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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31722021305 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2331722021330 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23510790763<strong>01</strong> SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2351079076320 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2354458091302 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2354458092405 SERTRALINE TAB 50MG 10/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2354458094405 SERTRALINE TAB 50MG 04/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2354458094410 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23597624900<strong>01</strong> SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2359762490002 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2359762490003 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2359762490004 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2359762490005 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2360505<strong>01</strong>8103 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2360505<strong>01</strong>8108 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23658620<strong>01</strong>2<strong>01</strong> SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23658620<strong>01</strong>205 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23658620<strong>01</strong>230 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23658620<strong>01</strong>290 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2368084<strong>01</strong>81<strong>01</strong> SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23681800352<strong>01</strong> SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2368180035202 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2368180035205 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2368180035206 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>2368180035209 SERTRALINE TAB 50MG 12/31/9999 2<strong>01</strong>23387791855<strong>01</strong> SESAME OIL 12/31/9999 2<strong>01</strong>2338779185507 SESAME OIL 12/31/9999 2<strong>01</strong>2338779185508 SESAME OIL 12/31/9999 2<strong>01</strong>2351552044206 SESAME OIL 12/31/9999 2<strong>01</strong>2351552044208 SESAME OIL 12/31/9999 2<strong>01</strong>2313925<strong>01</strong>1990 SE-TAN DHA CAP 12/31/9999 2<strong>01</strong>2313925<strong>01</strong>1890 SE-TAN PLUS CAP 12/31/9999 2<strong>01</strong>2313925<strong>01</strong><strong>01</strong>60 SETON ET-EC PAK 12/31/9999 2<strong>01</strong>2313925<strong>01</strong>0060 SETONET PAK 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9065164 SEVOFLURANE SOL 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9065364 SEVOFLURANE SOL 12/31/9999 2<strong>01</strong>2360258<strong>01</strong>51<strong>01</strong> SF GEL 1.1% 12/31/9999 2<strong>01</strong>2360258<strong>01</strong>50<strong>01</strong> SF 5000 PLUS CRE 1.1% 12/31/9999 2<strong>01</strong>2368220002207 SFROWASA ENE 4GM 12/31/9999 2<strong>01</strong>2368220002228 SFROWASA ENE 4GM 12/31/9999 2<strong>01</strong>2351552065006 SHARK POW CARTLG 12/31/9999 2<strong>01</strong>2351552117505 SHEA BUTTER MIS 12/31/9999 2<strong>01</strong>2351552117506 SHEA BUTTER MIS 12/31/9999 2<strong>01</strong>2351552117507 SHEA BUTTER MIS 12/31/9999 2<strong>01</strong>2300066<strong>01</strong>0566 SHEPARDS LOT 08/10/2<strong>01</strong>4 2<strong>01</strong>2300066<strong>01</strong>0574 SHEPARDS LOT 08/13/2<strong>01</strong>4 2<strong>01</strong>2351552111605 SIB GINSENG POW 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>1680 SILACE LIQ 10MG/ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>0780 SILACE SYP 60/15ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3540 SILADRYL ALR LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3570 SILADRYL ALR LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3580 SILADRYL ALR LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong><strong>01</strong>40 SILAFED SYP 1.25-30 12/31/9999 2<strong>01</strong>2354838<strong>01</strong><strong>01</strong>70 SILAFED SYP 1.25-30 12/31/9999 2<strong>01</strong>2342847<strong>01</strong>0303 SILENOR TAB 3MG 12/31/9999 2<strong>01</strong>2342847<strong>01</strong>0310 SILENOR TAB 3MG 12/31/9999 2<strong>01</strong>2342847<strong>01</strong>0330 SILENOR TAB 3MG 12/31/9999 2<strong>01</strong>2342847<strong>01</strong>0603 SILENOR TAB 6MG 12/31/9999 2<strong>01</strong>2342847<strong>01</strong>0610 SILENOR TAB 6MG 12/31/9999 2<strong>01</strong>2342847<strong>01</strong>0630 SILENOR TAB 6MG 12/31/9999 2<strong>01</strong>23

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