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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65862<strong>01</strong>4736 SUMATRIPTAN TAB 50MG 12/31/9999 2<strong>01</strong>2368084034097 SUMATRIPTAN TAB 50MG 12/31/9999 2<strong>01</strong>2343376<strong>01</strong>06<strong>01</strong> SUMAVEL DOSE INJ 6MG/0.5 12/31/9999 2<strong>01</strong>2343376<strong>01</strong>0606 SUMAVEL DOSE INJ 6MG/0.5 12/31/9999 2<strong>01</strong>2343538<strong>01</strong>0060 SUMAXIN PAD 10-4% 12/31/9999 2<strong>01</strong>2343538<strong>01</strong><strong>01</strong>60 SUMAXIN CP KIT 12/31/9999 2<strong>01</strong>2343538<strong>01</strong>6<strong>01</strong>6 SUMAXIN TS SUS 8-4% 12/31/9999 2<strong>01</strong>2343538<strong>01</strong>3<strong>01</strong>6 SUMAXIN WASH LIQ 9-4% 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>4418 SUPHEDRINE TAB 10MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>4436 SUPHEDRINE TAB 10MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>4472 SUPHEDRINE TAB 10MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>4624 SUPHEDRINE TAB 30MG 12/31/9999 2<strong>01</strong>2363868<strong>01</strong>4648 SUPHEDRINE TAB 30MG 12/31/9999 2<strong>01</strong>2351552115606 SUPPOSIBLEND MIS 12/31/9999 2<strong>01</strong>2351552115608 SUPPOSIBLEND MIS 12/31/9999 2<strong>01</strong>23679790002<strong>01</strong> SUPPRELIN LA KIT 50MG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9064124 SUPRANE INH 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9064424 SUPRANE SOL 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9064460 SUPRANE SOL 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9064624 SUPRANE SOL 12/31/9999 2<strong>01</strong>23681800202<strong>01</strong> SUPRAX SUS 100/5ML 12/31/9999 2<strong>01</strong>2368180020202 SUPRAX SUS 100/5ML 12/31/9999 2<strong>01</strong>2368180020203 SUPRAX SUS 100/5ML 12/31/9999 2<strong>01</strong>2327437020602 SUPRAX SUS 200/5ML 12/31/9999 2<strong>01</strong>2327437020603 SUPRAX SUS 200/5ML 12/31/9999 2<strong>01</strong>232743702<strong>01</strong>08 SUPRAX TAB 400MG 12/31/9999 2<strong>01</strong>2324090072085 SUPRENZA TAB 15MG 12/31/9999 2<strong>01</strong>2324090072185 SUPRENZA TAB 30MG 12/31/9999 2<strong>01</strong>23522680<strong>01</strong>2<strong>01</strong> SUPREP BOWEL SOL PREP 12/31/9999 2<strong>01</strong>2351285055402 SURMONTIL CAP 100MG 12/31/9999 2<strong>01</strong>2351285053802 SURMONTIL CAP 25MG 12/31/9999 2<strong>01</strong>2351285053902 SURMONTIL CAP 50MG 12/31/9999 2<strong>01</strong>2300074104004 SURVANTA INH 12/31/9999 2<strong>01</strong>2300074104008 SURVANTA INH 12/31/9999 2<strong>01</strong>2300574030716 SUSPENDOL-S LIQ 12/31/9999 2<strong>01</strong>2300056047492 SUSTIVA CAP 200MG 12/31/9999 2<strong>01</strong>2300056047030 SUSTIVA CAP 50MG 12/31/9999 2<strong>01</strong>2300056051030 SUSTIVA TAB 600MG 12/31/9999 2<strong>01</strong>2300069055038 SUTENT CAP 12.5MG 12/31/9999 2<strong>01</strong>2300069077038 SUTENT CAP 25MG 12/31/9999 2<strong>01</strong>2300069098038 SUTENT CAP 50MG 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000203 SWEEN CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000213 SWEEN CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000214 SWEEN CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000221 SWEEN CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000223 SWEEN CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>0<strong>01</strong>903 SWEEN CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>006314 SWEEN 24 CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>006322 SWEEN 24 CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>006323 SWEEN 24 CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>006313 SWEEN 24 CRE 6% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000720 SWEEN PREP PAD WIPES 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000798 SWEEN PREP PAD WIPES 12/31/9999 2<strong>01</strong>23117<strong>01</strong>000703 SWEEN PREP SOL W/DABBER 12/31/9999 2<strong>01</strong>230<strong>01</strong>68<strong>01</strong>2691 SWIM EAR LIQ 95% OTIC 12/31/9999 2<strong>01</strong>2300781565815 SYEDA TAB 3-0.03MG 12/31/9999 2<strong>01</strong>23000851388<strong>01</strong> SYLATRON KIT 296MCG 12/31/9999 2<strong>01</strong>2300085138802 SYLATRON KIT 296MCG 12/31/9999 2<strong>01</strong>2300085128702 SYLATRON KIT 444MCG 12/31/9999 2<strong>01</strong>2300085128703 SYLATRON KIT 444MCG 12/31/9999 2<strong>01</strong>23

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