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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00536088097 BROMALINE SOL 1-15/5ML 07/31/2<strong>01</strong>3 2<strong>01</strong>2300536136085 BROMALINE DM ELX 15-1-5/5 07/31/2<strong>01</strong>3 2<strong>01</strong>2300472071104 BROMANATE ELX 2-12.5/5 12/31/9999 2<strong>01</strong>2300472071116 BROMANATE ELX 2-12.5/5 12/31/9999 2<strong>01</strong>2300472071128 BROMANATE ELX 2-12.5/5 12/31/9999 2<strong>01</strong>2300472071194 BROMANATE ELX 2-12.5/5 12/31/9999 2<strong>01</strong>2300472071198 BROMANATE ELX 2-12.5/5 12/31/9999 2<strong>01</strong>2300472164504 BROMANATE DC SYP 12/31/9999 2<strong>01</strong>2300472164516 BROMANATE DC SYP 12/31/9999 2<strong>01</strong>2300472164528 BROMANATE DC SYP 12/31/9999 2<strong>01</strong>2300472<strong>01</strong>1294 BROMANATE DM ELX 12/31/9999 2<strong>01</strong>2300472<strong>01</strong>1298 BROMANATE DM ELX 12/31/9999 2<strong>01</strong>2300472071294 BROMANATE DM ELX 12/31/9999 2<strong>01</strong>2300472071298 BROMANATE DM ELX 12/31/9999 2<strong>01</strong>2323359002210 BROMAX D TAB 03/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2367425099917 BROMDAY SOL 0.09% 12/31/9999 2<strong>01</strong>2367425099934 BROMDAY SOL 0.09% 12/31/9999 2<strong>01</strong>2351552105807 BROMELAIN POW 12/31/9999 2<strong>01</strong>2351552107404 BROMELAIN POW 12/31/9999 2<strong>01</strong>2350383059316 BROMETANE DX SYP 12/31/9999 2<strong>01</strong>2360432083704 BROMFED DM SYP 12/31/9999 2<strong>01</strong>2360432083716 BROMFED DM SYP 12/31/9999 2<strong>01</strong>2300378710935 BROMFENAC SOL 0.09% 12/31/9999 2<strong>01</strong>2300378711035 BROMFENAC SOL 0.09% 12/31/9999 2<strong>01</strong>23003787096<strong>01</strong> BROMOCRIPTIN CAP 5MG 12/31/9999 2<strong>01</strong>2300378709693 BROMOCRIPTIN CAP 5MG 12/31/9999 2<strong>01</strong>23007812119<strong>01</strong> BROMOCRIPTIN CAP 5MG 11/30/2<strong>01</strong>3 2<strong>01</strong>2300781211931 BROMOCRIPTIN CAP 5MG 11/30/2<strong>01</strong>3 2<strong>01</strong>2368382<strong>01</strong>10<strong>01</strong> BROMOCRIPTIN CAP 5MG 12/31/9999 2<strong>01</strong>2368382<strong>01</strong>1006 BROMOCRIPTIN CAP 5MG 12/31/9999 2<strong>01</strong>23003782042<strong>01</strong> BROMOCRIPTIN TAB 2.5MG 12/31/9999 2<strong>01</strong>2300378204293 BROMOCRIPTIN TAB 2.5MG 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>06<strong>01</strong> BROMOCRIPTIN TAB 2.5MG 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>0603 BROMOCRIPTIN TAB 2.5MG 12/31/9999 2<strong>01</strong>23007815325<strong>01</strong> BROMOCRIPTIN TAB 2.5MG 12/31/9999 2<strong>01</strong>2300781532531 BROMOCRIPTIN TAB 2.5MG 12/31/9999 2<strong>01</strong>2351991034716 BROMPHENEX SYP DM 12/31/9999 2<strong>01</strong>2312939<strong>01</strong>3216 BRONCOMAR-1 ELX 12/31/9999 2<strong>01</strong>23005363448<strong>01</strong> BRONTO-VITES CHW 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>2540 BROTAPP LIQ 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>2570 BROTAPP LIQ 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>2580 BROTAPP LIQ 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3640 BROTAPP DM LIQ 15-1-5/5 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>3670 BROTAPP DM LIQ 15-1-5/5 12/31/9999 2<strong>01</strong>2363402091130 BROVANA NEB 15MCG 12/31/9999 2<strong>01</strong>2363402091164 BROVANA NEB 15MCG 12/31/9999 2<strong>01</strong>2358605<strong>01</strong>52<strong>01</strong> BROVEX PEB LIQ 12/31/9999 2<strong>01</strong>2358605<strong>01</strong>53<strong>01</strong> BROVEX PEB LIQ DM 12/31/9999 2<strong>01</strong>2358605<strong>01</strong>50<strong>01</strong> BROVEX PSB LIQ 12/31/9999 2<strong>01</strong>2358605<strong>01</strong>51<strong>01</strong> BROVEX PSB LIQ DM 12/31/9999 2<strong>01</strong>23586050440<strong>01</strong> BROVEX PSE TAB 4-40MG 12/31/9999 2<strong>01</strong>23586050441<strong>01</strong> BROVEX PSE TAB DM 12/31/9999 2<strong>01</strong>2351552070503 BUBBLE GUM LIQ CONCENTR 12/31/9999 2<strong>01</strong>2351552083006 BUBBLE GUM SYP 12/31/9999 2<strong>01</strong>230009355<strong>01</strong><strong>01</strong> BUDEPRION TAB 100MG SR 12/31/9999 2<strong>01</strong>23000935502<strong>01</strong> BUDEPRION TAB 150MG SR 12/31/9999 2<strong>01</strong>2300093535005 BUDEPRION XL TAB 150MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300093535056 BUDEPRION XL TAB 150MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300093535105 BUDEPRION XL TAB 300MG 12/31/2<strong>01</strong>2 2<strong>01</strong>2300093535156 BUDEPRION XL TAB 300MG 12/31/9999 2<strong>01</strong>23

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