Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...
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Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

Rebatable Drug List for Iowa Medicaid Effective Date December 01 ...

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51552056909 CHICKEN LIQ FLAVOR 12/31/9999 2<strong>01</strong>2300573<strong>01</strong>9120 CHILD ADVIL DRO 50/1.25 12/31/9999 2<strong>01</strong>2337205046768 CHILD ASA CHW 81MG 12/31/9999 2<strong>01</strong>2337205070868 CHILD ASA CHW 81MG 12/31/9999 2<strong>01</strong>2362107002636 CHILD ASA LS CHW 81MG 12/31/9999 2<strong>01</strong>23621070048<strong>01</strong> CHILD CHEW CHW IRON 12/31/9999 2<strong>01</strong>2362107004810 CHILD CHEW CHW IRON 12/31/9999 2<strong>01</strong>23621070047<strong>01</strong> CHILD CHEW CHW VITAMINS 12/31/9999 2<strong>01</strong>2362107004710 CHILD CHEW CHW VITAMINS 12/31/9999 2<strong>01</strong>23461220<strong>01</strong>926 CHILD PAIN LIQ RELIEVER 12/31/9999 2<strong>01</strong>2300536193672 CHILD PN/FEV DRO 80/0.8ML 09/30/2<strong>01</strong>4 2<strong>01</strong>2354838<strong>01</strong>0440 CHILD SILFED LIQ 15MG/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>0470 CHILD SILFED LIQ 15MG/5ML 12/31/9999 2<strong>01</strong>2337000049024 CHILDRENS CHW PEPTO 12/31/9999 2<strong>01</strong>2324385037926 CHLD ALLERGY LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2336800037926 CHLD ALLERGY LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2336800037934 CHLD ALLERGY LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2363868082354 CHLD ALLERGY LIQ 12.5/5ML 12/31/9999 2<strong>01</strong>2300904546335 CHLD IBUPRFN DRO 40MG/ML 12/31/9999 2<strong>01</strong>2324385054934 CHLD IBUPROF SUS 100/5ML 12/31/9999 2<strong>01</strong>2337205051665 CHLD PAIN RL TAB 80MG 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>4440 CHLD SILAPAP LIQ 160/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>4470 CHLD SILAPAP LIQ 160/5ML 12/31/9999 2<strong>01</strong>2354838<strong>01</strong>4480 CHLD SILAPAP LIQ 160/5ML 12/31/9999 2<strong>01</strong>2300904575146 CHLDS MAPAP TAB 80MG RT 12/31/9999 2<strong>01</strong>2312830076<strong>01</strong>6 CHLO TUSS LIQ 12/31/9999 2<strong>01</strong>2312830076716 CHLO TUSS EX LIQ 12.5-100 12/31/9999 2<strong>01</strong>2344183051<strong>01</strong>6 CHLOR/PSE/DM SUS <strong>01</strong>/<strong>01</strong>/2<strong>01</strong>3 2<strong>01</strong>230<strong>01</strong>21053205 CHLORAL HYDR SYP 500/5ML 11/30/2<strong>01</strong>4 2<strong>01</strong>230<strong>01</strong>21053216 CHLORAL HYDR SYP 500/5ML 12/31/2<strong>01</strong>3 2<strong>01</strong>23633230<strong>01</strong>115 CHLORAMPHEN INJ 1GM 12/31/9999 2<strong>01</strong>2338779020402 CHLORAMPHENI POW PALMITAT 12/31/9999 2<strong>01</strong>2338779020403 CHLORAMPHENI POW PALMITAT 12/31/9999 2<strong>01</strong>2338779020404 CHLORAMPHENI POW PALMITAT 12/31/9999 2<strong>01</strong>2338779020405 CHLORAMPHENI POW PALMITAT 12/31/9999 2<strong>01</strong>2338779020409 CHLORAMPHENI POW PALMITAT 12/31/9999 2<strong>01</strong>23519910622<strong>01</strong> CHLORD/CLIDI CAP 5-2.5MG 12/31/9999 2<strong>01</strong>2364125<strong>01</strong>32<strong>01</strong> CHLORD/CLIDI CAP 5-2.5MG 12/31/9999 2<strong>01</strong>2364125<strong>01</strong>3210 CHLORD/CLIDI CAP 5-2.5MG 12/31/9999 2<strong>01</strong>2368682040910 CHLORD/CLIDI CAP 5-2.5MG 12/31/9999 2<strong>01</strong>2376439030210 CHLORD/CLIDI CAP 5-2.5MG 12/31/9999 2<strong>01</strong>2300555003302 CHLORDIAZEP CAP 10MG 12/31/9999 2<strong>01</strong>2300555003305 CHLORDIAZEP CAP 10MG 12/31/9999 2<strong>01</strong>2343547025210 CHLORDIAZEP CAP 10MG 12/31/9999 2<strong>01</strong>23510790375<strong>01</strong> CHLORDIAZEP CAP 10MG 12/31/9999 2<strong>01</strong>2351079037520 CHLORDIAZEP CAP 10MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>5902 CHLORDIAZEP CAP 25MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>5904 CHLORDIAZEP CAP 25MG 12/31/9999 2<strong>01</strong>2343547025310 CHLORDIAZEP CAP 25MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>41<strong>01</strong> CHLORDIAZEP CAP 25MG 12/31/9999 2<strong>01</strong>2351079<strong>01</strong>4120 CHLORDIAZEP CAP 25MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>5802 CHLORDIAZEP CAP 5MG 12/31/9999 2<strong>01</strong>2300555<strong>01</strong>5804 CHLORDIAZEP CAP 5MG 12/31/9999 2<strong>01</strong>2343547025110 CHLORDIAZEP CAP 5MG 12/31/9999 2<strong>01</strong>23510790374<strong>01</strong> CHLORDIAZEP CAP 5MG 12/31/9999 2<strong>01</strong>2351079037420 CHLORDIAZEP CAP 5MG 12/31/9999 2<strong>01</strong>2351552097605 CHLORELLA POW 12/31/9999 2<strong>01</strong>2351552097607 CHLORELLA POW 12/31/9999 2<strong>01</strong>230<strong>01</strong>1620<strong>01</strong>16 CHLORHEX GLU SOL 0.12% 12/31/9999 2<strong>01</strong>2350383072<strong>01</strong>6 CHLORHEX GLU SOL 0.12% 12/31/9999 2<strong>01</strong>23

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