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

00338004746 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338004747 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338004802 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338004803 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338004804 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338004805 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338005047 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300338005144 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409613803 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409613822 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409713809 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409713836 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409797205 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409797207 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012300409797208 SODIUM CHLOR SOL 0.9% IRR 12/31/9999 2012351552034506 SODIUM NITRA GRA 12/31/9999 2012351552104701 SODIUM TETRA POW SULFATE 12/31/9999 2012300132075160 SOF-LAX CAP 100MG 12/31/9999 2012310337080301 SOLARAZE GEL 3% W/W 12/31/9999 2012300096068704 SOLBAR AVO LOT SPF32 12/31/9999 2012300096068604 SOLBAR PF CRE SPF50 12/31/9999 2012300096068504 SOLBAR PF GEL SPF30 12/31/9999 2012325682000101 SOLIRIS INJ 10MG/ML 12/31/9999 2012399207046730 SOLODYN TAB 105MG 12/31/9999 2012399207046430 SOLODYN TAB 115MG 12/31/9999 2012399207046210 SOLODYN TAB 135MG 03/31/2013 2012399207046230 SOLODYN TAB 135MG 05/31/2013 2012399207046010 SOLODYN TAB 45MG 01/31/2013 2012399207046030 SOLODYN TAB 45MG 10/31/2013 2012399207046530 SOLODYN TAB 55MG 12/31/9999 2012399207046330 SOLODYN TAB 65MG 12/31/9999 2012399207046630 SOLODYN TAB 80MG 12/31/9999 2012399207046110 SOLODYN TAB 90MG 02/28/2013 2012399207046130 SOLODYN TAB 90MG 05/31/2013 2012300904567516 SOLUBLE FIB POW THERAPY 12/31/9999 2012300009000501 SOLU-CORTEF INJ 1000MG 12/31/9999 2012300009092003 SOLU-CORTEF INJ 1000MG 12/31/9999 2012300009001103 SOLU-CORTEF INJ 100MG 12/31/9999 2012300009001104 SOLU-CORTEF INJ 100MG 12/31/9999 2012300009082501 SOLU-CORTEF INJ 100MG 12/31/9999 2012300009090013 SOLU-CORTEF INJ 100MG 11/01/2014 2012300009090020 SOLU-CORTEF INJ 100MG 02/01/2015 2012300009001305 SOLU-CORTEF INJ 250MG 12/31/9999 2012300009001306 SOLU-CORTEF INJ 250MG 12/31/9999 2012300009090908 SOLU-CORTEF INJ 250MG 12/31/9999 2012300009090916 SOLU-CORTEF INJ 250MG 12/31/9999 2012300009001612 SOLU-CORTEF INJ 500MG 12/31/9999 2012300009091205 SOLU-CORTEF INJ 500MG 12/31/9999 2012300009004722 SOLU-MEDROL INJ 125MG 12/31/9999 2012300009004725 SOLU-MEDROL INJ 125MG 12/31/9999 2012300009004726 SOLU-MEDROL INJ 125MG 12/31/9999 2012300009019009 SOLU-MEDROL INJ 125MG 12/01/2012 2012300009019016 SOLU-MEDROL INJ 125MG 12/01/2012 2012300009001820 SOLU-MEDROL INJ 1GM 12/31/9999 2012300009069801 SOLU-MEDROL INJ 1GM 12/31/9999 2012300009079601 SOLU-MEDROL INJ 2GM 12/31/9999 2012300009003928 SOLU-MEDROL INJ 40MG 12/31/9999 2012300009003930 SOLU-MEDROL INJ 40MG 12/31/9999 2012300009003932 SOLU-MEDROL INJ 40MG 12/31/9999 2012300009000302 SOLU-MEDROL INJ 500MG 12/31/9999 20123