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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00832102510 BACLOFEN TAB 20MG 12/31/9999 2<strong>01</strong>2300832102550 BACLOFEN TAB 20MG 12/31/9999 2<strong>01</strong>2300904522261 BACLOFEN TAB 20MG 12/31/9999 2<strong>01</strong>2316714007204 BACLOFEN TAB 20MG 12/31/2020 2<strong>01</strong>2316714007205 BACLOFEN TAB 20MG 12/31/2020 2<strong>01</strong>23510790043<strong>01</strong> BACLOFEN TAB 20MG 04/30/2<strong>01</strong>3 2<strong>01</strong>2351079004320 BACLOFEN TAB 20MG 04/30/2<strong>01</strong>3 2<strong>01</strong>2363739048<strong>01</strong>0 BACLOFEN TAB 20MG 12/31/9999 2<strong>01</strong>23680840039<strong>01</strong> BACLOFEN TAB 20MG 12/31/9999 2<strong>01</strong>230068230<strong>01</strong><strong>01</strong> BACMIN TAB 12/31/9999 2<strong>01</strong>2351552066209 BACON FLAVOR LIQ 12/31/9999 2<strong>01</strong>2300409397703 BACTER WATER INJ BENZ ALC 12/31/9999 2<strong>01</strong>2363323024930 BACTER WATER INJ PARABENS 12/31/9999 2<strong>01</strong>23621070<strong>01</strong>103 BACTERICIN OIN 500/GM 12/31/9999 2<strong>01</strong>23621070<strong>01</strong>115 BACTERICIN OIN 500/GM 12/31/9999 2<strong>01</strong>23003381<strong>01</strong>341 BACTOCILL INJ DEX 1GM 12/31/9999 2<strong>01</strong>23003381<strong>01</strong>541 BACTOCILL INJ DEX 2GM 12/31/9999 2<strong>01</strong>2313310<strong>01</strong>45<strong>01</strong> BACTRIM TAB 400-80MG 12/31/9999 2<strong>01</strong>2313310<strong>01</strong>46<strong>01</strong> BACTRIM DS TAB 800-160 12/31/9999 2<strong>01</strong>2300029152722 BACTROBAN CRE 2% 12/31/9999 2<strong>01</strong>2300029152725 BACTROBAN CRE 2% 12/31/9999 2<strong>01</strong>2300029152544 BACTROBAN OIN 2% 12/31/9999 2<strong>01</strong>2300029152611 BACTROBAN OIN NASAL 2% 12/31/9999 2<strong>01</strong>2311098052603 BAL IN OIL INJ 100MG/ML 02/28/2<strong>01</strong>4 2<strong>01</strong>2300264251410 BAL SALT SOL OP 12/31/9999 2<strong>01</strong>2342546<strong>01</strong>8030 BAL-CARE MIS DHA 12/31/9999 2<strong>01</strong>2342546<strong>01</strong>8530 BAL-CARE DHA MIS ESSNTIAL 12/31/9999 2<strong>01</strong>2310631<strong>01</strong>0608 BALNETAR EMU 2.5% <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2300054007928 BALSALAZIDE CAP 750MG 12/31/9999 2<strong>01</strong>2300378675082 BALSALAZIDE CAP 750MG 12/31/9999 2<strong>01</strong>2360505257507 BALSALAZIDE CAP 750MG 12/31/9999 2<strong>01</strong>2300555903458 BALZIVA TAB 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6803 BANANA LIQ FLAVOR 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6806 BANANA LIQ FLAVOR 12/31/9999 2<strong>01</strong>2300904203524 BANOPHEN CAP 25MG 12/31/9999 2<strong>01</strong>2300904203559 BANOPHEN CAP 25MG 12/31/9999 2<strong>01</strong>2300904535431 BANOPHEN CRE 2-0.1% 12/31/9999 2<strong>01</strong>2300904122800 BANOPHEN LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2300904122820 BANOPHEN LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2300904517416 BANOPHEN LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2300904517428 BANOPHEN LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2300904555124 BANOPHEN TAB 25MG 12/31/9999 2<strong>01</strong>2300904555159 BANOPHEN TAB 25MG 12/31/9999 2<strong>01</strong>2362856058446 BANZEL SUS 40MG/ML 12/31/9999 2<strong>01</strong>2362856058230 BANZEL TAB 200MG 12/31/9999 2<strong>01</strong>2362856058252 BANZEL TAB 200MG 12/31/9999 2<strong>01</strong>2362856058352 BANZEL TAB 400MG 12/31/9999 2<strong>01</strong>2300003161412 BARACLUDE SOL .05MG/ML 12/31/9999 2<strong>01</strong>2300003161112 BARACLUDE TAB 0.5MG 12/31/9999 2<strong>01</strong>2300003161113 BARACLUDE TAB 0.5MG 12/31/9999 2<strong>01</strong>2300003161212 BARACLUDE TAB 1MG 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>5406 BARIUM POW SULFATE 12/31/9999 2<strong>01</strong>2364679081008 BAYCADRON ELX 0.5/5ML 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004514 BAZA ANTIFUN CRE 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004522 BAZA ANTIFUN CRE 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004523 BAZA ANTIFUN CRE 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004705 BAZA CLEANSE LOT 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004722 BAZA CLEANSE LOT 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>006205 BAZA CLEANSE LOT 2% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>0048<strong>01</strong> BAZA CLEAR OIN 12/31/9999 2<strong>01</strong>23

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