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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534890328<strong>01</strong> SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>2353489032805 SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>2353489032806 SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>2353489032807 SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>23597625<strong>01</strong>2<strong>01</strong> SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>2363739054510 SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>2365162051410 SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>2365162051450 SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>23680840207<strong>01</strong> SPIRONOLACT TAB 50MG 12/31/9999 2<strong>01</strong>23504580290<strong>01</strong> SPORANOX CAP 100MG 12/31/9999 2<strong>01</strong>2350458029004 SPORANOX CAP 100MG 12/31/9999 2<strong>01</strong>2350458029028 SPORANOX CAP PULSEPAK 12/31/9999 2<strong>01</strong>2350458029515 SPORANOX SOL 10MG/ML 12/31/9999 2<strong>01</strong>23005559<strong>01</strong>658 SPRINTEC 28 TAB 28 DAY 12/31/9999 2<strong>01</strong>23005178880<strong>01</strong> SPRIX SPR 15.75MG 12/31/9999 2<strong>01</strong>2300517888005 SPRIX SPR 15.75MG 12/31/9999 2<strong>01</strong>2300003085222 SPRYCEL TAB 100MG 12/31/9999 2<strong>01</strong>2300003085722 SPRYCEL TAB 140MG 12/31/9999 2<strong>01</strong>2300003052711 SPRYCEL TAB 20MG 12/31/9999 2<strong>01</strong>2300003052811 SPRYCEL TAB 50MG 12/31/9999 2<strong>01</strong>2300003052411 SPRYCEL TAB 70MG 12/31/9999 2<strong>01</strong>2300003085522 SPRYCEL TAB 80MG 12/31/9999 2<strong>01</strong>23462870006<strong>01</strong> SPS SUS 15GM/60 12/31/9999 2<strong>01</strong>2346287000604 SPS SUS 15GM/60 12/31/9999 2<strong>01</strong>2346287000660 SPS SUS 15GM/60 12/31/9999 2<strong>01</strong>2351552085006 SQUALANE LIQ 12/31/9999 2<strong>01</strong>2338779026005 SQUALANE OIL 12/31/9999 2<strong>01</strong>2338779026008 SQUALANE OIL 12/31/9999 2<strong>01</strong>23515521291<strong>01</strong> SQUARIC ACID LIQ BUTANOL 12/31/9999 2<strong>01</strong>2351552129109 SQUARIC ACID LIQ BUTANOL 12/31/9999 2<strong>01</strong>2352544096728 SRONYX TAB 12/31/9999 2<strong>01</strong>2343598021025 SSD CRE 1% 12/31/9999 2<strong>01</strong>2343598021040 SSD CRE 1% 12/31/9999 2<strong>01</strong>2343598021050 SSD CRE 1% 12/31/9999 2<strong>01</strong>2343598021055 SSD CRE 1% 12/31/9999 2<strong>01</strong>2343598021085 SSD CRE 1% 12/31/9999 2<strong>01</strong>2349884060036 SSD CRE 1% 02/28/2<strong>01</strong>4 2<strong>01</strong>2349884060040 SSD CRE 1% 03/31/2<strong>01</strong>4 2<strong>01</strong>2349884060057 SSD CRE 1% <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2349884060058 SSD CRE 1% 07/31/2<strong>01</strong>3 2<strong>01</strong>2349884060085 SSD CRE 1% <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>234988406<strong>01</strong>36 SSD AF CRE 1% 07/31/2<strong>01</strong>3 2<strong>01</strong>234988406<strong>01</strong>40 SSD AF CRE 1% <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2300245000308 SSKI SOL 1GM/ML 12/31/9999 2<strong>01</strong>2300245000331 SSKI SOL 1GM/ML 12/31/9999 2<strong>01</strong>23584070091<strong>01</strong> STAGESIC CAP 5-500MG 12/31/9999 2<strong>01</strong>2358407062404 STAHIST AD LIQ 12/31/9999 2<strong>01</strong>2358407062530 STAHIST AD TAB 25-60MG 12/31/9999 2<strong>01</strong>2300078040805 STALEVO 100 TAB 12/31/9999 2<strong>01</strong>2300078054505 STALEVO 125 TAB 12/31/9999 2<strong>01</strong>2300078040905 STALEVO 150 TAB 12/31/9999 2<strong>01</strong>2300078052705 STALEVO 200 TAB 12/31/9999 2<strong>01</strong>2300078040705 STALEVO 50 TAB 12/31/9999 2<strong>01</strong>2300078054405 STALEVO 75 TAB 12/31/9999 2<strong>01</strong>2360258<strong>01</strong>5910 STAN FLUORID CON 0.63% 12/31/9999 2<strong>01</strong>230<strong>01</strong>35049902 STANBACK POW HEADACHE 12/31/9999 2<strong>01</strong>230<strong>01</strong>35049906 STANBACK POW HEADACHE 12/31/9999 2<strong>01</strong>230<strong>01</strong>35049924 STANBACK POW HEADACHE 12/31/9999 2<strong>01</strong>230<strong>01</strong>35049950 STANBACK POW HEADACHE 12/31/9999 2<strong>01</strong>2311530000202 STANBACK POW HEADACHE 12/31/9999 2<strong>01</strong>23

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