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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65597<strong>01</strong>0630 BENICAR HCT TAB 40-12.5 12/31/9999 2<strong>01</strong>2365597<strong>01</strong>0690 BENICAR HCT TAB 40-12.5 12/31/9999 2<strong>01</strong>2365597<strong>01</strong>0730 BENICAR HCT TAB 40-25MG 12/31/9999 2<strong>01</strong>2365597<strong>01</strong>0790 BENICAR HCT TAB 40-25MG 12/31/9999 2<strong>01</strong>23494<strong>01</strong><strong>01</strong><strong>01</strong><strong>01</strong> BENLYSTA INJ 120MG 12/31/9999 2<strong>01</strong>23494<strong>01</strong><strong>01</strong>02<strong>01</strong> BENLYSTA INJ 400MG 12/31/9999 2<strong>01</strong>23638<strong>01</strong><strong>01</strong>07<strong>01</strong> BENSAL HP OIN 12/31/9999 2<strong>01</strong>23638<strong>01</strong><strong>01</strong>0705 BENSAL HP OIN 12/31/9999 2<strong>01</strong>23638<strong>01</strong><strong>01</strong>0709 BENSAL HP OIN 12/31/9999 2<strong>01</strong>23638<strong>01</strong><strong>01</strong>0712 BENSAL HP OIN 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>3504 BENTONITE POW 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>3506 BENTONITE POW 12/31/9999 2<strong>01</strong>23589140<strong>01</strong>210 BENTYL CAP 10MG 12/31/9999 2<strong>01</strong>2358914008052 BENTYL INJ 10MG/ML 12/31/9999 2<strong>01</strong>23589140<strong>01</strong>516 BENTYL SYP 10MG/5ML 05/13/2<strong>01</strong>3 2<strong>01</strong>23589140<strong>01</strong>310 BENTYL TAB 20MG 12/31/9999 2<strong>01</strong>2300066049425 BENZACLIN GEL 1-5% 12/31/9999 2<strong>01</strong>2300066049435 BENZACLIN GEL 1-5%PUMP 12/31/9999 2<strong>01</strong>2300066049455 BENZACLIN GEL 1-5%PUMP 12/31/9999 2<strong>01</strong>2351552024105 BENZALDEHYDE ELX 12/31/9999 2<strong>01</strong>2351552024106 BENZALDEHYDE ELX 12/31/9999 2<strong>01</strong>2351552064806 BENZALKONIUM SOL 17% 12/31/9999 2<strong>01</strong>2351552064808 BENZALKONIUM SOL 17% 12/31/9999 2<strong>01</strong>2338779026405 BENZALKONIUM SOL NF 12/31/9999 2<strong>01</strong>2338779026408 BENZALKONIUM SOL NF 12/31/9999 2<strong>01</strong>2338779026409 BENZALKONIUM SOL NF 12/31/9999 2<strong>01</strong>2300066051046 BENZAMYCIN GEL 12/31/9999 2<strong>01</strong>2300066057760 BENZAMYCIN GEL PAK 12/31/9999 2<strong>01</strong>2310337080641 BENZASHAVE CRE 10% 12/31/9999 2<strong>01</strong>2300225061023 BENZEDREX INH 12/31/9999 2<strong>01</strong>2316781<strong>01</strong>9460 BENZEFOAM AER 5.3% 12/31/9999 2<strong>01</strong>2316781<strong>01</strong>9496 BENZEFOAM AER 5.3% 12/31/9999 2<strong>01</strong>231678102<strong>01</strong>96 BENZEFOAM AER 9.8% 12/31/9999 2<strong>01</strong>23425460<strong>01</strong>006 BENZEPRO AER 5.3% 12/31/9999 2<strong>01</strong>23425460<strong>01</strong><strong>01</strong>0 BENZEPRO AER 5.3% 12/31/9999 2<strong>01</strong>23425460<strong>01</strong>510 BENZEPRO SC AER 9.8% 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>77<strong>01</strong> BENZOIN TIN PLAIN 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>7703 BENZOIN TIN PLAIN 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>7704 BENZOIN TIN PLAIN 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>7706 BENZOIN TIN PLAIN 12/31/9999 2<strong>01</strong>2300574911902 BENZOIN CMPD TIN 12/31/9999 2<strong>01</strong>2351552022803 BENZOIN CMPD TIN 12/31/9999 2<strong>01</strong>2351552022804 BENZOIN CMPD TIN 12/31/9999 2<strong>01</strong>2351552022806 BENZOIN CMPD TIN 12/31/9999 2<strong>01</strong>2351552022808 BENZOIN CMPD TIN 12/31/9999 2<strong>01</strong>23004062247<strong>01</strong> BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2300406224705 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2300904590440 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2300904590460 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>110851<strong>01</strong> BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>11085102 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2357664<strong>01</strong>3388 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2365162053610 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2365162053650 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2367877<strong>01</strong>05<strong>01</strong> BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2367877<strong>01</strong>0505 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>23680840214<strong>01</strong> BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>23683820247<strong>01</strong> BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>2368382024705 BENZONATATE CAP 100MG 12/31/9999 2<strong>01</strong>23004062248<strong>01</strong> BENZONATATE CAP 200MG 12/31/9999 2<strong>01</strong>23

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