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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60505057804 AZELASTINE DRO 0.05% 12/31/9999 2<strong>01</strong>2347335077991 AZELASTINE SPR 0.1% 12/31/9999 2<strong>01</strong>2351525029403 AZELASTINE SPR 0.1% 12/31/9999 2<strong>01</strong>2360505083305 AZELASTINE SPR 0.1% 12/31/9999 2<strong>01</strong>2300023869430 AZELEX CRE 20% 12/31/9999 2<strong>01</strong>2300023869450 AZELEX CRE 20% 12/31/9999 2<strong>01</strong>2368546<strong>01</strong>4256 AZILECT TAB 0.5MG 12/31/9999 2<strong>01</strong>2368546022956 AZILECT TAB 1MG 12/31/9999 2<strong>01</strong>2300409<strong>01</strong>4411 AZITHROMYCIN INJ 500MG 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>1210 AZITHROMYCIN INJ 500MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11079478 AZITHROMYCIN INJ 500MG 12/31/9999 2<strong>01</strong>2360505607604 AZITHROMYCIN INJ 500MG 12/31/9999 2<strong>01</strong>2363323039810 AZITHROMYCIN INJ 500MG 12/31/9999 2<strong>01</strong>2363323039812 AZITHROMYCIN INJ 500MG 12/31/9999 2<strong>01</strong>23597623051<strong>01</strong> AZITHROMYCIN POW 1GM PAK 12/31/9999 2<strong>01</strong>2359762305102 AZITHROMYCIN POW 1GM PAK 12/31/9999 2<strong>01</strong>2351552130404 AZITHROMYCIN POW DIHYDRAT 12/31/9999 2<strong>01</strong>2351552130405 AZITHROMYCIN POW DIHYDRAT 12/31/9999 2<strong>01</strong>2351552130406 AZITHROMYCIN POW DIHYDRAT 12/31/9999 2<strong>01</strong>2300093202723 AZITHROMYCIN SUS 100/5ML 12/31/9999 2<strong>01</strong>2300093714823 AZITHROMYCIN SUS 100/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>85720370 AZITHROMYCIN SUS 100/5ML 12/31/9999 2<strong>01</strong>23597623110<strong>01</strong> AZITHROMYCIN SUS 100/5ML 12/31/9999 2<strong>01</strong>2300093202623 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>2300093202631 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>2300093202694 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>2300093714923 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>2300093714931 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>2300093714994 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>85720670 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>85720969 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>85721268 AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>23597623120<strong>01</strong> AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>23597623130<strong>01</strong> AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>23597623140<strong>01</strong> AZITHROMYCIN SUS 200/5ML 12/31/9999 2<strong>01</strong>2300093714609 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300093714618 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300093714619 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300093714656 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300093714693 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300781149631 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300781149668 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300781149669 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>23009046<strong>01</strong>004 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11078751 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11078766 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2350268009815 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>23597623060<strong>01</strong> AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2359762306002 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2359762306003 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2360505258100 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2360505258102 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2360505258103 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>23646790961<strong>01</strong> AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2364679096104 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2364679096105 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>23680840278<strong>01</strong> AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2368084044365 AZITHROMYCIN TAB 250MG 12/31/9999 2<strong>01</strong>2300093716919 AZITHROMYCIN TAB 500MG 12/31/9999 2<strong>01</strong>2300093716933 AZITHROMYCIN TAB 500MG 12/31/9999 2<strong>01</strong>23

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