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

45802005436 TRIAMCINOLON OIN 0.025% 12/31/9999 2012346287001016 TRIAMCINOLON OIN 0.05% 12/31/9999 2012300168000615 TRIAMCINOLON OIN 0.1% 12/31/9999 2012300168000616 TRIAMCINOLON OIN 0.1% 12/31/9999 2012300168000680 TRIAMCINOLON OIN 0.1% 12/31/9999 2012300472030680 TRIAMCINOLON OIN 0.1% 12/31/9999 2012345802005505 TRIAMCINOLON OIN 0.1% 12/31/9999 2012345802005535 TRIAMCINOLON OIN 0.1% 12/31/9999 2012345802005536 TRIAMCINOLON OIN 0.1% 12/31/9999 2012351672128401 TRIAMCINOLON OIN 0.1% 12/31/9999 2012351672128408 TRIAMCINOLON OIN 0.1% 12/31/9999 2012345802004935 TRIAMCINOLON OIN 0.5% 12/31/9999 2012339822530005 TRIAMCINOLON POW ACETONID 02/28/2013 2012364980032005 TRIAMCINOLON PST 0.1% 12/31/9999 2012300093208517 TRIAMCINOLON SPR 55MCG/AC 12/31/9999 2012300955171016 TRIAMCINOLON SPR 55MCG/AC 12/31/9999 2012300067634904 TRIAMIN FLU/ SYP CGH/FVR 12/31/9999 2012300067618518 TRIAMINIC CHW 12/31/9999 2012300067618618 TRIAMINIC CHW 12/31/9999 2012300067635718 TRIAMINIC CHW 12/31/9999 2012300067643355 TRIAMINIC DRO INFANTS 12/31/9999 2012300067643555 TRIAMINIC DRO INFANTS 12/31/9999 2012300067050104 TRIAMINIC LIQ 12/31/9999 2012300067638314 TRIAMINIC MIS ALLERGY 12/31/9999 2012300067635514 TRIAMINIC MIS COLD/CGH 12/31/9999 2012300067614814 TRIAMINIC MIS COUGH 12/31/9999 2012300067635314 TRIAMINIC MIS COUGH 12/31/9999 2012300067614914 TRIAMINIC MIS GRAPE 12/31/9999 2012300067635414 TRIAMINIC MIS GRAPE 12/31/9999 2012300067621716 TRIAMINIC MIS INFANT 12/31/9999 2012300067621816 TRIAMINIC MIS INFANT 12/31/9999 2012300067634504 TRIAMINIC SOL COLD/CGH 12/31/9999 2012300067634804 TRIAMINIC SYP CGH/SORE 12/31/9999 2012300067643104 TRIAMINIC SYP CHILD 12/31/9999 2012300067643204 TRIAMINIC SYP CHILD 12/31/9999 2012300067634704 TRIAMINIC SYP CHST/NSL 12/31/9999 2012300067634604 TRIAMINIC SYP COLD/ALL 12/31/9999 2012300067635004 TRIAMINIC SYP COUGH 12/31/9999 2012300067639404 TRIAMINIC SYP FEVER 12/31/9999 2012300067644059 TRIAMINIC SYP INFANT 12/31/9999 2012300067644159 TRIAMINIC SYP INFANT 12/31/9999 2012300067634404 TRIAMINIC NT LIQ COLD/CGH 12/31/9999 2012300067634408 TRIAMINIC NT LIQ COLD/CGH 12/31/9999 2012300067635614 TRIAMINIC NT MIS COLD/CGH 12/31/9999 2012300067638104 TRIAMINIC-D SYP 12/31/9999 2012300378253701 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012300378253710 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012300527163201 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012300527163210 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012300555048802 TRIAMT/HCTZ CAP 37.5-25 10/31/2013 2012300555048805 TRIAMT/HCTZ CAP 37.5-25 10/31/2013 2012300781207401 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012300781207410 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012351079093501 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012351079093520 TRIAMT/HCTZ CAP 37.5-25 12/31/9999 2012300781271501 TRIAMT/HCTZ CAP 50-25MG 12/31/9999 2012300378135201 TRIAMT/HCTZ TAB 37.5-25 12/31/9999 2012300378135205 TRIAMT/HCTZ TAB 37.5-25 12/31/9999 2012300591042401 TRIAMT/HCTZ TAB 37.5-25 12/31/9999 2012300591042405 TRIAMT/HCTZ TAB 37.5-25 12/31/9999 20123