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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00517271025 CALCIUM CL INJ 10% 12/31/9999 2<strong>01</strong>2300548330400 CALCIUM CL INJ 10% 12/31/9999 2<strong>01</strong>2399207024<strong>01</strong>0 CALCIUM DISO INJ 500/2.5M 12/31/9999 2<strong>01</strong>2300517390025 CALCIUM GLUC INJ 10% 12/31/9999 2<strong>01</strong>2300517395025 CALCIUM GLUC INJ 10% 12/31/9999 2<strong>01</strong>2363323031110 CALCIUM GLUC INJ 10% 12/31/9999 2<strong>01</strong>2363323031150 CALCIUM GLUC INJ 10% 12/31/9999 2<strong>01</strong>2363323031161 CALCIUM GLUC INJ 10% 12/31/9999 2<strong>01</strong>2351552051506 CALCIUM GLUC POW 12/31/9999 2<strong>01</strong>2351552051509 CALCIUM GLUC POW 12/31/9999 2<strong>01</strong>2351552100606 CALCIUM GLUC POW MONOHYDR 12/31/9999 2<strong>01</strong>2300054026220 CALCIUM GLUC TAB 500MG 12/31/9999 2<strong>01</strong>2300054026225 CALCIUM GLUC TAB 500MG 12/31/9999 2<strong>01</strong>2300536341610 CALCIUM GLUC TAB 650MG 12/31/9999 2<strong>01</strong>2316103036807 CALCIUM HIGH TAB POTENCY 12/31/9999 2<strong>01</strong>2351552008106 CALCIUM LACT POW MONOHYDR 12/31/9999 2<strong>01</strong>23005363422<strong>01</strong> CALCIUM LACT TAB 648MG 12/31/9999 2<strong>01</strong>2300536342210 CALCIUM LACT TAB 648MG 12/31/9999 2<strong>01</strong>2351552047406 CALCIUM PHOS POW DIBASIC 12/31/9999 2<strong>01</strong>2351552059406 CALCIUM PHOS POW TRIBASIC 12/31/9999 2<strong>01</strong>2342192070660 CALCIUM-FA WAF PLUS D 12/31/9999 2<strong>01</strong>2366220024704 CALDOLOR INJ 400/4ML 12/31/9999 2<strong>01</strong>2366220028708 CALDOLOR INJ 800/8ML 12/31/9999 2<strong>01</strong>2324385007282 CALDYPHEN LOT 1-8% 12/31/9999 2<strong>01</strong>2337205<strong>01</strong>3030 CALDYPHEN LOT 1-8% 12/31/9999 2<strong>01</strong>2324385043930 CALDYPHEN LOT CLEAR 12/31/9999 2<strong>01</strong>2337205028130 CALDYPHEN LOT CLEAR 12/31/9999 2<strong>01</strong>2300536474297 CAL-GEST CHW 500MG 12/31/9999 2<strong>01</strong>2300904776021 CALLERGY LOT CLEAR 12/31/9999 2<strong>01</strong>2359528033102 CALPHRON TAB 667MG 12/31/9999 2<strong>01</strong>235<strong>01</strong>92<strong>01</strong>1309 CAMBIA POW 50MG 12/31/9999 2<strong>01</strong>2300555071558 CAMILA TAB 0.35MG 12/31/9999 2<strong>01</strong>2358468035703 CAMPATH INJ 30MG/ML 12/31/9999 2<strong>01</strong>2300904785175 CAMPHOR/PHEN LIQ 12/31/9999 2<strong>01</strong>23004563330<strong>01</strong> CAMPRAL TAB 333MG 12/31/9999 2<strong>01</strong>2300456333060 CAMPRAL TAB 333MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300456333063 CAMPRAL TAB 333MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300009111102 CAMPTOSAR INJ 100/5ML 12/31/9999 2<strong>01</strong>23000097529<strong>01</strong> CAMPTOSAR INJ 100/5ML 09/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2300009752903 CAMPTOSAR INJ 100/5ML 12/31/9999 2<strong>01</strong>2300009752905 CAMPTOSAR INJ 300/15ML 12/31/9999 2<strong>01</strong>23000091111<strong>01</strong> CAMPTOSAR INJ 40MG/2ML 12/31/9999 2<strong>01</strong>2300009752902 CAMPTOSAR INJ 40MG/2ML 06/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>2300009752904 CAMPTOSAR INJ 40MG/2ML 12/31/9999 2<strong>01</strong>2300093313482 CAMRESE TAB 12/31/9999 2<strong>01</strong>2300093313491 CAMRESE TAB 12/31/9999 2<strong>01</strong>2300093614882 CAMRESE LO TAB 12/31/9999 2<strong>01</strong>235891405<strong>01</strong>18 CANASA SUP 1000MG 12/31/9999 2<strong>01</strong>235891405<strong>01</strong>42 CANASA SUP 1000MG 12/31/9999 2<strong>01</strong>235891405<strong>01</strong>56 CANASA SUP 1000MG 12/31/9999 2<strong>01</strong>2300006382210 CANCIDAS INJ 50MG 12/31/9999 2<strong>01</strong>2300006382310 CANCIDAS INJ 70MG 12/31/9999 2<strong>01</strong>23000680037<strong>01</strong> CANTIL TAB 25MG 12/31/9999 2<strong>01</strong>23584070534<strong>01</strong> CAPACET CAP 12/31/9999 2<strong>01</strong>2317478008050 CAPASTAT SUL INJ 1GM 12/31/9999 2<strong>01</strong>2329978042<strong>01</strong>6 CAPCOF SYP 12/31/9999 2<strong>01</strong>2300299550004 CAPEX SHA 0.<strong>01</strong>% 12/31/9999 2<strong>01</strong>230<strong>01</strong>870003<strong>01</strong> CAPITAL/COD SUS 120-12/5 12/31/9999 2<strong>01</strong>2329978060630 CAPMIST DM TAB 12/31/9999 2<strong>01</strong>2329978060690 CAPMIST DM TAB 12/31/9999 2<strong>01</strong>23

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