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

58809057101 VANACOF G LIQ 12/31/9999 2012366593312502 VANCOCIN HCL CAP 125MG 12/31/9999 2012366593312602 VANCOCIN HCL CAP 250MG 12/31/9999 2012300338355248 VANCOMYC/DEX INJ 1GM 12/31/9999 2012300338355148 VANCOMYC/DEX INJ 500MG 12/31/9999 2012300338358048 VANCOMYC/DEX INJ 750MG 12/31/9999 2012300591356015 VANCOMYCIN CAP 125MG 12/31/9999 2012317478074102 VANCOMYCIN CAP 125MG 12/31/9999 2012347781072902 VANCOMYCIN CAP 125MG 12/31/9999 2012363323033820 VANCOMYCIN CAP 125MG 12/31/9999 2012366993021019 VANCOMYCIN CAP 125MG 12/31/9999 2012300591356115 VANCOMYCIN CAP 250MG 12/31/9999 2012317478074202 VANCOMYCIN CAP 250MG 12/31/9999 2012347781073002 VANCOMYCIN CAP 250MG 12/31/9999 2012363323033920 VANCOMYCIN CAP 250MG 12/31/9999 2012366993021119 VANCOMYCIN CAP 250MG 12/31/9999 2012300069258903 VANCOMYCIN INJ 1 GM 12/31/9999 2012300069258910 VANCOMYCIN INJ 1 GM 12/31/9999 2012300781318880 VANCOMYCIN INJ 1 GM 12/31/9999 2012300781318895 VANCOMYCIN INJ 1 GM 12/31/2013 2012323360015250 VANCOMYCIN INJ 1 GM 02/28/2013 2012367457022220 VANCOMYCIN INJ 1 GM 12/31/9999 2012300409653301 VANCOMYCIN INJ 1000MG 12/31/9999 2012300409653349 VANCOMYCIN INJ 1000MG 12/31/9999 2012300409653501 VANCOMYCIN INJ 1000MG 12/31/9999 2012300409653549 VANCOMYCIN INJ 1000MG 12/31/9999 2012310139050112 VANCOMYCIN INJ 1000MG 12/31/9999 2012310139050120 VANCOMYCIN INJ 1000MG 12/31/9999 2012363323028420 VANCOMYCIN INJ 1000MG 12/31/9999 2012300069259999 VANCOMYCIN INJ 10GM 12/31/9999 2012300409651001 VANCOMYCIN INJ 10GM 12/31/9999 2012300409651049 VANCOMYCIN INJ 10GM 12/31/9999 2012363323031461 VANCOMYCIN INJ 10GM 12/31/9999 2012300069258703 VANCOMYCIN INJ 500MG 12/31/9999 2012300069258710 VANCOMYCIN INJ 500MG 12/31/9999 2012300409433201 VANCOMYCIN INJ 500MG 12/31/9999 2012300409433249 VANCOMYCIN INJ 500MG 12/31/9999 2012300409653401 VANCOMYCIN INJ 500MG 12/31/9999 2012300409653449 VANCOMYCIN INJ 500MG 12/31/9999 2012300781318770 VANCOMYCIN INJ 500MG 12/31/9999 2012300781318795 VANCOMYCIN INJ 500MG 12/31/9999 2012323360015140 VANCOMYCIN INJ 500MG 02/28/2013 2012363323022110 VANCOMYCIN INJ 500MG 12/31/9999 2012367457022510 VANCOMYCIN INJ 500MG 12/31/9999 2012300069259001 VANCOMYCIN INJ 5GM 12/31/9999 2012300409650901 VANCOMYCIN INJ 5GM 12/31/9999 2012300409650949 VANCOMYCIN INJ 5GM 12/31/9999 2012323360015365 VANCOMYCIN INJ 5GM 03/31/2013 2012325021015799 VANCOMYCIN INJ 5GM 12/31/9999 2012363323029561 VANCOMYCIN INJ 5GM 12/31/9999 2012300409653102 VANCOMYCIN INJ 750MG 12/31/9999 2012300245086070 VANDAZOLE GEL 0.75% 12/31/9999 2012300310783030 VANDETANIB TAB 300MG 12/31/9999 2012351552127305 VANIBASE CRE 12/31/9999 2012351552127306 VANIBASE CRE 12/31/9999 2012351552127308 VANIBASE CRE 12/31/9999 2012351552127309 VANIBASE CRE 12/31/9999 2012351552129405 VANIBASE CRE 12/31/9999 2012351552129406 VANIBASE CRE 12/31/9999 2012351552129408 VANIBASE CRE 12/31/9999 20123