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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0<strong>01</strong>73069604 ADVAIR DISKU AER 250/50 12/31/9999 2<strong>01</strong>230<strong>01</strong>73069700 ADVAIR DISKU AER 500/50 12/31/9999 2<strong>01</strong>230<strong>01</strong>73069704 ADVAIR DISKU AER 500/50 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071620 ADVAIR HFA AER 115/21 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071622 ADVAIR HFA AER 115/21 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071720 ADVAIR HFA AER 230/21 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071722 ADVAIR HFA AER 230/21 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071520 ADVAIR HFA AER 45/21 12/31/9999 2<strong>01</strong>230<strong>01</strong>73071522 ADVAIR HFA AER 45/21 12/31/9999 2<strong>01</strong>2313811006412 ADVANCED MIS AM/PM 12/31/9999 2<strong>01</strong>2362<strong>01</strong>1<strong>01</strong>22<strong>01</strong> ADVANCED SUS ANTACID 12/31/9999 2<strong>01</strong>2346122004972 ADVANCED EYE CAP HEALTH 12/31/9999 2<strong>01</strong>2300944292302 ADVATE INJ 1000UNIT 12/31/9999 2<strong>01</strong>2300944294310 ADVATE INJ 1000UNIT 12/31/9999 2<strong>01</strong>2300944292402 ADVATE INJ 1500UNIT 12/31/9999 2<strong>01</strong>2300944294410 ADVATE INJ 1500UNIT 12/31/9999 2<strong>01</strong>2300944294510 ADVATE INJ 2000UNIT 12/31/9999 2<strong>01</strong>2300944296410 ADVATE INJ 2000UNIT 12/31/9999 2<strong>01</strong>2300944292102 ADVATE INJ 250UNIT 12/31/9999 2<strong>01</strong>2300944294110 ADVATE INJ 250UNIT 12/31/9999 2<strong>01</strong>2300944294610 ADVATE INJ 3000UNIT 12/31/9999 2<strong>01</strong>2300944296510 ADVATE INJ 3000UNIT 12/31/9999 2<strong>01</strong>2300944294810 ADVATE INJ 4000UNIT 12/31/9999 2<strong>01</strong>2300944292202 ADVATE INJ 500UNIT 12/31/9999 2<strong>01</strong>2300944294210 ADVATE INJ 500UNIT 12/31/9999 2<strong>01</strong>2300074300790 ADVICOR TAB 1000-20 12/31/9999 2<strong>01</strong>23000743<strong>01</strong>090 ADVICOR TAB 1000-40 12/31/9999 2<strong>01</strong>2300074300590 ADVICOR TAB 500-20MG 12/31/9999 2<strong>01</strong>2300074307290 ADVICOR TAB 750-20MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6902 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6911 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6917 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6919 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6920 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6930 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6940 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6942 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6949 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6989 ADVIL CAP 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5020 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5030 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5032 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5040 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5043 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5048 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5110 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5112 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5113 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5140 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5417 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5435 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5475 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5489 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>5498 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6020 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6030 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6040 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6135 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6151 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>6520 ADVIL TAB 200MG 12/31/9999 2<strong>01</strong>23

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