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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00310782030 CAPRELSA TAB 100MG 12/31/9999 2<strong>01</strong>2300310784030 CAPRELSA TAB 300MG 12/31/9999 2<strong>01</strong>2362107000302 CAPREX CRE 0.025% 12/31/9999 2<strong>01</strong>2362107000402 CAPREX + CRE 0.075% 12/31/9999 2<strong>01</strong>2300472<strong>01</strong>0242 CAPSAICIN CRE 0.025% 12/31/9999 2<strong>01</strong>2300536252525 CAPSAICIN CRE 0.025% 12/31/9999 2<strong>01</strong>2338779083703 CAPSAICIN POW 95% 12/31/9999 2<strong>01</strong>2338779083706 CAPSAICIN POW 95% 12/31/9999 2<strong>01</strong>23515520708<strong>01</strong> CAPSICUM LIQ OLEORESI 12/31/9999 2<strong>01</strong>2351552070804 CAPSICUM LIQ OLEORESI 12/31/9999 2<strong>01</strong>2351552070805 CAPSICUM LIQ OLEORESI 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>76<strong>01</strong> CAPTOPR/HCTZ TAB 25-15MG 12/31/9999 2<strong>01</strong>23003780081<strong>01</strong> CAPTOPR/HCTZ TAB 25-15MG 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>77<strong>01</strong> CAPTOPR/HCTZ TAB 25-25MG 12/31/9999 2<strong>01</strong>23003780083<strong>01</strong> CAPTOPR/HCTZ TAB 25-25MG 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>81<strong>01</strong> CAPTOPR/HCTZ TAB 50-15MG 12/31/9999 2<strong>01</strong>23003780084<strong>01</strong> CAPTOPR/HCTZ TAB 50-15MG 12/31/9999 2<strong>01</strong>2300093<strong>01</strong>82<strong>01</strong> CAPTOPR/HCTZ TAB 50-25MG 12/31/9999 2<strong>01</strong>23003780086<strong>01</strong> CAPTOPR/HCTZ TAB 50-25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431174<strong>01</strong> CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>23003783022<strong>01</strong> CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>23007811839<strong>01</strong> CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>2360505000606 CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>2360505000609 CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>23646790905<strong>01</strong> CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>2368645<strong>01</strong>6359 CAPTOPRIL TAB 100MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431171<strong>01</strong> CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43117110 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>23003783007<strong>01</strong> CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2300378300710 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>23007811828<strong>01</strong> CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2300904504561 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>23510790863<strong>01</strong> CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2351079086320 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2360505000306 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2360505000309 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>23646790902<strong>01</strong> CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2364679090202 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>2368645<strong>01</strong>6059 CAPTOPRIL TAB 12.5MG 12/31/9999 2<strong>01</strong>23000938133<strong>01</strong> CAPTOPRIL TAB 25MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>431172<strong>01</strong> CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43117210 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>23003783<strong>01</strong>2<strong>01</strong> CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>23003783<strong>01</strong>210 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>2300904504661 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>23510790864<strong>01</strong> CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>2351079086420 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>2360505000406 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>2360505000409 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>23646790903<strong>01</strong> CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>2364679090302 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>2368645<strong>01</strong>6159 CAPTOPRIL TAB 25MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>431173<strong>01</strong> CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43117310 CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>23003783<strong>01</strong>7<strong>01</strong> CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>23003783<strong>01</strong>710 CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>2300904504761 CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>2360505000506 CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>2360505000509 CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>23646790904<strong>01</strong> CAPTOPRIL TAB 50MG 12/31/9999 2<strong>01</strong>23

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