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

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42192<strong>01</strong><strong>01</strong>10 UREA EMU 50% 12/31/9999 2<strong>01</strong>2345802<strong>01</strong>7156 UREA GEL 40% 12/31/9999 2<strong>01</strong>2350383069715 UREA GEL 40% 12/31/9999 2<strong>01</strong>230<strong>01</strong>68048811 UREA LOT 35% 12/31/9999 2<strong>01</strong>2345802<strong>01</strong>7655 UREA LOT 40% 12/31/9999 2<strong>01</strong>2351862<strong>01</strong>8216 UREA LOT 45% 12/31/9999 2<strong>01</strong>2351552131305 UREA POW PEROXIDE 12/31/9999 2<strong>01</strong>2351552131306 UREA POW PEROXIDE 12/31/9999 2<strong>01</strong>2342192070718 UREA 40% SUS NAIL 12/31/9999 2<strong>01</strong>2351862<strong>01</strong>8128 UREA NAIL GEL 45% 12/31/9999 2<strong>01</strong>2300884324908 UREACIN-10 LOT 10% 12/31/9999 2<strong>01</strong>2300884044904 UREACIN-20 CRE 20% 12/31/9999 2<strong>01</strong>2351285069002 URECHOLINE TAB 10MG 12/31/9999 2<strong>01</strong>2351285069102 URECHOLINE TAB 25MG 12/31/9999 2<strong>01</strong>2351285069202 URECHOLINE TAB 50MG 12/31/9999 2<strong>01</strong>2351285069702 URECHOLINE TAB 5MG 12/31/9999 2<strong>01</strong>23666630219<strong>01</strong> URELLE TAB 12/31/9999 2<strong>01</strong>23006820333<strong>01</strong> URIMAR T TAB 12/31/9999 2<strong>01</strong>23006820334<strong>01</strong> URIMAR-T TAB 12/31/9999 2<strong>01</strong>235485907<strong>01</strong>10 URIN D/S TAB 12/31/9999 2<strong>01</strong>23243850<strong>01</strong>365 URINARY PAIN TAB 95MG 12/31/9999 2<strong>01</strong>2349348036444 URINARY PAIN TAB 95MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>780610<strong>01</strong> UROCIT-K 10 TAB 12/31/9999 2<strong>01</strong>230<strong>01</strong>780615<strong>01</strong> UROCIT-K 15 TAB 12/31/9999 2<strong>01</strong>230<strong>01</strong>780600<strong>01</strong> UROCIT-K 5 TAB 12/31/9999 2<strong>01</strong>23004850051<strong>01</strong> UROGESIC- TAB BLUE 12/31/9999 2<strong>01</strong>2300485<strong>01</strong>51<strong>01</strong> UROGESIC- TAB BLUE 12/31/9999 2<strong>01</strong>23004861114<strong>01</strong> UROQID #2 TAB 12/31/9999 2<strong>01</strong>2300024420<strong>01</strong>0 UROXATRAL TAB 10MG 12/31/9999 2<strong>01</strong>2358914078510 URSO 250 TAB 250MG 12/31/9999 2<strong>01</strong>2358914078550 URSO 250 TAB 250MG 11/29/2<strong>01</strong>3 2<strong>01</strong>2358914079<strong>01</strong>0 URSO FORTE TAB 500MG 12/31/9999 2<strong>01</strong>23000939380<strong>01</strong> URSODIOL CAP 300MG 03/31/2<strong>01</strong>3 2<strong>01</strong>23003781730<strong>01</strong> URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>23005271326<strong>01</strong> URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>23005913159<strong>01</strong> URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>2300904622160 URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>23428060503<strong>01</strong> URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>2350268079515 URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>23510790383<strong>01</strong> URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>2351079038320 URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>2351224<strong>01</strong>5150 URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>2352152006002 URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>2352152006003 URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>23680840213<strong>01</strong> URSODIOL CAP 300MG 12/31/9999 2<strong>01</strong>23000935360<strong>01</strong> URSODIOL TAB 250MG <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>23005912368<strong>01</strong> URSODIOL TAB 250MG 12/31/9999 2<strong>01</strong>2366993040502 URSODIOL TAB 250MG 12/31/9999 2<strong>01</strong>23684620473<strong>01</strong> URSODIOL TAB 250MG 12/31/9999 2<strong>01</strong>23000935361<strong>01</strong> URSODIOL TAB 500MG <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>23005912369<strong>01</strong> URSODIOL TAB 500MG 12/31/9999 2<strong>01</strong>2366993040602 URSODIOL TAB 500MG 12/31/9999 2<strong>01</strong>23684620474<strong>01</strong> URSODIOL TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69517603 VAGIFEM TAB 10MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69517604 VAGIFEM TAB 10MCG 12/31/9999 2<strong>01</strong>230<strong>01</strong>69517303 VAGIFEM TAB 25MCG 02/28/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>69517304 VAGIFEM TAB 25MCG 12/31/2<strong>01</strong>2 2<strong>01</strong>2300067209046 VAGISTAT-1 OIN 6.5% VAG 12/31/9999 2<strong>01</strong>2300067209103 VAGISTAT-3 KIT 200MG/2% 12/31/9999 2<strong>01</strong>2300054<strong>01</strong>1513 VALACYCLOVIR TAB 1GM 12/31/9999 2<strong>01</strong>23

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