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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51552<strong>01</strong>2605 SILICA GEL 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>2607 SILICA GEL 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>2609 SILICA GEL 12/31/9999 2<strong>01</strong>2351552126009 SILICONE LIQ BLEND 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>5440 SILPHEN COUG SYP 12.5/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>5470 SILPHEN COUG SYP 12.5/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>5480 SILPHEN COUG SYP 12.5/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>0540 SILPHEN DM SYP 10MG/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3040 SILTUSS DAS LIQ 100/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3840 SILTUSS DAS LIQ 100/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3340 SILTUSSIN DM LIQ DAS 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>1740 SILTUSSIN SA SYP 100/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>1770 SILTUSSIN SA SYP 100/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>1780 SILTUSSIN SA SYP 100/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3940 SILTUSSIN-DM LIQ DIABETIC 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>4040 SILTUSSIN-DM LIQ MAX ST 12/31/9999 2<strong>01</strong>2354838020940 SILTUSSIN-DM SYP ALC FREE 12/31/9999 2<strong>01</strong>2354838020970 SILTUSSIN-DM SYP ALC FREE 12/31/9999 2<strong>01</strong>2354838020980 SILTUSSIN-DM SYP ALC FREE 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>3120 SILVADENE CRE 1% 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>3140 SILVADENE CRE 1% 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>3150 SILVADENE CRE 1% 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>3185 SILVADENE CRE 1% 12/31/9999 2<strong>01</strong>2361570<strong>01</strong>3198 SILVADENE CRE 1% 12/31/9999 2<strong>01</strong>2300093961413 SILVER NITRA SOL 0.5% 12/31/9999 2<strong>01</strong>2351552123704 SILVER PROTE POW MILD 12/31/9999 2<strong>01</strong>2300591081046 SILVER SULFA CRE 1% 12/31/9999 2<strong>01</strong>2300591081055 SILVER SULFA CRE 1% 12/31/9999 2<strong>01</strong>2300591081083 SILVER SULFA CRE 1% 12/31/9999 2<strong>01</strong>2300591081085 SILVER SULFA CRE 1% 12/31/9999 2<strong>01</strong>2366977<strong>01</strong>4003 SILVERMED GEL 12/31/9999 2<strong>01</strong>2366977<strong>01</strong>4005 SILVERMED GEL 12/31/9999 2<strong>01</strong>2366977<strong>01</strong>4<strong>01</strong>5 SILVERMED GEL 12/31/9999 2<strong>01</strong>2300074345590 SIMCOR TAB 1000-20 12/31/9999 2<strong>01</strong>2300074345790 SIMCOR TAB 1000-40 12/31/9999 2<strong>01</strong>2300074331290 SIMCOR TAB 500-20MG 12/31/9999 2<strong>01</strong>2300074345990 SIMCOR TAB 500-40MG 12/31/9999 2<strong>01</strong>2300074331590 SIMCOR TAB 750-20MG 12/31/9999 2<strong>01</strong>2300536360408 SIMETHICONE CAP 180MG 12/31/9999 2<strong>01</strong>2300536453408 SIMETHICONE CHW 125MG 12/31/9999 2<strong>01</strong>23005364533<strong>01</strong> SIMETHICONE CHW 80MG 12/31/9999 2<strong>01</strong>2350844<strong>01</strong>3712 SIMETHICONE CHW 80MG 12/31/9999 2<strong>01</strong>23516450860<strong>01</strong> SIMETHICONE CHW 80MG 12/31/9999 2<strong>01</strong>2363739022510 SIMETHICONE CHW 80MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13088210 SIMETHICONE DRO 20/0.3ML 12/31/9999 2<strong>01</strong>2300536222075 SIMETHICONE DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2300603089450 SIMETHICONE DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>1910 SIMETHICONE DRO 40/0.6ML 12/31/9999 2<strong>01</strong>2346287050630 SIMETHICONE DRO 40/0.6ML 12/31/9999 2<strong>01</strong>23578940070<strong>01</strong> SIMPONI INJ 50MG 12/31/9999 2<strong>01</strong>2357894007002 SIMPONI INJ 50MG 12/31/9999 2<strong>01</strong>2300078039361 SIMULECT INJ 10MG 12/31/9999 2<strong>01</strong>2300078033184 SIMULECT INJ 20MG 12/31/9999 2<strong>01</strong>2300093715310 SIMVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300093715319 SIMVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300093715356 SIMVASTATIN TAB 10MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300093715393 SIMVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300093715398 SIMVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300904580061 SIMVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2316252050650 SIMVASTATIN TAB 10MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23

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