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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00409733649 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>23007030346<strong>01</strong> CEFTRIAXONE INJ 2GM <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300703034603 CEFTRIAXONE INJ 2GM <strong>01</strong>/31/2<strong>01</strong>3 2<strong>01</strong>2300781320990 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2300781320995 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2300781932990 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2300781932995 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068804 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068827 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>0720 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2355390031210 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2360505067909 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2360505075300 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2360505075304 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2363323034720 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>23646790703<strong>01</strong> CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2364679070302 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>23681800644<strong>01</strong> CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>2368180064410 CEFTRIAXONE INJ 2GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43985825 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>23004097338<strong>01</strong> CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2300781320785 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2300781320795 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2300781932785 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2300781932795 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9068671 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>0510 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2355390031<strong>01</strong>0 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2360505075100 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2360505075104 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2363323034510 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>23646790702<strong>01</strong> CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2364679070202 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>23681800622<strong>01</strong> CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2368180062210 CEFTRIAXONE INJ 500MG 12/31/9999 2<strong>01</strong>2300338500241 CEFTRIAXONE/ INJ DEX 1GM 12/31/9999 2<strong>01</strong>2300338500341 CEFTRIAXONE/ INJ DEX 2GM 12/31/9999 2<strong>01</strong>2300264311411 CEFUROX/DEXT INJ 1.5GM 12/31/9999 2<strong>01</strong>2300264311211 CEFUROX/DEXT INJ 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43997722 CEFUROXIME INJ 1.5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43997790 CEFUROXIME INJ 1.5GM 12/31/9999 2<strong>01</strong>23004090802<strong>01</strong> CEFUROXIME INJ 1.5GM 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9062120 CEFUROXIME INJ 1.5GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>1920 CEFUROXIME INJ 1.5GM 12/31/9999 2<strong>01</strong>2363323035345 CEFUROXIME INJ 1.5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43997603 CEFUROXIME INJ 7.5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43997691 CEFUROXIME INJ 7.5GM 12/31/9999 2<strong>01</strong>23004090803<strong>01</strong> CEFUROXIME INJ 7.5GM 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>2059 CEFUROXIME INJ 7.5GM 12/31/9999 2<strong>01</strong>2363323035445 CEFUROXIME INJ 7.5GM 12/31/9999 2<strong>01</strong>230<strong>01</strong>43997922 CEFUROXIME INJ 750MG 12/31/9999 2<strong>01</strong>230<strong>01</strong>43997990 CEFUROXIME INJ 750MG 12/31/9999 2<strong>01</strong>2310<strong>01</strong>9062<strong>01</strong>0 CEFUROXIME INJ 750MG 12/31/9999 2<strong>01</strong>2325021<strong>01</strong>1810 CEFUROXIME INJ 750MG 12/31/9999 2<strong>01</strong>2363323035245 CEFUROXIME INJ 750MG 12/31/9999 2<strong>01</strong>2363304096304 CEFUROXIME SUS 125/5ML 12/31/9999 2<strong>01</strong>2363304096403 CEFUROXIME SUS 250/5ML 12/31/9999 2<strong>01</strong>2363304096404 CEFUROXIME SUS 250/5ML 12/31/9999 2<strong>01</strong>23167140232<strong>01</strong> CEFUROXIME TAB 250MG 12/31/2020 2<strong>01</strong>2316714023202 CEFUROXIME TAB 250MG 12/31/2020 2<strong>01</strong>23

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