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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63323029280 ASTRAMORPH INJ 2MG/2ML 12/31/9999 2<strong>01</strong>2363323029197 ASTRAMORPH INJ 5MG/10ML 11/30/2<strong>01</strong>2 2<strong>01</strong>230<strong>01</strong>860<strong>01</strong>628 ATACAND TAB 16MG 04/30/2<strong>01</strong>5 2<strong>01</strong>230<strong>01</strong>860<strong>01</strong>631 ATACAND TAB 16MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>860<strong>01</strong>654 ATACAND TAB 16MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>86003228 ATACAND TAB 32MG 02/28/2<strong>01</strong>4 2<strong>01</strong>230<strong>01</strong>86003231 ATACAND TAB 32MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>86003254 ATACAND TAB 32MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>86000431 ATACAND TAB 4MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>86000831 ATACAND TAB 8MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>6228 ATACAND HCT TAB 16-12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>86<strong>01</strong>6254 ATACAND HCT TAB 16-12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>86032228 ATACAND HCT TAB 32-12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>86032254 ATACAND HCT TAB 32-12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>86032454 ATACAND HCT TAB 32-25MG 12/31/9999 2<strong>01</strong>2300430097903 ATELVIA TAB 12/31/9999 2<strong>01</strong>23003782064<strong>01</strong> ATENOL/CHLOR TAB 100-25MG 12/31/9999 2<strong>01</strong>2300378206493 ATENOL/CHLOR TAB 100-25MG 12/31/9999 2<strong>01</strong>23005915783<strong>01</strong> ATENOL/CHLOR TAB 100-25MG 12/31/9999 2<strong>01</strong>23534890532<strong>01</strong> ATENOL/CHLOR TAB 100-25MG 12/31/9999 2<strong>01</strong>23003782063<strong>01</strong> ATENOL/CHLOR TAB 50-25MG 12/31/9999 2<strong>01</strong>23005915782<strong>01</strong> ATENOL/CHLOR TAB 50-25MG 12/31/9999 2<strong>01</strong>2300904620060 ATENOL/CHLOR TAB 50-25MG 04/30/2<strong>01</strong>4 2<strong>01</strong>23534890531<strong>01</strong> ATENOL/CHLOR TAB 50-25MG 04/30/2<strong>01</strong>4 2<strong>01</strong>23000930753<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2300093075305 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23003780757<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2300378075710 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2300378075793 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23004062024<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2300406202410 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23007811507<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2300781150710 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2316571044111 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2316714003304 ATENOLOL TAB 100MG 12/31/2020 2<strong>01</strong>2316714003306 ATENOLOL TAB 100MG 12/31/2020 2<strong>01</strong>2350742<strong>01</strong>03<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2350742<strong>01</strong>0310 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23510790685<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2351079068520 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23534890530<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2353489053<strong>01</strong>0 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23625840715<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23633040623<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2363304062310 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2365862<strong>01</strong>70<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2365862<strong>01</strong>7099 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23683820024<strong>01</strong> ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>2368382002410 ATENOLOL TAB 100MG 12/31/9999 2<strong>01</strong>23000930787<strong>01</strong> ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>2300093078710 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82823500 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>82823589 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>23003780218<strong>01</strong> ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>2300378021810 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>23004062022<strong>01</strong> ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>2300406202210 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>23007811078<strong>01</strong> ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>2300781107810 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>2300904539261 ATENOLOL TAB 25MG 12/31/9999 2<strong>01</strong>23

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