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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62<strong>01</strong>1<strong>01</strong>6302 STOOL SOFTNR CAP 100MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>6303 STOOL SOFTNR CAP 100MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>10<strong>01</strong> STOOL SOFTNR CAP 100MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>1025 STOOL SOFTNR CAP 100MG 12/31/9999 2<strong>01</strong>2366424003<strong>01</strong>0 STOOL SOFTNR CAP 100MG 12/31/9999 2<strong>01</strong>2324385044378 STOOL SOFTNR CAP 250MG 12/31/9999 2<strong>01</strong>2349348071410 STOOL SOFTNR CAP 250MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>64<strong>01</strong> STOOL SOFTNR CAP 250MG 12/31/9999 2<strong>01</strong>2324385046943 STOOL SOFTNR SYP 60/15ML 12/31/9999 2<strong>01</strong>2324385049572 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2324385049578 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2337205034978 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2349348054410 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2349348054419 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>65<strong>01</strong> STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>31<strong>01</strong> STOOL SOFTNR TAB 8.6-50MG 12/31/9999 2<strong>01</strong>2300002325130 STRATTERA CAP 100MG 12/31/9999 2<strong>01</strong>2300002322730 STRATTERA CAP 10MG 12/31/9999 2<strong>01</strong>2300002323830 STRATTERA CAP 18MG 12/31/9999 2<strong>01</strong>2300002322830 STRATTERA CAP 25MG 12/31/9999 2<strong>01</strong>2300002322930 STRATTERA CAP 40MG 12/31/9999 2<strong>01</strong>2300002323930 STRATTERA CAP 60MG 12/31/9999 2<strong>01</strong>2300002325030 STRATTERA CAP 80MG 12/31/9999 2<strong>01</strong>2351552028303 STRAWBERRY LIQ FLAVOR 12/31/9999 2<strong>01</strong>23684058<strong>01</strong>306 STRAZEPAM PAK 12/31/9999 2<strong>01</strong>23398220706<strong>01</strong> STREPTOMYCIN INJ 1GM 12/31/9999 2<strong>01</strong>2339822070602 STREPTOMYCIN INJ 1GM 12/31/9999 2<strong>01</strong>236195812<strong>01</strong><strong>01</strong> STRIBILD TAB 12/31/9999 2<strong>01</strong>2300006003220 STROMECTOL TAB 3MG 12/31/9999 2<strong>01</strong>2300642020<strong>01</strong>0 STROVITE TAB 12/31/9999 2<strong>01</strong>2300642020410 STROVITE FOR TAB 12/31/9999 2<strong>01</strong>2300642020790 STROVITE ONE TAB 12/31/9999 2<strong>01</strong>230064202<strong>01</strong>10 STROVITE PLU TAB 12/31/9999 2<strong>01</strong>23647310795<strong>01</strong> STUART PREN TAB 11/30/2<strong>01</strong>3 2<strong>01</strong>2366479079606 STUART PRENA PAK + DHA 05/26/2<strong>01</strong>3 2<strong>01</strong>23124961202<strong>01</strong> SUBOXONE MIS 2-0.5MG 12/31/9999 2<strong>01</strong>2312496120203 SUBOXONE MIS 2-0.5MG 12/31/9999 2<strong>01</strong>23124961208<strong>01</strong> SUBOXONE MIS 8-2MG 12/31/9999 2<strong>01</strong>2312496120803 SUBOXONE MIS 8-2MG 12/31/9999 2<strong>01</strong>2312496128302 SUBOXONE SUB 2-0.5MG 12/31/9999 2<strong>01</strong>2312496130602 SUBOXONE SUB 8-2MG 12/31/9999 2<strong>01</strong>232048200<strong>01</strong>30 SUBSYS SPR 100MCG 12/31/9999 2<strong>01</strong>23204820<strong>01</strong>230 SUBSYS SPR 1200MCG 12/31/9999 2<strong>01</strong>23204820<strong>01</strong>630 SUBSYS SPR 1600MCG 12/31/9999 2<strong>01</strong>2320482000230 SUBSYS SPR 200MCG 12/31/9999 2<strong>01</strong>2320482000430 SUBSYS SPR 400MCG 12/31/9999 2<strong>01</strong>2320482000630 SUBSYS SPR 600MCG 12/31/9999 2<strong>01</strong>2320482000830 SUBSYS SPR 800MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>21074710 SUCRALFATE SUS 1GM/10ML 12/31/9999 2<strong>01</strong>23666890790<strong>01</strong> SUCRALFATE SUS 1GM/10ML 12/31/9999 2<strong>01</strong>2366689079050 SUCRALFATE SUS 1GM/10ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>7159 SUCRALFATE SUS 1GM/10ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>7161 SUCRALFATE SUS 1GM/10ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>7162 SUCRALFATE SUS 1GM/10ML 12/31/9999 2<strong>01</strong>23000932210<strong>01</strong> SUCRALFATE TAB 1GM 12/31/9999 2<strong>01</strong>2300093221005 SUCRALFATE TAB 1GM 12/31/9999 2<strong>01</strong>2300093221<strong>01</strong>9 SUCRALFATE TAB 1GM 12/31/9999 2<strong>01</strong>2300093221093 SUCRALFATE TAB 1GM 12/31/9999 2<strong>01</strong>2300093221098 SUCRALFATE TAB 1GM 12/31/9999 2<strong>01</strong>23005910780<strong>01</strong> SUCRALFATE TAB 1GM 12/31/9999 2<strong>01</strong>23

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