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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0<strong>01</strong>350223<strong>01</strong> TUMS CALCIUM CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350482<strong>01</strong> TUMS DUAL CHW ACTION 12/31/9999 2<strong>01</strong>230<strong>01</strong>35048202 TUMS DUAL CHW ACTION 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007407 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007422 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007424 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007425 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007446 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35007625 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>40<strong>01</strong> TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>4002 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>4003 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>4004 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>5405 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>7802 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>7803 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>7808 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>7809 TUMS E-X CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35052203 TUMS FRESHER CHW 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350469<strong>01</strong> TUMS KIDS CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350243<strong>01</strong> TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024302 TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350244<strong>01</strong> TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024402 TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350245<strong>01</strong> TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024502 TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350246<strong>01</strong> TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35024602 TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35045603 TUMS SMOOTHI CHW 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>1814 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>1883 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>1983 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8002 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8004 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8<strong>01</strong>4 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>81<strong>01</strong> TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8102 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8103 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8105 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8114 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>35<strong>01</strong>8214 TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>350228<strong>01</strong> TUMS ULTRA CHW 1000MG 12/31/9999 2<strong>01</strong>235485908<strong>01</strong>60 TUSNEL CAP 12/31/9999 2<strong>01</strong>2354859050206 TUSNEL LIQ 12/31/9999 2<strong>01</strong>2354859050210 TUSNEL LIQ 12/31/9999 2<strong>01</strong>2354859050216 TUSNEL LIQ 12/31/9999 2<strong>01</strong>2354859052<strong>01</strong>6 TUSNEL C SYP 12/31/9999 2<strong>01</strong>2354859050504 TUSNEL DIABT LIQ 10-100/5 12/31/9999 2<strong>01</strong>2354859050516 TUSNEL DIABT LIQ 10-100/5 12/31/9999 2<strong>01</strong>2354859060202 TUSNEL PED DRO 7.5-50 12/31/9999 2<strong>01</strong>2354859054404 TUSNEL PEDI LIQ 15-5-50 12/31/9999 2<strong>01</strong>2354859060302 TUSNEL-DM DRO PEDIATRC 12/31/9999 2<strong>01</strong>2300037068110 TUSSI-12 TAB 5-60MG 03/31/2<strong>01</strong>3 2<strong>01</strong>2300095<strong>01</strong>08<strong>01</strong> TUSSICAPS CAP 10-8MG 12/31/9999 2<strong>01</strong>2300095<strong>01</strong>0820 TUSSICAPS CAP 10-8MG 12/31/9999 2<strong>01</strong>2323635<strong>01</strong>08<strong>01</strong> TUSSICAPS CAP 10-8MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2323635<strong>01</strong>0820 TUSSICAPS CAP 10-8MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23000950054<strong>01</strong> TUSSICAPS CAP 5-4MG 12/31/9999 2<strong>01</strong>23236350054<strong>01</strong> TUSSICAPS CAP 5-4MG 02/28/2<strong>01</strong>3 2<strong>01</strong>2323635005420 TUSSICAPS CAP 5-4MG 02/28/2<strong>01</strong>3 2<strong>01</strong>23
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