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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516722<strong>01</strong>6<strong>01</strong> TRIPLE ANTIB OIN 12/31/9999 2<strong>01</strong>23516722<strong>01</strong>602 TRIPLE ANTIB OIN 12/31/9999 2<strong>01</strong>2349348060072 TRIPLE ANTIB OIN MAX ST 12/31/9999 2<strong>01</strong>2362<strong>01</strong>10099<strong>01</strong> TRIPLE ANTIB OIN MAX ST 12/31/9999 2<strong>01</strong>2300713062231 TRIPLE ANTIB OIN PLUS 12/31/9999 2<strong>01</strong>2324385<strong>01</strong>4303 TRIPLE ANTIB OIN PLUS 12/31/9999 2<strong>01</strong>2337205026610 TRIPLE ANTIB OIN PLUS 12/31/9999 2<strong>01</strong>23516722027<strong>01</strong> TRIPLE ANTIB OIN PLUS 12/31/9999 2<strong>01</strong>2351672202702 TRIPLE ANTIB OIN PLUS 12/31/9999 2<strong>01</strong>2300472070078 TRIPLE SULFA CRE VAG 12/31/9999 2<strong>01</strong>234418302<strong>01</strong>30 TRIP-PSE LIQ 12/31/9999 2<strong>01</strong>2300603766317 TRI-PREVIFEM TAB 12/31/9999 2<strong>01</strong>2363459060<strong>01</strong>0 TRISENOX SOL 10MG/10M 12/31/9999 2<strong>01</strong>23005559<strong>01</strong>858 TRI-SPRINTEC TAB 12/31/9999 2<strong>01</strong>2350383080816 TRI-TANNATE SUS PED 12/31/9999 2<strong>01</strong>2313811059130 TRIVEEN-DUO PAK DHA 12/31/9999 2<strong>01</strong>2313811055830 TRIVEEN-PRX CAP RNF 12/31/9999 2<strong>01</strong>2313811055860 TRIVEEN-PRX CAP RNF 12/31/9999 2<strong>01</strong>2313811055960 TRIVEEN-TEN TAB 12/31/9999 2<strong>01</strong>23138110563<strong>01</strong> TRIVEEN-U CAP 12/31/9999 2<strong>01</strong>2300603178747 TRI-VIT/FE DRO /FL 0.25 12/31/9999 2<strong>01</strong>2350383062850 TRI-VIT/FE DRO /FL 0.25 12/31/9999 2<strong>01</strong>2300603178547 TRI-VIT/FL DRO 0.25MG 12/31/9999 2<strong>01</strong>2300603178647 TRI-VIT/FL DRO 0.5MG 12/31/9999 2<strong>01</strong>2300472089095 TRI-VIT/FLUO DRO 0.25MG 12/31/9999 2<strong>01</strong>2350383063750 TRI-VIT/FLUO DRO 0.25MG 12/31/9999 2<strong>01</strong>2300472089495 TRI-VIT/FLUO DRO 0.5MG 12/31/9999 2<strong>01</strong>2350383063650 TRI-VIT/FLUO DRO 0.5MG 12/31/9999 2<strong>01</strong>2352152000205 TRI-VITA BET CHW /FLUORID 12/31/9999 2<strong>01</strong>2364376082350 TRI-VITA/FL DRO 0.25MG 12/31/9999 2<strong>01</strong>230053685<strong>01</strong>80 TRI-VITAMIN DRO 12/31/9999 2<strong>01</strong>2350383063550 TRI-VITAMIN DRO 12/31/9999 2<strong>01</strong>2352544029128 TRIVORA-28 TAB 12/31/9999 2<strong>01</strong>2300603064888 TRIXAICIN CRE 0.025% 12/31/9999 2<strong>01</strong>2300603064988 TRIXAICIN HP CRE 0.075% 12/31/9999 2<strong>01</strong>230<strong>01</strong>73069100 TRIZIVIR TAB 08/16/2<strong>01</strong>3 2<strong>01</strong>2349702021718 TRIZIVIR TAB 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>3203 TROLAMINE LIQ 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>3206 TROLAMINE LIQ 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>3208 TROLAMINE LIQ 12/31/9999 2<strong>01</strong>2300264934155 TROPHAMINE INJ 10% 12/31/9999 2<strong>01</strong>2300264936155 TROPHAMINE INJ 6% 12/31/9999 2<strong>01</strong>2317478<strong>01</strong><strong>01</strong>12 TROPICAMIDE SOL 0.5% OP 12/31/9999 2<strong>01</strong>2324208059064 TROPICAMIDE SOL 0.5% OP 12/31/9999 2<strong>01</strong>23613140354<strong>01</strong> TROPICAMIDE SOL 0.5% OP 12/31/9999 2<strong>01</strong>2317478<strong>01</strong>0212 TROPICAMIDE SOL 1% OP 12/31/9999 2<strong>01</strong>2324208058559 TROPICAMIDE SOL 1% OP 12/31/9999 2<strong>01</strong>2324208058564 TROPICAMIDE SOL 1% OP 12/31/9999 2<strong>01</strong>23613140355<strong>01</strong> TROPICAMIDE SOL 1% OP 12/31/9999 2<strong>01</strong>2361314035502 TROPICAMIDE SOL 1% OP 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>4560 TROSPIUM CL TAB 20MG 12/31/9999 2<strong>01</strong>2368462046160 TROSPIUM CL TAB 20MG 12/31/9999 2<strong>01</strong>2300006351936 TRUSOPT SOL 2% OP 12/31/9999 2<strong>01</strong>236195807<strong>01</strong><strong>01</strong> TRUVADA TAB 12/31/9999 2<strong>01</strong>2323359002816 TRYMINE CG LIQ 225-7.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007003 TUMS CHW 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007027 TUMS CHW 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007048 TUMS CHW 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007127 TUMS CHW 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007148 TUMS CHW 500MG 12/31/9999 2<strong>01</strong>23

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