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>73074100 CEFTIN SUS 250/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>73074110 CEFTIN SUS 250/5ML 12/31/9999 2<strong>01</strong>230<strong>01</strong>73038700 CEFTIN TAB 250MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>73039400 CEFTIN TAB 500MG 12/31/9999 2<strong>01</strong>2300264315311 CEFTRIAX/DEX INJ 1GM 12/31/9999 2<strong>01</strong>2300264315511 CEFTRIAX/DEX INJ 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>439768<strong>01</strong> CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2300409733410 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>23007030359<strong>01</strong> CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2300781321046 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2300781933046 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068905 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068911 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>0899 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>23553900316<strong>01</strong> CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2360505067905 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>2363323034861 CEFTRIAXONE INJ 10GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43985725 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>23004097332<strong>01</strong> CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2300409733304 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2300409733349 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>23007030335<strong>01</strong> CEFTRIAXONE INJ 1GM 04/30/2<strong>01</strong>3 2<strong>01</strong>2300703033504 CEFTRIAXONE INJ 1GM 04/30/2<strong>01</strong>3 2<strong>01</strong>2300781320885 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2300781320895 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2300781932885 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2300781932895 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>90098<strong>01</strong> CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9009871 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068771 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>0610 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2355390031110 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2360505067908 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2360505075200 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2360505075204 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2363323034610 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>23646790983<strong>01</strong> CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2364679098302 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>23681800633<strong>01</strong> CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>2368180063310 CEFTRIAXONE INJ 1GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43985925 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>23004097337<strong>01</strong> CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>23007030315<strong>01</strong> CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2300703031503 CEFTRIAXONE INJ 250MG <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300781320685 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2300781320695 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2300781932685 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2300781932695 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068571 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2355390030910 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2360505075000 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2360505075004 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2363323034410 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>236467907<strong>01</strong><strong>01</strong> CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>236467907<strong>01</strong>02 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>23681800611<strong>01</strong> CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>2368180061110 CEFTRIAXONE INJ 250MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43985625 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2300409733503 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2300409733604 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>23

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