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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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00409798325 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798330 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798348 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798353 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798355 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798361 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798406 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798411 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798413 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798420 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798423 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798436 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409798437 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300517281025 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8600 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8602 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8610 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8620 SOD CHLORIDE INJ 0.9% 12/31/9999 2<strong>01</strong>2300409196605 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 2<strong>01</strong>2300409196607 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 2<strong>01</strong>2300409196612 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 2<strong>01</strong>2363323025930 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 2<strong>01</strong>2300409665773 SOD CHLORIDE INJ 2.5/ML 12/31/9999 2<strong>01</strong>2300409666075 SOD CHLORIDE INJ 2.5/ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>3920 SOD CHLORIDE INJ 2.5/ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>3940 SOD CHLORIDE INJ 2.5/ML 12/31/9999 2<strong>01</strong>2300409113002 SOD CHLORIDE INJ 23.4% 12/31/9999 2<strong>01</strong>2300409114102 SOD CHLORIDE INJ 23.4% 12/31/9999 2<strong>01</strong>2363323008861 SOD CHLORIDE INJ 23.4% 12/31/9999 2<strong>01</strong>2363323008863 SOD CHLORIDE INJ 23.4% 12/31/9999 2<strong>01</strong>2300264780510 SOD CHLORIDE INJ 3% 12/31/9999 2<strong>01</strong>2300338005403 SOD CHLORIDE INJ 3% 12/31/9999 2<strong>01</strong>2300517290025 SOD CHLORIDE INJ 4MEQ/ML <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300517293025 SOD CHLORIDE INJ 4MEQ/ML 12/31/9999 2<strong>01</strong>2363323<strong>01</strong>8730 SOD CHLORIDE INJ 4MEQ/ML 12/31/9999 2<strong>01</strong>2300264780610 SOD CHLORIDE INJ 5% 12/31/9999 2<strong>01</strong>2300338005603 SOD CHLORIDE INJ 5% 12/31/9999 2<strong>01</strong>230048793<strong>01</strong>02 SOD CHLORIDE NEB 0.9% 12/31/9999 2<strong>01</strong>230048793<strong>01</strong>03 SOD CHLORIDE NEB 0.9% 12/31/9999 2<strong>01</strong>230048793<strong>01</strong>33 SOD CHLORIDE NEB 0.9% 12/31/9999 2<strong>01</strong>23004879302<strong>01</strong> SOD CHLORIDE NEB 0.9% 12/31/9999 2<strong>01</strong>2300904531538 SOD CHLORIDE OIN 5% OP 12/31/9999 2<strong>01</strong>2317478062235 SOD CHLORIDE OIN 5% OP 12/31/9999 2<strong>01</strong>2300904531435 SOD CHLORIDE SOL 5% OP 12/31/9999 2<strong>01</strong>2317478062312 SOD CHLORIDE SOL 5% OP 12/31/9999 2<strong>01</strong>2300527111610 SOD CHLORIDE TAB 1000MG 12/31/9999 2<strong>01</strong>2367386071155 SOD DIURIL INJ 500MG 11/30/2<strong>01</strong>2 2<strong>01</strong>2325<strong>01</strong>0021027 SOD EDECRIN INJ 50MG 12/31/9999 2<strong>01</strong>2351991067636 SOD FLUORIDE CHW 0.25MG F 12/31/9999 2<strong>01</strong>2351991067736 SOD FLUORIDE CHW 0.5MG F 12/31/9999 2<strong>01</strong>2351991067836 SOD FLUORIDE CHW 1MG F 12/31/9999 2<strong>01</strong>2344946103208 SOD FLUORIDE DRO 0.5MG/ML 12/31/9999 2<strong>01</strong>2350383065650 SOD FLUORIDE DRO 0.5MG/ML 12/31/9999 2<strong>01</strong>2351862<strong>01</strong>6550 SOD FLUORIDE DRO 0.5MG/ML 12/31/9999 2<strong>01</strong>2360258<strong>01</strong>5816 SOD FLUORIDE SOL 0.2%MINT 12/31/9999 2<strong>01</strong>23102671640<strong>01</strong> SOD FLUORIDE TAB 0.5MG F 12/31/9999 2<strong>01</strong>2310267164004 SOD FLUORIDE TAB 0.5MG F 12/31/9999 2<strong>01</strong>23102671641<strong>01</strong> SOD FLUORIDE TAB 1MG F 12/31/9999 2<strong>01</strong>2310267164104 SOD FLUORIDE TAB 1MG F 12/31/9999 2<strong>01</strong>2351552049404 SOD IODIDE POW 12/31/9999 2<strong>01</strong>23

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