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

51645091001 VITAMIN B-6 TAB 100MG 12/31/9999 2012362107006101 VITAMIN B-6 TAB 100MG 12/31/9999 2012351645090901 VITAMIN B-6 TAB 50MG 12/31/9999 2012300536329101 VITAMIN C CHW 500MG 12/31/9999 2012300536016085 VITAMIN C SYP 500/5ML 12/31/9999 2012300536016097 VITAMIN C SYP 500/5ML 12/31/9999 2012350383016716 VITAMIN C SYP 500/5ML 12/31/9999 2012300536329201 VITAMIN C TAB 500MG 12/31/9999 2012300536329210 VITAMIN C TAB 500MG 12/31/9999 2012351645092001 VITAMIN C TAB 500MG 12/31/9999 2012351645092010 VITAMIN C TAB 500MG 12/31/9999 2012362107004601 VITAMIN C TAB 500MG 12/31/9999 2012362107004610 VITAMIN C TAB 500MG 12/31/9999 2012300574019401 VITAMIN D CAP 50000UNT 07/31/2013 2012350111099001 VITAMIN D CAP 50000UNT 12/31/9999 2012351991060401 VITAMIN D CAP 50000UNT 12/31/9999 2012364980015701 VITAMIN D CAP 50000UNT 12/31/9999 2012368084046301 VITAMIN D CAP 50000UNT 12/31/9999 2012363044401101 VITAMIN D3 CAP 10000 IU 12/31/9999 2012300536479301 VITAMIN E CAP 100UNIT 12/31/9999 2012300536479901 VITAMIN E CAP 400UNIT 12/31/9999 2012362107006401 VITAMIN E CAP 400UNIT 12/31/9999 2012300182079943 VITAMIN E CRE 3000UNIT 12/31/2012 2012351552072604 VITAMIN E LIQ ACETATE 12/31/9999 2012351552072605 VITAMIN E LIQ ACETATE 12/31/9999 2012351552072606 VITAMIN E LIQ ACETATE 12/31/9999 2012300536853396 VITAMIN E OIL 06/14/2015 2012300409915801 VITAMIN K1 INJ 10MG/ML 12/31/9999 2012300409915701 VITAMIN K1 INJ 1MG/0.5 12/31/9999 2012351552112904 VITAMIN K-1 POW 12/31/9999 2012351552112905 VITAMIN K-1 POW 12/31/9999 2012351552112906 VITAMIN K-1 POW 12/31/9999 2012351552112907 VITAMIN K-1 POW 12/31/9999 2012300603041054 VITAMINS A&D OIN 03/31/2013 2012310267073701 VITAMN FORTE CAP 12/31/9999 2012360575091390 VITA-RESPA TAB 12/31/9999 2012313811001190 VITASPIRE TAB 11/30/2012 2012349908010060 VITAZOL CRE 0.75% 12/31/9999 2012300536344901 VITE/IRON CHW CHILDREN 12/31/9999 2012367425000210 VITRASE INJ 200/ML 12/31/9999 2012324208041201 VITRASERT IMP 4.5MG 12/31/9999 2012364661008030 VIVA DHA CAP 12/31/9999 2012351285059402 VIVACTIL TAB 10MG 12/31/9999 2012351285059502 VIVACTIL TAB 5MG 12/31/9999 2012300053759601 VIVAGLOBIN SOL 160MG/ML 09/07/2013 2012300053759610 VIVAGLOBIN SOL 160MG/ML 05/06/2013 2012300053759620 VIVAGLOBIN SOL 160MG/ML 06/08/2013 2012300135007707 VIVARIN TAB 200MG 12/31/9999 2012300135007713 VIVARIN TAB 200MG 12/31/9999 2012300135007717 VIVARIN TAB 200MG 12/31/9999 2012300135007809 VIVARIN TAB 200MG 12/31/9999 2012300078036542 VIVELLE-DOT DIS 0.025MG 12/31/9999 2012300078036545 VIVELLE-DOT DIS 0.025MG 12/31/9999 2012300078034342 VIVELLE-DOT DIS 0.0375MG 12/31/9999 2012300078034345 VIVELLE-DOT DIS 0.0375MG 12/31/9999 2012300078034362 VIVELLE-DOT DIS 0.0375MG 12/31/9999 2012300078034442 VIVELLE-DOT DIS 0.05MG 12/31/9999 2012300078034445 VIVELLE-DOT DIS 0.05MG 12/31/9999 2012300078034462 VIVELLE-DOT DIS 0.05MG 12/31/9999 2012300078034542 VIVELLE-DOT DIS 0.075MG 12/31/9999 20123