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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117<strong>01</strong>004814 BAZA CLEAR OIN 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004822 BAZA CLEAR OIN 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004824 BAZA CLEAR OIN 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004614 BAZA PROTECT CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004622 BAZA PROTECT CRE 12/31/9999 2<strong>01</strong>23117<strong>01</strong>004623 BAZA PROTECT CRE 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050002 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050006 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050<strong>01</strong>8 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050024 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>230<strong>01</strong>35050050 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000908 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000910 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000912 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000916 BC FAST PAIN POW RELIEF 12/31/9999 2<strong>01</strong>230<strong>01</strong>3505<strong>01</strong>06 BC FAST PAIN POW RLF ARTH 12/31/9999 2<strong>01</strong>230<strong>01</strong>3505<strong>01</strong>24 BC FAST PAIN POW RLF ARTH 12/31/9999 2<strong>01</strong>230<strong>01</strong>3505<strong>01</strong>50 BC FAST PAIN POW RLF ARTH 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000810 BC FAST PAIN POW RLF ARTH 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000812 BC FAST PAIN POW RLF ARTH 12/31/9999 2<strong>01</strong>231<strong>01</strong>58000816 BC FAST PAIN POW RLF ARTH 12/31/9999 2<strong>01</strong>2367457<strong>01</strong>4630 B-COMPLEX INJ 12/31/9999 2<strong>01</strong>2351552084705 B-CREAM CRE 12/31/9999 2<strong>01</strong>2351552084706 B-CREAM CRE 12/31/9999 2<strong>01</strong>2351552084709 B-CREAM CRE 12/31/9999 2<strong>01</strong>2364193044502 BEBULIN INJ 200-1200 12/31/9999 2<strong>01</strong>230<strong>01</strong>73038879 BECONASE AQ SUS 0.042% 12/31/9999 2<strong>01</strong>23117<strong>01</strong>002004 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>002005 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>002009 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>005204 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>005205 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>005304 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>23117<strong>01</strong>005305 BEDSIDE-CARE SOL 12/31/9999 2<strong>01</strong>2300536335708 BEE ZEE TAB 12/31/9999 2<strong>01</strong>2351552063409 BEEF FLAVOR LIQ 12/31/9999 2<strong>01</strong>2351552116206 BEESWAX MIS WHITE 12/31/9999 2<strong>01</strong>230<strong>01</strong>43114<strong>01</strong>0 BELLA ALK/PB TAB 16.2MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43114051 BELLA ALK/PB TAB 16.2MG 12/31/9999 2<strong>01</strong>2315338060060 BELLA ALK/PB TAB 16.2MG 12/31/9999 2<strong>01</strong>2364125<strong>01</strong>2810 BELLA ALK/PB TAB 16.2MG 12/31/9999 2<strong>01</strong>2300574704512 BELLA/OPIUM SUP 16.2-30 12/31/9999 2<strong>01</strong>2300574704<strong>01</strong>2 BELLA/OPIUM SUP 16.2-60 12/31/9999 2<strong>01</strong>2351552129906 BELLADONNA TIN 12/31/9999 2<strong>01</strong>230<strong>01</strong>850204<strong>01</strong> BENAZEP/HCTZ TAB 10-12.5 12/31/9999 2<strong>01</strong>23003784735<strong>01</strong> BENAZEP/HCTZ TAB 10-12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>850211<strong>01</strong> BENAZEP/HCTZ TAB 20-12.5 12/31/9999 2<strong>01</strong>23003784745<strong>01</strong> BENAZEP/HCTZ TAB 20-12.5 12/31/9999 2<strong>01</strong>230<strong>01</strong>850277<strong>01</strong> BENAZEP/HCTZ TAB 20-25MG 12/31/9999 2<strong>01</strong>23003784775<strong>01</strong> BENAZEP/HCTZ TAB 20-25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85<strong>01</strong>24<strong>01</strong> BENAZEP/HCTZ TAB 5-6.25 12/31/9999 2<strong>01</strong>23003784725<strong>01</strong> BENAZEP/HCTZ TAB 5-6.25 12/31/9999 2<strong>01</strong>23000935125<strong>01</strong> BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2300093512505 BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>850053<strong>01</strong> BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>85005305 BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23003780443<strong>01</strong> BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>45<strong>01</strong> BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>4520 BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23605050266<strong>01</strong> BENAZEPRIL TAB 10MG 12/31/9999 2<strong>01</strong>23

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