Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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55390035803 CAFCIT SOL 60MG/3ML 12/31/9999 2<strong>01</strong>23007815405<strong>01</strong> CAFERGOT TAB 1-100MG 12/31/9999 2<strong>01</strong>23102670212<strong>01</strong> CAFFEINE TAB 200MG 12/31/9999 2<strong>01</strong>2310267021204 CAFFEINE TAB 200MG 12/31/9999 2<strong>01</strong>2350844022610 CAFFEINE TAB 200MG 12/31/9999 2<strong>01</strong>2350844022621 CAFFEINE TAB 200MG 12/31/9999 2<strong>01</strong>23005740823<strong>01</strong> CAFFEINE CIT INJ 20MG/ML 12/31/9999 2<strong>01</strong>2363323040703 CAFFEINE CIT INJ 20MG/ML 12/31/9999 2<strong>01</strong>2300517002<strong>01</strong>0 CAFFEINE CIT INJ 60MG/3ML 12/31/9999 2<strong>01</strong>2300574082381 CAFFEINE CIT INJ 60MG/3ML 12/31/9999 2<strong>01</strong>2347335028940 CAFFEINE CIT INJ 60MG/3ML 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>5210 CAFFEINE CIT SOL 20MG/ML 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>5280 CAFFEINE CIT SOL 20MG/ML 12/31/9999 2<strong>01</strong>2363323040603 CAFFEINE CIT SOL 20MG/ML 12/31/9999 2<strong>01</strong>2347335029044 CAFFEINE CIT SOL 60MG/3ML 12/31/9999 2<strong>01</strong>2300517250210 CAFFEINE/SOD INJ BENZOATE 12/31/9999 2<strong>01</strong>230<strong>01</strong>13059523 CAL ANTACID CHW 1000MG 12/31/9999 2<strong>01</strong>2337205033369 CAL ANTACID CHW 1000MG 12/31/9999 2<strong>01</strong>2363868005572 CAL ANTACID CHW 1000MG 12/31/9999 2<strong>01</strong>2368220009990 CALAFOL RX TAB 12/31/9999 2<strong>01</strong>2351879080006 CALAGEL GEL MAX ST 12/31/9999 2<strong>01</strong>2300904253300 CALAMINE LOT 12/31/9999 2<strong>01</strong>2363868031706 CALAMINE LOT 12/31/9999 2<strong>01</strong>2300025186131 CALAN TAB 120MG 12/31/9999 2<strong>01</strong>2300025185131 CALAN TAB 80MG 12/31/9999 2<strong>01</strong>230002519<strong>01</strong>31 CALAN SR TAB 120MG 12/31/9999 2<strong>01</strong>2300025191131 CALAN SR TAB 180MG 12/31/9999 2<strong>01</strong>2300025189131 CALAN SR TAB 240MG 12/31/9999 2<strong>01</strong>2300025189151 CALAN SR TAB 240MG 12/31/9999 2<strong>01</strong>2300054008826 CALC ACETATE CAP 667MG 12/31/9999 2<strong>01</strong>2300781267202 CALC ACETATE CAP 667MG 12/31/9999 2<strong>01</strong>2300574<strong>01</strong>1302 CALC ACETATE TAB 667MG 12/31/9999 2<strong>01</strong>2336800059523 CALC ANTACID CHW 1000MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13047847 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2300603009526 CALC ANTACID CHW 500MG 10/31/2<strong>01</strong>3 2<strong>01</strong>2300904125792 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2300904125892 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2336800048547 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2349348095721 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2349348095821 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2351645073515 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>32<strong>01</strong> CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2363868005315 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>2363868005415 CALC ANTACID CHW 500MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>13<strong>01</strong>7980 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2300603009627 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2300904769591 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2336800<strong>01</strong>7980 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2336800046880 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2336800048980 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2349348095434 CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>31<strong>01</strong> CALC ANTACID CHW 750MG 12/31/9999 2<strong>01</strong>23007032793<strong>01</strong> CALC FOLINAT INJ 100/10ML 12/31/9999 2<strong>01</strong>23007032797<strong>01</strong> CALC FOLINAT INJ 300/30ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>82414126 CALCARB 600 TAB /VIT D 12/31/9999 2<strong>01</strong>230<strong>01</strong>780251<strong>01</strong> CALCET TAB 12/31/9999 2<strong>01</strong>23005363792<strong>01</strong> CALCI-CHEW CHW CHERRY 12/31/9999 2<strong>01</strong>2300074811031 CALCIJEX INJ 1MCG/ML 12/31/9999 2<strong>01</strong>23005363791<strong>01</strong> CALCI-MIX CAP 1250MG 12/31/9999 2<strong>01</strong>2312939051760 CALCIO DEL TAB MAR 12/31/9999 2<strong>01</strong>23

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