Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

13811006816 TL-HIST DM LIQ 12/31/9999 2012313811008330 TL-HIST PD LIQ 1-7.5MG 12/31/9999 2012313811060030 TL-SELECT CAP 12/31/9999 2012350242012001 TNKASE KIT 50MG 12/31/9999 2012300078049461 TOBI NEB 300/5ML 12/31/9999 2012300078049471 TOBI NEB 300/5ML 12/31/9999 2012324208029505 TOBRA/DEXAME SUS 0.3-0.1% 12/31/9999 2012324208029510 TOBRA/DEXAME SUS 0.3-0.1% 12/31/9999 2012324208029525 TOBRA/DEXAME SUS 0.3-0.1% 12/31/9999 2012361314064705 TOBRA/DEXAME SUS 0.3-0.1% 12/31/9999 2012361314064710 TOBRA/DEXAME SUS 0.3-0.1% 12/31/9999 2012361314064725 TOBRA/DEXAME SUS 0.3-0.1% 12/31/9999 2012300409347023 TOBRA/NACL INJ 80/0.9 12/31/9999 2012300065064835 TOBRADEX OIN 0.3-0.1% 12/31/9999 2012300065064705 TOBRADEX SUS 0.3-0.1% 12/31/9999 2012300065064710 TOBRADEX SUS 0.3-0.1% 12/31/9999 2012300065064725 TOBRADEX SUS 0.3-0.1% 12/31/9999 2012300065065205 TOBRADEX ST SUS 0.3-0.05 12/31/9999 2012300069009102 TOBRAMYCIN INJ 1.2/30ML 12/31/9999 2012300069009103 TOBRAMYCIN INJ 1.2/30ML 12/31/9999 2012323360001430 TOBRAMYCIN INJ 1.2/30ML 11/30/2012 2012339822041201 TOBRAMYCIN INJ 1.2GM 12/31/9999 2012339822041206 TOBRAMYCIN INJ 1.2GM 12/31/9999 2012363323030351 TOBRAMYCIN INJ 1.2GM 12/31/9999 2012363323030355 TOBRAMYCIN INJ 1.2GM 12/31/9999 2012300409357701 TOBRAMYCIN INJ 10MG/ML 12/31/9999 2012363323030502 TOBRAMYCIN INJ 10MG/ML 12/31/9999 2012300409359002 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012300703940201 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012300703940204 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012300703941601 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012363323030602 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012363323030630 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012363323030655 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012363323030656 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012363323030751 TOBRAMYCIN INJ 40MG/ML 12/31/9999 2012300069008801 TOBRAMYCIN INJ 80MG/2ML 12/31/9999 2012300069008802 TOBRAMYCIN INJ 80MG/2ML 12/31/9999 2012300409357801 TOBRAMYCIN INJ 80MG/2ML 12/31/9999 2012323360001402 TOBRAMYCIN INJ 80MG/2ML 11/30/2012 2012317478029010 TOBRAMYCIN SOL 0.3% OP 12/31/9999 2012324208029005 TOBRAMYCIN SOL 0.3% OP 12/31/9999 2012361314064305 TOBRAMYCIN SOL 0.3% OP 12/31/9999 2012300065064435 TOBREX OIN 0.3% OP 12/31/9999 2012300065064305 TOBREX SOL 0.3% OP 12/31/9999 2012300406992003 TOFRANIL TAB 10MG 12/31/9999 2012300406992103 TOFRANIL TAB 25MG 12/31/9999 2012300406992203 TOFRANIL TAB 50MG 12/31/9999 2012300406992403 TOFRANIL-PM CAP 100MG 12/31/9999 2012300406992503 TOFRANIL-PM CAP 125MG 12/31/9999 2012300406992603 TOFRANIL-PM CAP 150MG 12/31/9999 2012300406992303 TOFRANIL-PM CAP 75MG 12/31/9999 2012300378021701 TOLAZAMIDE TAB 250MG 12/31/9999 2012368084055621 TOLAZAMIDE TAB 250MG 12/31/9999 2012300378055101 TOLAZAMIDE TAB 500MG 12/31/9999 2012300378021501 TOLBUTAMIDE TAB 500MG 12/31/9999 2012300378021505 TOLBUTAMIDE TAB 500MG 12/31/9999 2012300093207501 TOLMETIN SOD CAP 400MG 12/31/9999 2012300093881501 TOLMETIN SOD CAP 400MG 12/31/9999 2012300378520001 TOLMETIN SOD CAP 400MG 12/31/9999 20123