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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0<strong>01</strong>35048702 BIOTENE DRY PST MOUTH 12/31/9999 2<strong>01</strong>230<strong>01</strong>350489<strong>01</strong> BIOTENE DRY PST MTH/SENS 12/31/9999 2<strong>01</strong>230<strong>01</strong>350490<strong>01</strong> BIOTENE PBF PST DRY MTH 12/31/9999 2<strong>01</strong>23005366659<strong>01</strong> BIOTIN TAB 300MCG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>09<strong>01</strong> BISAC-EVAC SUP 10MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0905 BISAC-EVAC SUP 10MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0908 BISAC-EVAC SUP 10MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0910 BISAC-EVAC SUP 10MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0912 BISAC-EVAC SUP 10MG 12/31/9999 2<strong>01</strong>2300713<strong>01</strong>0950 BISAC-EVAC SUP 10MG 12/31/9999 2<strong>01</strong>23005361355<strong>01</strong> BISACODYL SUP 10MG 12/31/9999 2<strong>01</strong>2300536135512 BISACODYL SUP 10MG 12/31/9999 2<strong>01</strong>2300574705<strong>01</strong>2 BISACODYL SUP 10MG 12/31/9999 2<strong>01</strong>2300574705050 BISACODYL SUP 10MG 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>0253 BISACODYL SUP 10MG 12/31/9999 2<strong>01</strong>2345802071030 BISACODYL SUP 10MG 04/19/2<strong>01</strong>5 2<strong>01</strong>2345802071032 BISACODYL SUP 10MG 04/17/2<strong>01</strong>5 2<strong>01</strong>2345802071033 BISACODYL SUP 10MG 11/09/2<strong>01</strong>4 2<strong>01</strong>23005363381<strong>01</strong> BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300536338110 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300603248321 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300603248332 BISACODYL TAB 5MG EC 09/30/2<strong>01</strong>3 2<strong>01</strong>2300904792717 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300904792760 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300904792761 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300904792780 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>2863 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>23494830003<strong>01</strong> BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2349483000310 BISACODYL TAB 5MG EC 12/31/9999 2<strong>01</strong>2300904505812 BISCOLAX SUP 10MG 12/31/9999 2<strong>01</strong>2300904505860 BISCOLAX SUP 10MG 12/31/9999 2<strong>01</strong>2300904131503 BISMATROL CHW 262MG 12/31/9999 2<strong>01</strong>2300904131546 BISMATROL CHW 262MG 12/31/9999 2<strong>01</strong>2300904131309 BISMATROL SUS 262/15ML 12/31/9999 2<strong>01</strong>2300904131409 BISMATROL SUS 525/15ML 12/31/9999 2<strong>01</strong>2338779104604 BISMUTH POW SUBGALLA 12/31/9999 2<strong>01</strong>2338779104605 BISMUTH POW SUBGALLA 12/31/9999 2<strong>01</strong>2338779104608 BISMUTH POW SUBGALLA 12/31/9999 2<strong>01</strong>2351552020205 BISMUTH POW SUBGALLA 12/31/9999 2<strong>01</strong>2351552020206 BISMUTH POW SUBGALLA 12/31/9999 2<strong>01</strong>2338779104704 BISMUTH POW SUBNITRA 12/31/9999 2<strong>01</strong>2338779104705 BISMUTH POW SUBNITRA 12/31/9999 2<strong>01</strong>2338779104708 BISMUTH POW SUBNITRA 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6204 BISMUTH POW SUBNITRA 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6206 BISMUTH POW SUBNITRA 12/31/9999 2<strong>01</strong>2351552<strong>01</strong>6209 BISMUTH POW SUBNITRA 12/31/9999 2<strong>01</strong>2315127055568 BISMUTH MS SUS 525/15ML 12/31/9999 2<strong>01</strong>2338779065904 BISMUTH SUBC POW 12/31/9999 2<strong>01</strong>2338779065905 BISMUTH SUBC POW 12/31/9999 2<strong>01</strong>2338779065908 BISMUTH SUBC POW 12/31/9999 2<strong>01</strong>230<strong>01</strong>850707<strong>01</strong> BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>230<strong>01</strong>85070705 BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>230<strong>01</strong>85070730 BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>2300228265203 BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>23003780505<strong>01</strong> BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>2300378050505 BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>2329300<strong>01</strong>89<strong>01</strong> BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>2329300<strong>01</strong>8905 BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>2329300<strong>01</strong>8913 BISOPRL/HCTZ TAB 10/6.25 12/31/9999 2<strong>01</strong>230<strong>01</strong>8507<strong>01</strong><strong>01</strong> BISOPRL/HCTZ TAB 2.5/6.25 12/31/9999 2<strong>01</strong>23

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