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

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

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

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60977<strong>01</strong>16<strong>01</strong> ATIVAN INJ 2MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>1602 ATIVAN INJ 2MG/ML 12/31/9999 2<strong>01</strong>23006416002<strong>01</strong> ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>2300641600210 ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>23006416003<strong>01</strong> ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>2300641600325 ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>13<strong>01</strong> ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>1302 ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>1371 ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>2360977<strong>01</strong>1381 ATIVAN INJ 4MG/ML 12/31/9999 2<strong>01</strong>23644550063<strong>01</strong> ATIVAN TAB 0.5MG 12/31/9999 2<strong>01</strong>23644550064<strong>01</strong> ATIVAN TAB 1MG 12/31/9999 2<strong>01</strong>2364455006410 ATIVAN TAB 1MG 12/31/9999 2<strong>01</strong>23644550065<strong>01</strong> ATIVAN TAB 2MG 12/31/9999 2<strong>01</strong>23003782<strong>01</strong>505 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>23003782<strong>01</strong>577 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300591377410 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300591377419 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300781538192 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2300904629061 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>23510790409<strong>01</strong> ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2351079040920 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>2105 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>2190 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2360505257808 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2360505257809 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2363304082705 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>2363304082790 ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>23680840564<strong>01</strong> ATORVASTATIN TAB 10MG 12/31/9999 2<strong>01</strong>23003782<strong>01</strong>705 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>23003782<strong>01</strong>777 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2300591377510 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2300591377519 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2300781538292 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2300904629161 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>23510790410<strong>01</strong> ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2351079041020 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>2205 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>2290 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2360505257908 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2360505257909 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2363304082805 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2363304082890 ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>23680840565<strong>01</strong> ATORVASTATIN TAB 20MG 12/31/9999 2<strong>01</strong>2300378212105 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2300378212177 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2300591377605 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2300591377619 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2300781538492 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>23510790411<strong>01</strong> ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2351079041120 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>2305 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2355111<strong>01</strong>2390 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2360505258008 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2360505258009 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2363304082905 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2363304082990 ATORVASTATIN TAB 40MG 12/31/9999 2<strong>01</strong>2300378212205 ATORVASTATIN TAB 80MG 12/31/9999 2<strong>01</strong>2300378212277 ATORVASTATIN TAB 80MG 12/31/9999 2<strong>01</strong>2300591377705 ATORVASTATIN TAB 80MG 12/31/9999 2<strong>01</strong>23

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