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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55513007430 SENSIPAR TAB 60MG 12/31/9999 2<strong>01</strong>2355513007530 SENSIPAR TAB 90MG 12/31/9999 2<strong>01</strong>231<strong>01</strong>58098204 SENSODYNE GEL MAX COOL 12/31/9999 2<strong>01</strong>230<strong>01</strong>350502<strong>01</strong> SENSODYNE GEL MULTIACT 12/31/9999 2<strong>01</strong>230<strong>01</strong>350503<strong>01</strong> SENSODYNE GEL WHITENIN 12/31/9999 2<strong>01</strong>231<strong>01</strong>58008111 SENSODYNE PST MAX MINT 12/31/9999 2<strong>01</strong>231<strong>01</strong>58087704 SENSODYNE PST MAX ORIG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350460<strong>01</strong> SENSODYNE PST PRONAMEL 12/31/9999 2<strong>01</strong>231<strong>01</strong>58008504 SENSODYNE PST TARTAR 12/31/9999 2<strong>01</strong>231<strong>01</strong>58007704 SENSODYNE-SC PST ORIGINAL 12/31/9999 2<strong>01</strong>230<strong>01</strong>861031<strong>01</strong> SENSORCAINE INJ 0.25% 04/30/2<strong>01</strong>3 2<strong>01</strong>2363323046550 SENSORCAINE INJ 0.25% 03/30/2<strong>01</strong>5 2<strong>01</strong>2363323046557 SENSORCAINE INJ 0.25% 12/31/9999 2<strong>01</strong>230<strong>01</strong>861035<strong>01</strong> SENSORCAINE INJ 0.5% 05/31/2<strong>01</strong>3 2<strong>01</strong>2363323046750 SENSORCAINE INJ 0.5% 03/30/2<strong>01</strong>5 2<strong>01</strong>2363323046757 SENSORCAINE INJ 0.5% 12/31/9999 2<strong>01</strong>230<strong>01</strong>861033<strong>01</strong> SENSORCAINE INJ MPF 0.5% 05/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>86103312 SENSORCAINE INJ MPF 0.5% 04/30/2<strong>01</strong>3 2<strong>01</strong>2363323046610 SENSORCAINE INJ MPF 0.5% 05/30/2<strong>01</strong>4 2<strong>01</strong>2363323046617 SENSORCAINE INJ MPF 0.5% 12/31/9999 2<strong>01</strong>2363323046630 SENSORCAINE INJ MPF 0.5% 12/30/2<strong>01</strong>3 2<strong>01</strong>2363323046631 SENSORCAINE INJ MPF 0.5% 12/31/9999 2<strong>01</strong>2363323046633 SENSORCAINE INJ MPF 0.5% 12/31/9999 2<strong>01</strong>2363323046637 SENSORCAINE INJ MPF 0.5% 12/31/9999 2<strong>01</strong>2363323047302 SENSORCAINE INJ MPF SPIN 12/31/9999 2<strong>01</strong>2363323046037 SENSORCAINE INJ -MPF/EPI 12/31/9999 2<strong>01</strong>2363323046217 SENSORCAINE INJ -MPF/EPI 12/31/9999 2<strong>01</strong>2363323046231 SENSORCAINE INJ -MPF/EPI 12/31/9999 2<strong>01</strong>2363323046237 SENSORCAINE INJ -MPF/EPI 12/31/9999 2<strong>01</strong>2363323046817 SENSORCAINE INJ -MPF/EPI 12/31/9999 2<strong>01</strong>2363323046837 SENSORCAINE INJ -MPF/EPI 12/31/9999 2<strong>01</strong>230<strong>01</strong>861030<strong>01</strong> SENSORCAINE INJ MPF0.25% 04/30/2<strong>01</strong>3 2<strong>01</strong>2363323046410 SENSORCAINE INJ MPF0.25% 04/30/2<strong>01</strong>5 2<strong>01</strong>2363323046417 SENSORCAINE INJ MPF0.25% 12/31/9999 2<strong>01</strong>2363323046430 SENSORCAINE INJ MPF0.25% 09/30/2<strong>01</strong>4 2<strong>01</strong>2363323046431 SENSORCAINE INJ MPF0.25% 12/31/9999 2<strong>01</strong>2363323046433 SENSORCAINE INJ MPF0.25% 12/31/9999 2<strong>01</strong>2363323046437 SENSORCAINE INJ MPF0.25% 12/31/9999 2<strong>01</strong>230<strong>01</strong>86103702 SENSORCAINE INJ MPF0.75% 11/30/2<strong>01</strong>2 2<strong>01</strong>2363323047210 SENSORCAINE INJ MPF0.75% 05/30/2<strong>01</strong>3 2<strong>01</strong>2363323047217 SENSORCAINE INJ MPF0.75% 12/31/9999 2<strong>01</strong>2363323047230 SENSORCAINE INJ MPF0.75% 06/30/2<strong>01</strong>3 2<strong>01</strong>2363323047233 SENSORCAINE INJ MPF0.75% 12/31/9999 2<strong>01</strong>2363323047237 SENSORCAINE INJ MPF0.75% 12/31/9999 2<strong>01</strong>2363323046150 SENSORCAINE/ INJ EPI 0.25 11/30/2<strong>01</strong>2 2<strong>01</strong>2363323046157 SENSORCAINE/ INJ EPI 0.25 12/31/9999 2<strong>01</strong>2363323046357 SENSORCAINE/ INJ EPI 0.5% 12/31/9999 2<strong>01</strong>2368405100202 SENTRA AM CAP 12/31/9999 2<strong>01</strong>2368405100302 SENTRA PM CAP 12/31/9999 2<strong>01</strong>2368405803326 SENTRADINE PAK 12/31/9999 2<strong>01</strong>2368405802226 SENTRAFLOX PAK AM-10 12/31/9999 2<strong>01</strong>23684058<strong>01</strong>226 SENTRALOPRAM PAK AM-10 12/31/9999 2<strong>01</strong>2368405805326 SENTRAVIL PM PAK -25 12/31/9999 2<strong>01</strong>2368405803226 SENTRAZOLAM PAK AM 0.25 12/31/9999 2<strong>01</strong>2368405802326 SENTRAZOLPID PAK PM-5 12/31/9999 2<strong>01</strong>2368405804326 SENTROXATINE PAK 12/31/9999 2<strong>01</strong>230<strong>01</strong>73052000 SEREVENT DIS AER 50MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73052100 SEREVENT DIS AER 50MCG 12/31/9999 2<strong>01</strong>2313845120003 SEROMYCIN CAP 250MG 12/31/9999 2<strong>01</strong>2344087809006 SEROPHENE TAB 50MG 12/31/9999 2<strong>01</strong>23

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