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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44183060430 CARDEC DRO 12/31/9999 2<strong>01</strong>2344183055030 CARDEC DM DRO 12/31/9999 2<strong>01</strong>2324477003025 CARDENE I.V. INJ 2.5MG/ML 12/31/9999 2<strong>01</strong>2324477032302 CARDENE IV INJ 40/200ML 12/31/9999 2<strong>01</strong>2324477032402 CARDENE IV INJ 40/200ML 12/31/9999 2<strong>01</strong>2324477031102 CARDENE IV SOL 20/200ML 12/31/9999 2<strong>01</strong>2324477031202 CARDENE IV SOL 20/200ML 12/31/9999 2<strong>01</strong>23244770515<strong>01</strong> CARDENE SR CAP 30MG 07/31/2<strong>01</strong>4 2<strong>01</strong>23244770516<strong>01</strong> CARDENE SR CAP 60MG 10/31/2<strong>01</strong>4 2<strong>01</strong>2300338034104 CARDIOPLEGIC SOL 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079247 CARDIZEM TAB 120MG 12/31/9999 2<strong>01</strong>2364455079247 CARDIZEM TAB 120MG 05/31/2<strong>01</strong>4 2<strong>01</strong>2364455077147 CARDIZEM TAB 30MG 12/31/9999 2<strong>01</strong>2364455077155 CARDIZEM TAB 30MG 12/31/9999 2<strong>01</strong>2364455077247 CARDIZEM TAB 60MG 12/31/9999 2<strong>01</strong>2364455079147 CARDIZEM TAB 90MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079530 CARDIZEM CD CAP 120MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079542 CARDIZEM CD CAP 120MG/24 12/31/9999 2<strong>01</strong>2364455079530 CARDIZEM CD CAP 120MG/24 03/31/2<strong>01</strong>4 2<strong>01</strong>2364455079542 CARDIZEM CD CAP 120MG/24 03/30/2<strong>01</strong>4 2<strong>01</strong>2364455079549 CARDIZEM CD CAP 120MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079630 CARDIZEM CD CAP 180MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079642 CARDIZEM CD CAP 180MG/24 12/31/9999 2<strong>01</strong>2364455079630 CARDIZEM CD CAP 180MG/24 <strong>01</strong>/31/2<strong>01</strong>4 2<strong>01</strong>2364455079642 CARDIZEM CD CAP 180MG/24 12/31/9999 2<strong>01</strong>2364455079649 CARDIZEM CD CAP 180MG/24 12/31/9999 2<strong>01</strong>2364455079650 CARDIZEM CD CAP 180MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079730 CARDIZEM CD CAP 240MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079742 CARDIZEM CD CAP 240MG/24 12/31/9999 2<strong>01</strong>2364455079730 CARDIZEM CD CAP 240MG/24 05/31/2<strong>01</strong>4 2<strong>01</strong>2364455079742 CARDIZEM CD CAP 240MG/24 08/31/2<strong>01</strong>3 2<strong>01</strong>2364455079749 CARDIZEM CD CAP 240MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079830 CARDIZEM CD CAP 300MG/24 12/31/9999 2<strong>01</strong>230<strong>01</strong>87079842 CARDIZEM CD CAP 300MG/24 12/31/9999 2<strong>01</strong>2364455079830 CARDIZEM CD CAP 300MG/24 04/30/2<strong>01</strong>4 2<strong>01</strong>2364455079842 CARDIZEM CD CAP 300MG/24 04/30/2<strong>01</strong>4 2<strong>01</strong>230<strong>01</strong>87079942 CARDIZEM CD CAP 360MG/24 12/31/9999 2<strong>01</strong>2364455079942 CARDIZEM CD CAP 360MG/24 05/31/2<strong>01</strong>6 2<strong>01</strong>2300074304530 CARDIZEM LA TAB 120MG 12/31/9999 2<strong>01</strong>2300074304590 CARDIZEM LA TAB 120MG 12/31/9999 2<strong>01</strong>2300074306130 CARDIZEM LA TAB 180MG 12/31/9999 2<strong>01</strong>2300074306190 CARDIZEM LA TAB 180MG 12/31/9999 2<strong>01</strong>2300074306230 CARDIZEM LA TAB 240MG 12/31/9999 2<strong>01</strong>2300074306290 CARDIZEM LA TAB 240MG 12/31/9999 2<strong>01</strong>2300074306330 CARDIZEM LA TAB 300MG/24 12/31/9999 2<strong>01</strong>2300074306390 CARDIZEM LA TAB 300MG/24 12/31/9999 2<strong>01</strong>2300074306430 CARDIZEM LA TAB 360MG 12/31/9999 2<strong>01</strong>2300074306490 CARDIZEM LA TAB 360MG 12/31/9999 2<strong>01</strong>2300074306930 CARDIZEM LA TAB 420MG/24 12/31/9999 2<strong>01</strong>2300074306990 CARDIZEM LA TAB 420MG/24 12/31/9999 2<strong>01</strong>2300049275066 CARDURA TAB 1MG 12/31/9999 2<strong>01</strong>2300049276066 CARDURA TAB 2MG 12/31/9999 2<strong>01</strong>2300049277066 CARDURA TAB 4MG 12/31/9999 2<strong>01</strong>2300049278066 CARDURA TAB 8MG 12/31/9999 2<strong>01</strong>2300049271030 CARDURA XL TAB 4MG 12/31/9999 2<strong>01</strong>2300049272030 CARDURA XL TAB 8MG 12/31/9999 2<strong>01</strong>2344206041812 CARIMUNE NF INJ 12GM 12/31/9999 2<strong>01</strong>2344206041603 CARIMUNE NF INJ 3GM 12/31/9999 2<strong>01</strong>2344206041706 CARIMUNE NF INJ 6GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>850724<strong>01</strong> CARISOPR/ASA TAB 200-325 12/31/9999 2<strong>01</strong>23

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