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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0<strong>01</strong>45213007 SORILUX AER 0.005% 12/31/9999 2<strong>01</strong>23002450<strong>01</strong>3<strong>01</strong> SORINE TAB 120MG 12/31/9999 2<strong>01</strong>23002450<strong>01</strong>4<strong>01</strong> SORINE TAB 160MG 12/31/9999 2<strong>01</strong>23002450<strong>01</strong>5<strong>01</strong> SORINE TAB 240MG 12/31/9999 2<strong>01</strong>23002450<strong>01</strong>2<strong>01</strong> SORINE TAB 80MG 12/31/9999 2<strong>01</strong>23003785124<strong>01</strong> SOTALOL AF TAB 120MG 12/31/9999 2<strong>01</strong>23605050223<strong>01</strong> SOTALOL AF TAB 120MG 12/31/9999 2<strong>01</strong>23003785125<strong>01</strong> SOTALOL AF TAB 160MG 12/31/9999 2<strong>01</strong>23605050224<strong>01</strong> SOTALOL AF TAB 160MG 12/31/9999 2<strong>01</strong>23003785123<strong>01</strong> SOTALOL AF TAB 80MG 12/31/9999 2<strong>01</strong>23605050222<strong>01</strong> SOTALOL AF TAB 80MG 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>7610 SOTALOL HCL INJ 150/10ML 12/31/9999 2<strong>01</strong>23000931060<strong>01</strong> SOTALOL HCL TAB 120MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>70<strong>01</strong> SOTALOL HCL TAB 120MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>7009 SOTALOL HCL TAB 120MG 12/31/9999 2<strong>01</strong>23003780310<strong>01</strong> SOTALOL HCL TAB 120MG 12/31/2<strong>01</strong>2 2<strong>01</strong>2300603577021 SOTALOL HCL TAB 120MG 12/31/9999 2<strong>01</strong>2300603577025 SOTALOL HCL TAB 120MG 12/31/9999 2<strong>01</strong>2360505<strong>01</strong>5900 SOTALOL HCL TAB 120MG 12/31/9999 2<strong>01</strong>23000931062<strong>01</strong> SOTALOL HCL TAB 160MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>77<strong>01</strong> SOTALOL HCL TAB 160MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>7709 SOTALOL HCL TAB 160MG 12/31/9999 2<strong>01</strong>2300603577121 SOTALOL HCL TAB 160MG 12/31/9999 2<strong>01</strong>2360505008100 SOTALOL HCL TAB 160MG 12/31/9999 2<strong>01</strong>23000931063<strong>01</strong> SOTALOL HCL TAB 240MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>74<strong>01</strong> SOTALOL HCL TAB 240MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>7409 SOTALOL HCL TAB 240MG 12/31/9999 2<strong>01</strong>2360505008200 SOTALOL HCL TAB 240MG 12/31/9999 2<strong>01</strong>23000931061<strong>01</strong> SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>71<strong>01</strong> SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>7105 SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>7109 SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>2300603576921 SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>2300603576928 SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>2360505008000 SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>23680840497<strong>01</strong> SOTALOL HCL TAB 80MG 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>6202 SOTRADECOL INJ 1% 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>6302 SOTRADECOL INJ 3% 12/31/9999 2<strong>01</strong>2310631058431 SOTRET CAP 10MG 12/31/9999 2<strong>01</strong>2310631058477 SOTRET CAP 10MG 12/31/9999 2<strong>01</strong>2310631058531 SOTRET CAP 20MG 12/31/9999 2<strong>01</strong>2310631058577 SOTRET CAP 20MG 12/31/9999 2<strong>01</strong>2310631044731 SOTRET CAP 30MG 12/31/9999 2<strong>01</strong>2310631058631 SOTRET CAP 40MG 12/31/9999 2<strong>01</strong>2310631058677 SOTRET CAP 40MG 12/31/9999 2<strong>01</strong>2351552096207 SOY ISOFLAVO POW 40% 12/31/9999 2<strong>01</strong>2351552087306 SOYBEAN OIL REFINED 12/31/9999 2<strong>01</strong>2351552096406 SPAN 20 LIQ 12/31/9999 2<strong>01</strong>2351552032106 SPAN 80 LIQ 12/31/9999 2<strong>01</strong>231<strong>01</strong>2208<strong>01</strong>20 SPECTRACEF TAB 200MG 03/31/2<strong>01</strong>4 2<strong>01</strong>231<strong>01</strong>22080220 SPECTRACEF TAB 400MG 11/30/2<strong>01</strong>3 2<strong>01</strong>231<strong>01</strong>22080228 SPECTRACEF TAB 400MG 11/30/2<strong>01</strong>3 2<strong>01</strong>2351552047106 SPERMACETI MIS 12/31/9999 2<strong>01</strong>2300597007541 SPIRIVA CAP HANDIHLR 12/31/9999 2<strong>01</strong>2300597007547 SPIRIVA CAP HANDIHLR 12/31/9999 2<strong>01</strong>2300597007575 SPIRIVA CAP HANDIHLR 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>41<strong>01</strong> SPIRONO/HCTZ TAB 25/25 12/31/9999 2<strong>01</strong>2300378<strong>01</strong>4105 SPIRONO/HCTZ TAB 25/25 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>04<strong>01</strong> SPIRONO/HCTZ TAB 25/25 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>0420 SPIRONO/HCTZ TAB 25/25 12/31/9999 2<strong>01</strong>23

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