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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00004003822 VALCYTE TAB 450MG 12/31/9999 2<strong>01</strong>2351552075006 VALERIAN EXT ROOT 12/31/9999 2<strong>01</strong>2363323049405 VALPROATE INJ 100MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>43978510 VALPROATE INJ 500/5ML 12/31/9999 2<strong>01</strong>23005914<strong>01</strong>2<strong>01</strong> VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>2300832100800 VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110852<strong>01</strong> VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>23510790298<strong>01</strong> VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>2351079029808 VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>2351079029856 VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>23637390251<strong>01</strong> VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>2363739025110 VALPROIC ACD CAP 250MG 12/31/9999 2<strong>01</strong>2300591042616 VALPROIC ACD SOL 250/5ML 12/31/9999 2<strong>01</strong>2357664<strong>01</strong>2434 VALPROIC ACD SOL 250/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21067516 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>21467505 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2300603184158 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2350383079216 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2360432062116 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>9358 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>9359 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>9361 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2368094<strong>01</strong>9362 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>236809407<strong>01</strong>59 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>236809407<strong>01</strong>61 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>236809407<strong>01</strong>62 VALPROIC ACD SYP 250/5ML 12/31/9999 2<strong>01</strong>2300378632205 VALSART/HCTZ TAB 160-12.5 12/31/9999 2<strong>01</strong>2300378632277 VALSART/HCTZ TAB 160-12.5 12/31/9999 2<strong>01</strong>2300781594910 VALSART/HCTZ TAB 160-12.5 12/31/9999 2<strong>01</strong>2300781594964 VALSART/HCTZ TAB 160-12.5 12/31/9999 2<strong>01</strong>2300781594992 VALSART/HCTZ TAB 160-12.5 12/31/9999 2<strong>01</strong>2300378632305 VALSART/HCTZ TAB 160-25MG 12/31/9999 2<strong>01</strong>2300378632377 VALSART/HCTZ TAB 160-25MG 12/31/9999 2<strong>01</strong>2300781595<strong>01</strong>0 VALSART/HCTZ TAB 160-25MG 12/31/9999 2<strong>01</strong>2300781595064 VALSART/HCTZ TAB 160-25MG 12/31/9999 2<strong>01</strong>2300781595092 VALSART/HCTZ TAB 160-25MG 12/31/9999 2<strong>01</strong>2300378632405 VALSART/HCTZ TAB 320-12.5 12/31/9999 2<strong>01</strong>2300378632477 VALSART/HCTZ TAB 320-12.5 12/31/9999 2<strong>01</strong>2300781595110 VALSART/HCTZ TAB 320-12.5 12/31/9999 2<strong>01</strong>2300781595164 VALSART/HCTZ TAB 320-12.5 12/31/9999 2<strong>01</strong>2300781595192 VALSART/HCTZ TAB 320-12.5 12/31/9999 2<strong>01</strong>2300378632505 VALSART/HCTZ TAB 320-25MG 12/31/9999 2<strong>01</strong>2300378632577 VALSART/HCTZ TAB 320-25MG 12/31/9999 2<strong>01</strong>2300781595210 VALSART/HCTZ TAB 320-25MG 12/31/9999 2<strong>01</strong>2300781595264 VALSART/HCTZ TAB 320-25MG 12/31/9999 2<strong>01</strong>2300781595292 VALSART/HCTZ TAB 320-25MG 12/31/9999 2<strong>01</strong>2300378632105 VALSART/HCTZ TAB 80-12.5 12/31/9999 2<strong>01</strong>2300378632177 VALSART/HCTZ TAB 80-12.5 12/31/9999 2<strong>01</strong>2300781594810 VALSART/HCTZ TAB 80-12.5 12/31/9999 2<strong>01</strong>2300781594892 VALSART/HCTZ TAB 80-12.5 12/31/9999 2<strong>01</strong>236797900<strong>01</strong><strong>01</strong> VALSTAR SOL 40MG/ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>73056504 VALTREX TAB 1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73056510 VALTREX TAB 1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>73093308 VALTREX TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73093310 VALTREX TAB 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73093356 VALTREX TAB 500MG 12/31/9999 2<strong>01</strong>2300078057215 VALTURNA TAB 150-160 10/31/2<strong>01</strong>3 2<strong>01</strong>2300078057415 VALTURNA TAB 300-320 10/31/2<strong>01</strong>3 2<strong>01</strong>23588090999<strong>01</strong> VANACOF LIQ 12/31/9999 2<strong>01</strong>23588090907<strong>01</strong> VANACOF DX LIQ 12/31/9999 2<strong>01</strong>23

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