</strong>2351552125309 ASCORBYL POW PALMITAT 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>4910 ASCRIPTIN TAB 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>4922 ASCRIPTIN TAB 12/31/9999 2<strong>01</strong>2300067<strong>01</strong>4385 ASCRIPTIN TAB MAX-STR 12/31/9999 2<strong>01</strong>23000851341<strong>01</strong> ASMANEX 120 AER 220MCG 12/31/9999 2<strong>01</strong>23

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