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 ...

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

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49348087934 SM CHILDRENS SUS MS COLD 12/31/9999 2<strong>01</strong>2349348077734 SM CLD/ALRGY ELX CHILDREN 12/31/9999 2<strong>01</strong>2349348077737 SM CLD/ALRGY ELX CHILDREN 12/31/9999 2<strong>01</strong>2349348089350 SM CLEARLAX POW 12/31/9999 2<strong>01</strong>2349348089370 SM CLEARLAX POW 12/31/9999 2<strong>01</strong>2349348089392 SM CLEARLAX POW 12/31/9999 2<strong>01</strong>2349348084004 SM COLD HEAD TAB CONGEST 12/31/9999 2<strong>01</strong>2349348077534 SM COLD/CGH ELX DM CHILD 12/31/9999 2<strong>01</strong>2349348090334 SM COUGH REL SYP 15MG/5ML 12/31/9999 2<strong>01</strong>2349348052071 SM DANDRUFF SHA 1% 12/31/9999 2<strong>01</strong>2349348089071 SM DANDRUFF SHA 2 IN 1 12/31/9999 2<strong>01</strong>2349348073802 SM DAY TIME CAP PE 12/31/9999 2<strong>01</strong>2349348073847 SM DAY TIME CAP PE 12/31/9999 2<strong>01</strong>2349348075336 SM DAY TIME LIQ COLD/FLU 12/31/9999 2<strong>01</strong>2349348052720 SM ENEMA ENE 12/31/9999 2<strong>01</strong>23493480<strong>01</strong>863 SM EPSOM GRA SALT 12/31/9999 2<strong>01</strong>23493480<strong>01</strong>875 SM EPSOM GRA SALT 12/31/9999 2<strong>01</strong>2349348069729 SM EYE DRO 12/31/9999 2<strong>01</strong>2349348003729 SM EYE DROPS SOL 0.05% OP 12/31/9999 2<strong>01</strong>2349348004765 SM FIBER POW 28.3% 12/31/9999 2<strong>01</strong>2349348009168 SM FIBER POW 28.3% 12/31/9999 2<strong>01</strong>2349348<strong>01</strong>6665 SM FIBER POW 48.57% 12/31/9999 2<strong>01</strong>2349348<strong>01</strong>6693 SM FIBER POW 48.57% 12/31/9999 2<strong>01</strong>2349348009092 SM FIBER POW 58.6% 12/31/9999 2<strong>01</strong>2349348063349 SM FIBER LAX CAP 0.52GM 12/31/9999 2<strong>01</strong>2349348054110 SM FIBER LAX TAB 500MG 12/31/9999 2<strong>01</strong>2349348<strong>01</strong>5472 SM FIRST AID OIN 500/GM 12/31/9999 2<strong>01</strong>2349348090470 SM FLU RELF LIQ NIGHTIME 12/31/9999 2<strong>01</strong>2349348060315 SM FLUORIDE SOL MINT 12/31/9999 2<strong>01</strong>2349348050907 SM GAS RELF CHW 80MG 12/31/9999 2<strong>01</strong>23493480913<strong>01</strong> SM GLUCOSE CHW ORANGE 12/31/9999 2<strong>01</strong>2349348091409 SM GLUCOSE CHW ORANGE 12/31/9999 2<strong>01</strong>23493480915<strong>01</strong> SM GLUCOSE CHW RASPBERY 12/31/9999 2<strong>01</strong>2349348091609 SM GLUCOSE CHW RASPBERY 12/31/9999 2<strong>01</strong>23493480734<strong>01</strong> SM GLUCOSE CHW SOUR APP 12/31/9999 2<strong>01</strong>2349348073409 SM GLUCOSE CHW SOUR APP 12/31/9999 2<strong>01</strong>2349348083936 SM GLYCERIN LIQ 12/31/9999 2<strong>01</strong>2349348<strong>01</strong>5805 SM GLYCERIN SUP 80.7% 12/31/9999 2<strong>01</strong>2349348052172 SM HYDROCORT CRE 1% 12/31/9999 2<strong>01</strong>2349348044172 SM HYDROCORT CRE 1% PLUS 12/31/9999 2<strong>01</strong>2349348052272 SM HYDROCORT OIN 1% 12/31/9999 2<strong>01</strong>2349348056847 SM IBUPROFEN CAP 200MG 12/31/9999 2<strong>01</strong>2349348056859 SM IBUPROFEN CAP 200MG 12/31/9999 2<strong>01</strong>2349348072709 SM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2349348072710 SM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2349348082909 SM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2349348082910 SM IBUPROFEN TAB 200MG 12/31/9999 2<strong>01</strong>2349348071130 SM IODIDES TIN 12/31/9999 2<strong>01</strong>2349348059905 SM LAXATIVE TAB 5MG EC 12/31/9999 2<strong>01</strong>2349348046030 SM LICE LOT TREATMNT 12/31/9999 2<strong>01</strong>2349348046034 SM LICE LOT TREATMNT 12/31/9999 2<strong>01</strong>2349348063634 SM LORATADIN SYP 5MG/5ML 12/31/9999 2<strong>01</strong>2349348089185 SM LUBRICATI GEL JELLY 12/31/9999 2<strong>01</strong>2349348050449 SM MAG CITR SOL CHERRY 12/31/9999 2<strong>01</strong>2349348069649 SM MAG CITR SOL LEMON 12/31/9999 2<strong>01</strong>2349348039896 SM MEDICATED MIS CHST RUB 12/31/9999 2<strong>01</strong>2349348083492 SM MEDICATED POW BODY 12/31/9999 2<strong>01</strong>2349348083361 SM MICON 7 SUP 100MG 12/31/9999 2<strong>01</strong>2349348035543 SM MICONAZOL KIT COMBO PK 12/31/9999 2<strong>01</strong>2349348050610 SM MIGRAINE TAB RELIEF 12/31/9999 2<strong>01</strong>23

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