[xls]dhs.iowa.govdhs.iowa.gov/sites/default/files/rebatabledruglist.xls · web viewsheet2...

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Rebatable Drug List for Iowa Medicaid Initial List March 1, 2007 Please use control F as a search function for the drug names, NDC number or labeler This list will be updated quarterly 1 of 1592 Drug NDC Labeler METROGEL VAG GEL 0.75% 00089020025 3M PHARMACEUTICALS MINITRAN DIS 0.1MG/HR 00089030102 3M PHARMACEUTICALS MINITRAN DIS 0.2MG/HR 00089030202 3M PHARMACEUTICALS MINITRAN DIS 0.4MG/HR 00089030302 3M PHARMACEUTICALS MINITRAN DIS 0.6MG/HR 00089030402 3M PHARMACEUTICALS TAMBOCOR TAB 50MG 00089030510 3M PHARMACEUTICALS TAMBOCOR TAB 100MG 00089030710 3M PHARMACEUTICALS TAMBOCOR TAB 150MG 00089031410 3M PHARMACEUTICALS CALCIUM DISO INJ 200MG/ML 00089051006 3M PHARMACEUTICALS NORFLEX INJ 30MG/ML 00089054006 3M PHARMACEUTICALS ALDARA CRE 5% 00089061012 3M PHARMACEUTICALS MAXAIR AUTOH AER 200MCG 00089081521 3M PHARMACEUTICALS NITROGLYCER DIS 0.1MG/HR 00089130130 3M PHARMACEUTICALS NITROGLYCER DIS 0.1MG/HR 00089130140 3M PHARMACEUTICALS NITROGLYCER DIS 0.2MG/HR 00089130230 3M PHARMACEUTICALS NITROGLYCER DIS 0.2MG/HR 00089130240 3M PHARMACEUTICALS NITROGLYCER DIS 0.4MG/HR 00089130330 3M PHARMACEUTICALS NITROGLYCER DIS 0.4MG/HR 00089130340 3M PHARMACEUTICALS NITROGLYCER DIS 0.6MG/HR 00089130430 3M PHARMACEUTICALS NITROGLYCER DIS 0.6MG/HR 00089130440 3M PHARMACEUTICALS DURABLE BARR CRE 17518002601 3M PHARMACEUTICALS TITRALAC CHW PLUS 55298001310 3M PHARMACEUTICALS TITRALAC CHW EX STR 55298003710 3M PHARMACEUTICALS TITRALAC CHW 420MG 55298003810 3M PHARMACEUTICALS DIMETANE EXT TAB 12MG CR 00031184346 A. H. ROBINS DIMETAPP ELX 2-12.5/5 00031223012 A. H. ROBINS DIMETAPP ELX 2-12.5/5 00031223018 A. H. ROBINS DIMETAPP ELX 2-12.5/5 00031223022 A. H. ROBINS DIMETAPP ELX 2-12.5/5 00031223025 A. H. ROBINS DIMETAPP ELX CLD/ALLE 00031223033 A. H. ROBINS DIMETAPP ELX 1-15/5ML 00031223110 A. H. ROBINS DIMETAPP ELX 1-15/5ML 00031223120 A. H. ROBINS DIMETAPP ELX 1-15/5ML 00031223130 A. H. ROBINS

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Page 1: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

1 of 774

Drug NDC Labeler Eligible for Rebate

METROGEL VAG GEL 0.75% 00089020025 3M PHARMACEUTICALS yMINITRAN DIS 0.1MG/HR 00089030102 3M PHARMACEUTICALS yMINITRAN DIS 0.2MG/HR 00089030202 3M PHARMACEUTICALS yMINITRAN DIS 0.4MG/HR 00089030302 3M PHARMACEUTICALS yMINITRAN DIS 0.6MG/HR 00089030402 3M PHARMACEUTICALS yTAMBOCOR TAB 50MG 00089030510 3M PHARMACEUTICALS yTAMBOCOR TAB 100MG 00089030710 3M PHARMACEUTICALS yTAMBOCOR TAB 150MG 00089031410 3M PHARMACEUTICALS yCALCIUM DISO INJ 200MG/ML 00089051006 3M PHARMACEUTICALS yNORFLEX INJ 30MG/ML 00089054006 3M PHARMACEUTICALS yALDARA CRE 5% 00089061012 3M PHARMACEUTICALS yMAXAIR AUTOH AER 200MCG 00089081521 3M PHARMACEUTICALS yNITROGLYCER DIS 0.1MG/HR 00089130130 3M PHARMACEUTICALS yNITROGLYCER DIS 0.1MG/HR 00089130140 3M PHARMACEUTICALS yNITROGLYCER DIS 0.2MG/HR 00089130230 3M PHARMACEUTICALS yNITROGLYCER DIS 0.2MG/HR 00089130240 3M PHARMACEUTICALS yNITROGLYCER DIS 0.4MG/HR 00089130330 3M PHARMACEUTICALS yNITROGLYCER DIS 0.4MG/HR 00089130340 3M PHARMACEUTICALS yNITROGLYCER DIS 0.6MG/HR 00089130430 3M PHARMACEUTICALS yNITROGLYCER DIS 0.6MG/HR 00089130440 3M PHARMACEUTICALS yDURABLE BARR CRE 17518002601 3M PHARMACEUTICALS yTITRALAC CHW PLUS 55298001310 3M PHARMACEUTICALS yTITRALAC CHW EX STR 55298003710 3M PHARMACEUTICALS yTITRALAC CHW 420MG 55298003810 3M PHARMACEUTICALS yDIMETANE EXT TAB 12MG CR 00031184346 A. H. ROBINS yDIMETAPP ELX 2-12.5/5 00031223012 A. H. ROBINS yDIMETAPP ELX 2-12.5/5 00031223018 A. H. ROBINS yDIMETAPP ELX 2-12.5/5 00031223022 A. H. ROBINS yDIMETAPP ELX 2-12.5/5 00031223025 A. H. ROBINS yDIMETAPP ELX CLD/ALLE 00031223033 A. H. ROBINS yDIMETAPP ELX 1-15/5ML 00031223110 A. H. ROBINS yDIMETAPP ELX 1-15/5ML 00031223120 A. H. ROBINS yDIMETAPP ELX 1-15/5ML 00031223130 A. H. ROBINS yDIMETAPP ALL ELX 2MG/5ML 00031223212 A. H. ROBINS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

2 of 774

DIMETAPP DM ELX COLD/CGH 00031223412 A. H. ROBINS yDIMETAPP DM ELX COLD/CGH 00031223418 A. H. ROBINS yDIMETAPP CLD ELX /ALLERGY 00031223512 A. H. ROBINS yDIMETAPP CLD ELX /ALLERGY 00031223518 A. H. ROBINS yDIMETAPP CLD ELX /ALLERGY 00031223524 A. H. ROBINS yDIMETAPP DRO DECONGES 00031223612 A. H. ROBINS yDIMETAPP FLU SUS NIGHTTME 00031223712 A. H. ROBINS yDIMETAPP SYP CGH/COLD 00031223812 A. H. ROBINS yDIMETAPP DM ELX 00031224012 A. H. ROBINS yDIMETAPP DM ELX 00031224018 A. H. ROBINS yDIMETAPP DM ELX CLD/COUG 00031224021 A. H. ROBINS yDIMETAPP DM ELX 00031224022 A. H. ROBINS yDIMETAPP DM ELX CLD/COUG 00031224023 A. H. ROBINS yDIMETAPP SOL DCON/CGH 00031224201 A. H. ROBINS yDIMETAPP DRO DCON/CGH 00031224312 A. H. ROBINS yDIMETAPP DEC CAP 30 MG 00031224546 A. H. ROBINS yDIMETAPP DEC CAP 30 MG 00031224554 A. H. ROBINS yDIMETAPP ALL TAB 4MG 00031224854 A. H. ROBINS yDIMETAPP CAP ALLERGY 00031225054 A. H. ROBINS yDIMETAPP TAB 00031225454 A. H. ROBINS yDIMETAPP CAP ALLERGY 00031225546 A. H. ROBINS yDIMETAPP CAP ALLERGY 00031225554 A. H. ROBINS yDIMETAPP CLD TAB CONGESTI 00031225620 A. H. ROBINS yDIMETAPP TAB SINUS 00031226052 A. H. ROBINS yDIMETAPP TAB EXTENTAB 00031227746 A. H. ROBINS yDIMETAPP TAB EXTENTAB 00031227754 A. H. ROBINS yDIMETAPP TAB EXTENTAB 00031227759 A. H. ROBINS yDIMETAPP TAB EXTENTAB 00031227763 A. H. ROBINS yDIMETAPP TAB EXTENTAB 00031227764 A. H. ROBINS yDIMETAPP TAB EXTENTAB 00031227770 A. H. ROBINS yDIMETAPP CAP COLD/CGH 00031227946 A. H. ROBINS yDIMETAPP CAP COLD/CGH 00031227954 A. H. ROBINS yDIMETAPP SUS COLD/FVR 00031228112 A. H. ROBINS yDIMETAPP DRO 7.5/0.8 00031228378 A. H. ROBINS yDIMETAPP TAB ALL/SIN 00031228446 A. H. ROBINS yDIMETAPP TAB ALL/SIN 00031228454 A. H. ROBINS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

3 of 774

DIMETAPP CLD TAB /ALLERGY 00031228643 A. H. ROBINS yDIMETAPP ND TAB 10MG 00031228806 A. H. ROBINS yDIMETAPP ND TAB 10MG 00031228810 A. H. ROBINS yDIMETAPP SYP CGH/COLD 00031228910 A. H. ROBINS yDIMETAPP CHW 1-6.25MG 00031229054 A. H. ROBINS yDIMETAPP CLD CHW /ALLERGY 00031229320 A. H. ROBINS yDIMETAPP SUS COLD/FVR 00031229410 A. H. ROBINS yDOPRAM INJ 20MG/ML 00031484983 A. H. ROBINS yREGLAN TAB 10MG 00031670163 A. H. ROBINS yREGLAN TAB 10MG 00031670170 A. H. ROBINS yREGLAN TAB 5MG 00031670563 A. H. ROBINS yREGLAN INJ 10MG/2ML 00031670924 A. H. ROBINS yREGLAN INJ 10MG/2ML 00031670972 A. H. ROBINS yREGLAN INJ 10MG/2ML 00031670978 A. H. ROBINS yREGLAN INJ 10MG/2ML 00031670995 A. H. ROBINS yROBAXIN INJ 100MG/ML 00031740994 A. H. ROBINS yROBAXIN TAB 500MG 00031742963 A. H. ROBINS yROBAXIN-750 TAB 750MG 00031744963 A. H. ROBINS yROBAXIN-750 TAB 750MG 00031744970 A. H. ROBINS yROBINUL INJ 0.2MG/ML 00031789006 A. H. ROBINS yROBINUL INJ 0.2MG/ML 00031789011 A. H. ROBINS yROBINUL INJ 0.2MG/ML 00031789083 A. H. ROBINS yROBINUL INJ 0.2MG/ML 00031789095 A. H. ROBINS yROBITUSSIN CAP COLD/CGH 00031860046 A. H. ROBINS yROBITUSSIN CAP CLD/CGH 00031860052 A. H. ROBINS yROBITUSSIN CAP SEV CONG 00031860146 A. H. ROBINS yROBITUSSIN CAP SEV CONG 00031860152 A. H. ROBINS yROBITUSSIN CAP COLD/FLU 00031860246 A. H. ROBINS yROBITUSSIN CAP COLD/FLU 00031860252 A. H. ROBINS yROBITUSSIN CAP NIGHT-TM 00031860346 A. H. ROBINS yROBITUSSIN CAP NIGHT-TM 00031860352 A. H. ROBINS yROBITUSSIN LIQ PED NGHT 00031860812 A. H. ROBINS yROBITUSS PED LIQ CGH/COLD 00031860912 A. H. ROBINS yROBITUSS PED LIQ CGH/COLD 00031860918 A. H. ROBINS yROBITUSS PED SYP 7.5/5ML 00031861012 A. H. ROBINS yROBITUSSIN SYP FLU 00031861210 A. H. ROBINS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

4 of 774

ROBITUSSIN LIQ CGH/CLD 00031861612 A. H. ROBINS yROBITUSSIN LOZ SF CHERR 00031861851 A. H. ROBINS yROBITUSSIN LOZ SF PEPMT 00031861951 A. H. ROBINS yROBITUSSIN LOZ COUGH 00031862144 A. H. ROBINS yROBITUSSIN LOZ COUGH 00031862152 A. H. ROBINS yROBITUSSIN LOZ COUGH 00031862155 A. H. ROBINS yROBITUSSIN LOZ MEN EUCA 00031862244 A. H. ROBINS yROBITUSSIN LOZ MEN EUCA 00031862252 A. H. ROBINS yROBITUSSIN LOZ MEN EUCA 00031862255 A. H. ROBINS yROBITUSSIN LOZ CHERRY 00031862344 A. H. ROBINS yROBITUSSIN LOZ CHERRY 00031862352 A. H. ROBINS yROBITUSSIN LOZ CHERRY 00031862357 A. H. ROBINS yROBITUSSIN SYP CHST CNG 00031862412 A. H. ROBINS yROBITUSSIN SYP CHST CNG 00031862418 A. H. ROBINS yROBITUSSIN SYP CHST CNG 00031862425 A. H. ROBINS yROBITUSSIN LOZ HONY-LEM 00031862552 A. H. ROBINS yROBITUSSIN LOZ MENTHOL 00031862652 A. H. ROBINS yROBITUSSIN LOZ CHERRY 00031862752 A. H. ROBINS yROBITUSSIN SYP NGHT REL 00031863915 A. H. ROBINS yROBITUSSIN LIQ PM 00031864020 A. H. ROBINS yROBITUSSIN SYP 10MG/5ML 00031865201 A. H. ROBINS yROBITUSS PED LIQ CGH/COLD 00031866012 A. H. ROBINS yROBITUSSIN LIQ CGH/CONG 00031866212 A. H. ROBINS yROBITUSSIN LIQ HD/CHST 00031866512 A. H. ROBINS yROBITUSSIN SYP MAX-ST 00031867012 A. H. ROBINS yROBITUSSIN SYP MAX-ST 00031867018 A. H. ROBINS yROBITUSSIN SYP MAX/CGH 00031867112 A. H. ROBINS yROBITUSSIN SYP MAX/CGH 00031867118 A. H. ROBINS yROBITUSSIN SYP ALRG/CGH 00031867501 A. H. ROBINS yROBITUSSIN SYP CF 00031867712 A. H. ROBINS yROBITUSSIN SYP CF 00031867718 A. H. ROBINS yROBITUSSIN SYP CF 00031867722 A. H. ROBINS yROBITUSSIN LIQ CGH/CLD 00031867726 A. H. ROBINS yROBITUSSIN LIQ CF 00031867810 A. H. ROBINS yROBITUSSIN LIQ CF 00031867820 A. H. ROBINS yROBITUSSIN LIQ CF 00031867830 A. H. ROBINS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

5 of 774

ROBITUSSIN DRO PEDIATRC 00031867901 A. H. ROBINS yROBITUSSN DM DRO INFANT 00031868101 A. H. ROBINS yROBITUSSIN SYP DM 00031868512 A. H. ROBINS yROBITUSSIN SYP DM 00031868518 A. H. ROBINS yROBITUSSIN SYP DM 00031868522 A. H. ROBINS yROBITUSSIN SYP DM 00031868525 A. H. ROBINS yROBITUSSIN SYP DM 00031868612 A. H. ROBINS yCOUGH CALMER LOZ 00031869049 A. H. ROBINS yROBITUSSIN SYP PE 00031869512 A. H. ROBINS yROBITUSSIN SYP PE 00031869518 A. H. ROBINS yM.V.I. ADULT INJ 66591018432 AAI PHARMA yM.V.I. ADULT INJ 66591018442 AAI PHARMA yM.V.I. ADULT INJ 66591018452 AAI PHARMA yAZATHIOPRINE TAB 50MG 66591022141 AAI PHARMA yDARVON CAP CPD 65 66591061241 AAI PHARMA yDARVON CAP 65MG 66591062241 AAI PHARMA yDARVON-N TAB 100MG 66591063141 AAI PHARMA yDARVOCET-N TAB 100 66591064141 AAI PHARMA yDARVOCET-N TAB 100 66591064151 AAI PHARMA yDARVON COMPO CAP 32MG 66591066241 AAI PHARMA yDARVOCET TAB A500 66591069141 AAI PHARMA yMETHADONE INJ 10MG/ML 66591081551 AAI PHARMA yM.V.I PEDIAT INJ 66591083931 AAI PHARMA yORAMORPH SR TAB 15MG 66591084141 AAI PHARMA yORAMORPH SR TAB 15MG 66591084142 AAI PHARMA yORAMORPH SR TAB 30MG 66591085141 AAI PHARMA yORAMORPH SR TAB 30MG 66591085142 AAI PHARMA yORAMORPH SR TAB 100MG 66591087141 AAI PHARMA yROXICODONE SOL 5MG/5ML 66591091332 AAI PHARMA yROXICODONE SOL 5MG/5ML 66591091391 AAI PHARMA yROXICODONE CON 20MG/ML 66591092361 AAI PHARMA yROXICODONE TAB 5MG 66591093141 AAI PHARMA yROXICODONE TAB 5MG 66591093142 AAI PHARMA yROXICODONE TAB 15MG 66591094141 AAI PHARMA yROXICODONE TAB 30MG 66591095141 AAI PHARMA yDURACLON INJ 66591096541 AAI PHARMA y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

6 of 774

DURACLON INJ 66591097541 AAI PHARMA yPEDIAFLOR DRO 0.5MG/ML 00074010150 ABBOTT LABORATORIES yCARBOCAINE INJ 1% 00074103630 ABBOTT LABORATORIES yCARBOCAINE INJ 1% 00074103850 ABBOTT LABORATORIES yCARBOCAINE INJ 1.5% 00074104130 ABBOTT LABORATORIES yCARBOCAINE INJ 2% 00074106720 ABBOTT LABORATORIES yBUPIVACAINE INJ 0.25% 00074115902 ABBOTT LABORATORIES yBUPIVACAINE INJ 0.5% 00074116201 ABBOTT LABORATORIES yBUPIVACAINE INJ 0.5% 00074116202 ABBOTT LABORATORIES yDILTIAZEM INJ 5MG/ML 00074117101 ABBOTT LABORATORIES yDEMEROL INJ 25MG/ML 00074117630 ABBOTT LABORATORIES yDEMEROL INJ 50MG/ML 00074117830 ABBOTT LABORATORIES yDEMEROL INJ 75MG/ML 00074117930 ABBOTT LABORATORIES yDEMEROL INJ 100MG/ML 00074118069 ABBOTT LABORATORIES yDEMEROL INJ 50MG/ML 00074118130 ABBOTT LABORATORIES yCALCIJEX INJ 1MCG/ML 00074120001 ABBOTT LABORATORIES yDEMEROL INJ 100MG/ML 00074120120 ABBOTT LABORATORIES yDEXTROSE INJ 10% 00074120203 ABBOTT LABORATORIES yDEMEROL INJ 50MG/ML 00074120301 ABBOTT LABORATORIES yGENTAMICIN INJ 40MG/ML 00074120703 ABBOTT LABORATORIES yCALCIJEX INJ 2MCG/ML 00074121001 ABBOTT LABORATORIES yDEMEROL INJ 50MG/ML 00074125301 ABBOTT LABORATORIES yDEMEROL INJ 75MG/1.5 00074125401 ABBOTT LABORATORIES yDEMEROL INJ 100/2ML 00074125502 ABBOTT LABORATORIES yDEMEROL INJ 100MG/ML 00074125601 ABBOTT LABORATORIES yMORPHINE SUL INJ 10MG/ML 00074126130 ABBOTT LABORATORIES yHYDROMORPHON INJ 1MG/ML 00074128331 ABBOTT LABORATORIES yHYDROMORPHON INJ 2MG/ML 00074131230 ABBOTT LABORATORIES yLIDOCAINE INJ 20MG/ML 00074132305 ABBOTT LABORATORIES yBUMETANIDE INJ 0.25/ML 00074141204 ABBOTT LABORATORIES yBUMETANIDE INJ 0.25/ML 00074141210 ABBOTT LABORATORIES yALCOHOL/D5W INJ 5% 00074150005 ABBOTT LABORATORIES yLORAZEPAM INJ 4MG/ML 00074153931 ABBOTT LABORATORIES yLUMINAL INJ 130MG/ML 00074154001 ABBOTT LABORATORIES yMARCAINE INJ 0.25% 00074155910 ABBOTT LABORATORIES yMARCAINE INJ 0.25% 00074155930 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MARCAINE INJ 0.5% 00074156010 ABBOTT LABORATORIES yDEPACON INJ 100MG/ML 00074156410 ABBOTT LABORATORIES yMARCAINE INJ 0.25% 00074158750 ABBOTT LABORATORIES yMARCAINE INJ 0.5% 00074161050 ABBOTT LABORATORIES yRYTHMOL TAB 150MG 00074162812 ABBOTT LABORATORIES yRYTHMOL TAB 150MG 00074162814 ABBOTT LABORATORIES yATROPINE SUL INJ 0.1MG/ML 00074163010 ABBOTT LABORATORIES yCALCIUM CL INJ 10% 00074163110 ABBOTT LABORATORIES yVECURONIUM INJ 10MG 00074163249 ABBOTT LABORATORIES yZEMPLAR INJ 5MCG/ML 00074165801 ABBOTT LABORATORIES yZEMPLAR INJ 5MCG/ML 00074165802 ABBOTT LABORATORIES yRYTHMOL TAB 225MG 00074173212 ABBOTT LABORATORIES yRYTHMOL TAB 225MG 00074173214 ABBOTT LABORATORIES yMAGNESIUM SU INJ 50% 00074175410 ABBOTT LABORATORIES yMARCAINE INJ SPINAL 00074176102 ABBOTT LABORATORIES yDEXTROSE INJ 25% 00074177510 ABBOTT LABORATORIES yNEO-SYNEPHRI INJ 10MG/ML 00074180001 ABBOTT LABORATORIES yRYTHMOL TAB 300MG 00074183112 ABBOTT LABORATORIES yPONTOCAINE INJ 1% 00074184602 ABBOTT LABORATORIES yPONTOCAINE INJ 20MG 00074184906 ABBOTT LABORATORIES yPONTOCAINE SOL 2% 00074186601 ABBOTT LABORATORIES yPONTOCAINE SOL 2% 00074186602 ABBOTT LABORATORIES yTALWIN INJ 30MG/ML 00074192010 ABBOTT LABORATORIES yNORVIR SOL 80MG/ML 00074194063 ABBOTT LABORATORIES yTALWIN INJ 30MG/ML 00074194101 ABBOTT LABORATORIES yVICODIN TAB 5-500MG 00074194912 ABBOTT LABORATORIES yVICODIN TAB 5-500MG 00074194914 ABBOTT LABORATORIES yVICODIN TAB 5-500MG 00074194954 ABBOTT LABORATORIES yANTICOAG CPD SOL 00074196703 ABBOTT LABORATORIES yVICODIN ES TAB 7.5-750 00074197312 ABBOTT LABORATORIES yVICODIN ES TAB 7.5-750 00074197314 ABBOTT LABORATORIES yVICODIN ES TAB 7.5-750 00074197354 ABBOTT LABORATORIES yPANHEMATIN INJ 313MG 00074200043 ABBOTT LABORATORIES yMORPHINE SUL INJ 1MG/ML 00074202902 ABBOTT LABORATORIES yCARBOCAINE INJ 2% 00074204750 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.9% 00074210202 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRILAT INJ 1.25/ML 00074212201 ABBOTT LABORATORIES yALFENTANIL INJ 500/ML 00074226602 ABBOTT LABORATORIES yALFENTANIL INJ 500/ML 00074226605 ABBOTT LABORATORIES yALFENTANIL INJ 500/ML 00074226651 ABBOTT LABORATORIES yLABETALOL INJ 5MG/ML 00074226720 ABBOTT LABORATORIES yLABETALOL INJ 5MG/ML 00074226754 ABBOTT LABORATORIES yVICODIN HP TAB 10-660 00074227414 ABBOTT LABORATORIES yVICODIN HP TAB 10-660 00074227454 ABBOTT LABORATORIES yVICOPROFEN TAB 00074227712 ABBOTT LABORATORIES yVICOPROFEN TAB 00074227714 ABBOTT LABORATORIES yVICOPROFEN TAB 00074227754 ABBOTT LABORATORIES yMAVIK TAB 1MG 00074227811 ABBOTT LABORATORIES yMAVIK TAB 1MG 00074227813 ABBOTT LABORATORIES yMAVIK TAB 2MG 00074227911 ABBOTT LABORATORIES yMAVIK TAB 2MG 00074227913 ABBOTT LABORATORIES yMAVIK TAB 4MG 00074228011 ABBOTT LABORATORIES yMAVIK TAB 4MG 00074228013 ABBOTT LABORATORIES yMETOPROLOL INJ 1MG/ML 00074228505 ABBOTT LABORATORIES yMIDAZOLAM INJ 1MG/ML 00074230502 ABBOTT LABORATORIES yMIDAZOLAM INJ 1MG/ML 00074230505 ABBOTT LABORATORIES yMIDAZOLAM INJ 1MG/ML 00074230549 ABBOTT LABORATORIES yMIDAZOLAM INJ 1MG/ML 00074230550 ABBOTT LABORATORIES yMIDAZOLAM INJ 5MG/ML 00074230849 ABBOTT LABORATORIES yMIDAZOLAM INJ 5MG/ML 00074230850 ABBOTT LABORATORIES yDILAUDID INJ 1MG/ML 00074233211 ABBOTT LABORATORIES yDILAUDID INJ 2MG/ML 00074233311 ABBOTT LABORATORIES yDILAUDID INJ 2MG/ML 00074233326 ABBOTT LABORATORIES yDILAUDID INJ 4MG/ML 00074233411 ABBOTT LABORATORIES yDEFEROXAMINE INJ 500MG 00074233610 ABBOTT LABORATORIES yDEFEROXAMIN INJ 2GM 00074233725 ABBOTT LABORATORIES yLABETALOL INJ 5MG/ML 00074233934 ABBOTT LABORATORIES yDOBUTAMINE INJ 250MG 00074234401 ABBOTT LABORATORIES yDILAUDID INJ 2MG/ML 00074241421 ABBOTT LABORATORIES yDILAUDID TAB 2MG 00074241512 ABBOTT LABORATORIES yDILAUDID TAB 2MG 00074241514 ABBOTT LABORATORIES yDILAUDID TAB 2MG 00074241554 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DILAUDID TAB 4MG 00074241612 ABBOTT LABORATORIES yDILAUDID TAB 4MG 00074241614 ABBOTT LABORATORIES yDILAUDID TAB 4MG 00074241654 ABBOTT LABORATORIES yDILAUDID TAB 8MG 00074242614 ABBOTT LABORATORIES yDILAUDID POW 00074242816 ABBOTT LABORATORIES yDILAUDID SUP 3MG 00074245107 ABBOTT LABORATORIES yDILAUDID-5 LIQ 1MG/ML 00074245202 ABBOTT LABORATORIES yDILAUDID-HP INJ 10MG/ML 00074245311 ABBOTT LABORATORIES yDILAUDID-HP INJ 10MG/ML 00074245327 ABBOTT LABORATORIES yDILAUDID-HP INJ 10MG/ML 00074245351 ABBOTT LABORATORIES yDILAUDID-HP INJ 250MG 00074245531 ABBOTT LABORATORIES yMERIDIA CAP 5MG 00074245612 ABBOTT LABORATORIES yMERIDIA CAP 5MG 00074245613 ABBOTT LABORATORIES yMERIDIA CAP 10MG 00074245712 ABBOTT LABORATORIES yMERIDIA CAP 10MG 00074245713 ABBOTT LABORATORIES yMERIDIA CAP 15MG 00074245812 ABBOTT LABORATORIES yMERIDIA CAP 15MG 00074245813 ABBOTT LABORATORIES yBIAXIN TAB 500MG 00074258611 ABBOTT LABORATORIES yBIAXIN TAB 500MG 00074258660 ABBOTT LABORATORIES yMIDAZOLAM INJ 1MG/ML 00074258705 ABBOTT LABORATORIES yMIDAZOLAM INJ 1MG/ML 00074258753 ABBOTT LABORATORIES yERYTHROM ETH TAB 400MG 00074258913 ABBOTT LABORATORIES yERYTHROM ETH TAB 400MG 00074258953 ABBOTT LABORATORIES yMIDAZOLAM INJ 5MG/ML 00074259605 ABBOTT LABORATORIES yMIDAZOLAM INJ 5MG/ML 00074259653 ABBOTT LABORATORIES ySELSUN SHA 2.5% 00074266004 ABBOTT LABORATORIES yERYDERM SOL 2% 00074269802 ABBOTT LABORATORIES yTRANXENE-SD TAB 11.25MG 00074269913 ABBOTT LABORATORIES yTRANXENE-SD TAB 22.5MG 00074299713 ABBOTT LABORATORIES yEPHEDRINE SU INJ 50MG/ML 00074307331 ABBOTT LABORATORIES yCENOLATE INJ 500MG/ML 00074311831 ABBOTT LABORATORIES yBIAXIN SUS 125/5ML 00074316313 ABBOTT LABORATORIES yBIAXIN SUS 125/5ML 00074316350 ABBOTT LABORATORIES yBIAXIN XL TAB 500MG 00074316511 ABBOTT LABORATORIES yBIAXIN XL TAB PAC 500 00074316514 ABBOTT LABORATORIES yBIAXIN XL TAB PAC 500 00074316541 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BIAXIN XL TAB 500MG 00074316560 ABBOTT LABORATORIES yLIDO/EPI INJ 2% 00074318301 ABBOTT LABORATORIES yBIAXIN SUS 250/5ML 00074318813 ABBOTT LABORATORIES yBIAXIN SUS 250/5ML 00074318850 ABBOTT LABORATORIES yTARKA TAB 2-180 CR 00074328713 ABBOTT LABORATORIES yTARKA TAB 1-240 CR 00074328813 ABBOTT LABORATORIES yTARKA TAB 2-240 CR 00074328913 ABBOTT LABORATORIES yTARKA TAB 4-240 CR 00074329013 ABBOTT LABORATORIES yISOFLURANE SOL 00074329201 ABBOTT LABORATORIES yISOFLURANE SOL 00074329202 ABBOTT LABORATORIES yISOFLURANE SOL 00074329249 ABBOTT LABORATORIES yISOFLURANE SOL 00074329251 ABBOTT LABORATORIES yPENTOTHAL INJ 500MG 00074332901 ABBOTT LABORATORIES yBIAXIN TAB 250MG 00074336811 ABBOTT LABORATORIES yBIAXIN TAB 250MG 00074336860 ABBOTT LABORATORIES yDESOXYN TAB 5MG 00074337704 ABBOTT LABORATORIES ySUFENTANIL INJ 50MCG/ML 00074338035 ABBOTT LABORATORIES ySUFENTANIL INJ 50MCG/ML 00074338049 ABBOTT LABORATORIES ySUFENTANIL INJ 50MCG/ML 00074338050 ABBOTT LABORATORIES ySUFENTANIL INJ 50MCG/ML 00074338051 ABBOTT LABORATORIES yPCE TAB 500MG EC 00074338913 ABBOTT LABORATORIES yCENOLATE INJ 500MG/ML 00074339732 ABBOTT LABORATORIES yK-LOR POW 20MEQ 00074361101 ABBOTT LABORATORIES yK-LOR POW 20MEQ 00074361102 ABBOTT LABORATORIES ySYNTHROID TAB 137MCG 00074372713 ABBOTT LABORATORIES yPROSOM TAB 1MG 00074373513 ABBOTT LABORATORIES yPROSOM TAB 2MG 00074373613 ABBOTT LABORATORIES yERYTHROM ETH SUS 200/5ML 00074374716 ABBOTT LABORATORIES yERYTHROM ETH SUS 400/5ML 00074374816 ABBOTT LABORATORIES yOMNICEF CAP 300MG 00074376910 ABBOTT LABORATORIES yOMNI-PAC CAP 300MG 00074376930 ABBOTT LABORATORIES yOMNICEF CAP 300MG 00074376960 ABBOTT LABORATORIES yOMNICEF SUS 125MG/5 00074377113 ABBOTT LABORATORIES yOMNICEF SUS 125MG/5 00074377160 ABBOTT LABORATORIES yNEMBUTAL INJ 50MG/ML 00074377804 ABBOTT LABORATORIES yNEMBUTAL INJ 50MG/ML 00074377805 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KETOROLAC INJ 30MG/ML 00074379501 ABBOTT LABORATORIES yKETOROLAC INJ 30MG/ML 00074379549 ABBOTT LABORATORIES yKETOROLAC INJ 30MG/ML 00074379561 ABBOTT LABORATORIES yKETOROLAC INJ 30MG/ML 00074379601 ABBOTT LABORATORIES yKETOROLAC INJ 30MG/ML 00074379649 ABBOTT LABORATORIES yHUMIRA KIT 40MG/0.8 00074379902 ABBOTT LABORATORIES yHYTRIN CAP 1MG 00074380511 ABBOTT LABORATORIES yHYTRIN CAP 1MG 00074380513 ABBOTT LABORATORIES yHYTRIN CAP 2MG 00074380611 ABBOTT LABORATORIES yHYTRIN CAP 2MG 00074380613 ABBOTT LABORATORIES yHYTRIN CAP 5MG 00074380711 ABBOTT LABORATORIES yHYTRIN CAP 5MG 00074380713 ABBOTT LABORATORIES yHYTRIN CAP 10MG 00074380811 ABBOTT LABORATORIES yHYTRIN CAP 10MG 00074380813 ABBOTT LABORATORIES yDEPAKOTE ER TAB 250 MG 00074382611 ABBOTT LABORATORIES yDEPAKOTE ER TAB 250 MG 00074382613 ABBOTT LABORATORIES yBALANCED SAL SOL OP 00074391103 ABBOTT LABORATORIES yPOT CHLORIDE INJ 2MEQ/ML 00074393402 ABBOTT LABORATORIES yKALETRA SOL 00074395646 ABBOTT LABORATORIES yKALETRA CAP 00074395977 ABBOTT LABORATORIES yTRICOR TAB 54MG 00074400990 ABBOTT LABORATORIES yTRICOR TAB 160MG 00074401390 ABBOTT LABORATORIES ySTERIL WATER INJ 00074402702 ABBOTT LABORATORIES yLIDOCAINE INJ 1.5% 00074405601 ABBOTT LABORATORIES yMORPHINE SUL INJ 0.5MG/ML 00074405712 ABBOTT LABORATORIES yDEXTROSE INJ 10% 00074408902 ABBOTT LABORATORIES yNITROGLYCER INJ 5MG/ML 00074410401 ABBOTT LABORATORIES yAMINOSYN-HBC INJ 7% 00074416803 ABBOTT LABORATORIES yAMINOSYN INJ 8.5% 00074420303 ABBOTT LABORATORIES yLIDOCAINE INJ 1% 00074427001 ABBOTT LABORATORIES yBUPIVACAINE INJ 0.25% 00074427201 ABBOTT LABORATORIES yBUPIVACAINE INJ 0.5% 00074427301 ABBOTT LABORATORIES yBUPIVACAINE INJ 0.75% 00074427401 ABBOTT LABORATORIES yLIDOCAINE INJ 1% 00074427601 ABBOTT LABORATORIES yLIDOCAINE INJ 1% 00074427602 ABBOTT LABORATORIES yLIDOCAINE INJ 2% 00074427701 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIDOCAINE INJ 2% 00074427702 ABBOTT LABORATORIES yLIDOCAINE INJ 1% 00074427902 ABBOTT LABORATORIES yLIDOCAINE INJ 2% 00074428202 ABBOTT LABORATORIES yZEMPLAR CAP 2MCG 00074431430 ABBOTT LABORATORIES yZEMPLAR CAP 4MCG 00074431530 ABBOTT LABORATORIES yZEMPLAR CAP 1MCG 00074431730 ABBOTT LABORATORIES yHUMIRA PEN KIT 40MG/0.8 00074433902 ABBOTT LABORATORIES ySYNTHROID TAB 25MCG 00074434113 ABBOTT LABORATORIES ySYNTHROID TAB 25MCG 00074434119 ABBOTT LABORATORIES yAMIODARONE INJ 50MG/ML 00074434835 ABBOTT LABORATORIES yMIVACRON INJ 2MG/ML 00074436505 ABBOTT LABORATORIES yMIVACRON INJ 2MG/ML 00074436510 ABBOTT LABORATORIES yMIVACRON INJ 2MG/ML 00074437520 ABBOTT LABORATORIES yMIVACRON INJ 2MG/ML 00074437550 ABBOTT LABORATORIES yNIMBEX INJ 2MG/ML 00074437805 ABBOTT LABORATORIES yNIMBEX INJ 2MG/ML 00074438010 ABBOTT LABORATORIES yNIMBEX INJ 10MG/ML 00074438220 ABBOTT LABORATORIES yTRANXENE T TAB 3.75MG 00074438913 ABBOTT LABORATORIES yTRANXENE T TAB 7.5MG 00074439013 ABBOTT LABORATORIES yTRANXENE T TAB 7.5MG 00074439053 ABBOTT LABORATORIES yTRANXENE-T TAB 15MG 00074439113 ABBOTT LABORATORIES yULTANE SOL 00074445604 ABBOTT LABORATORIES yULTANE SOL 00074445649 ABBOTT LABORATORIES yULTANE SOL 00074445651 ABBOTT LABORATORIES yULTANE SOL 00074445661 ABBOTT LABORATORIES yULTIVA INJ 1MG 00074449803 ABBOTT LABORATORIES yULTIVA INJ 2MG 00074450405 ABBOTT LABORATORIES yULTIVA INJ 5MG 00074450710 ABBOTT LABORATORIES ySYNTHROID TAB 50MCG 00074455211 ABBOTT LABORATORIES ySYNTHROID TAB 50MCG 00074455213 ABBOTT LABORATORIES ySYNTHROID TAB 50MCG 00074455219 ABBOTT LABORATORIES yZEMPLAR INJ 2MCG/ML 00074463701 ABBOTT LABORATORIES yFLUCONAZOLE/ INJ DEX 400 00074468402 ABBOTT LABORATORIES yFLUCONAZOLE/ INJ NACL 400 00074468802 ABBOTT LABORATORIES yFLUCONAZOLE/ INJ NACL 200 00074468823 ABBOTT LABORATORIES yLIDO/DEXTROS INJ 5-7.5% 00074471201 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIDOCAINE INJ 1% 00074471302 ABBOTT LABORATORIES yLIDOCAINE INJ 1% 00074471332 ABBOTT LABORATORIES yCEFAZOLIN INJ 1GM 00074473203 ABBOTT LABORATORIES yLIDOCAINE INJ 1.5% 00074477601 ABBOTT LABORATORIES ySTERIL WATER INJ 00074488710 ABBOTT LABORATORIES ySTERIL WATER INJ 00074488725 ABBOTT LABORATORIES ySTERIL WATER INJ 00074488750 ABBOTT LABORATORIES ySTERIL WATER INJ 00074488799 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.9% 00074488825 ABBOTT LABORATORIES yDEXTROSE INJ 50% 00074490234 ABBOTT LABORATORIES yLIDOCAINE INJ 20MG/ML 00074490334 ABBOTT LABORATORIES yATROPINE SUL INJ 0.1MG/ML 00074491134 ABBOTT LABORATORIES ySOD BICARB INJ 7.5% 00074491634 ABBOTT LABORATORIES yEPINEPHRINE INJ 0.1MG/ML 00074492134 ABBOTT LABORATORIES yCALCIUM CL INJ 10% 00074492834 ABBOTT LABORATORIES yTAZICEF INJ 1GM 00074508216 ABBOTT LABORATORIES yTAZICEF INJ 2GM 00074508411 ABBOTT LABORATORIES yTAZICEF INJ 6GM 00074508611 ABBOTT LABORATORIES yTAZICEF INJ 1GM 00074509216 ABBOTT LABORATORIES yTAZICEF INJ 2GM 00074509311 ABBOTT LABORATORIES ySYNTHROID TAB 75MCG 00074518211 ABBOTT LABORATORIES ySYNTHROID TAB 75MCG 00074518213 ABBOTT LABORATORIES ySYNTHROID TAB 75MCG 00074518219 ABBOTT LABORATORIES ySOD BICARB INJ 4.2% 00074553434 ABBOTT LABORATORIES yDEPAKENE CAP 250MG 00074568113 ABBOTT LABORATORIES yDEPAKENE SYP 250/5ML 00074568216 ABBOTT LABORATORIES yA-METHAPRED INJ 40MG 00074568401 ABBOTT LABORATORIES yA-METHAPRED INJ 125MG 00074568502 ABBOTT LABORATORIES yE.E.S. 400 TAB 400MG 00074572913 ABBOTT LABORATORIES yE.E.S. 400 TAB 400MG 00074572953 ABBOTT LABORATORIES yDOPAMINE INJ 40MG/ML 00074582001 ABBOTT LABORATORIES yDOPAMINE INJ 40MG/ML 00074582010 ABBOTT LABORATORIES yCYLERT TAB 18.75MG 00074602513 ABBOTT LABORATORIES yMORPHINE SUL INJ 5MG/ML 00074602804 ABBOTT LABORATORIES yMEPERIDINE INJ 300MG 00074603004 ABBOTT LABORATORIES yCYLERT TAB 37.5MG 00074605713 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CYLERT TAB 75MG 00074607313 ABBOTT LABORATORIES yCYLERT CHW 37.5MG 00074608813 ABBOTT LABORATORIES yCEFOL TAB 00074608913 ABBOTT LABORATORIES yABBOKINASE INJ 5000U 00074611101 ABBOTT LABORATORIES yDEPAKOTE SPR CAP 125 MG 00074611411 ABBOTT LABORATORIES yDEPAKOTE SPR CAP 125 MG 00074611413 ABBOTT LABORATORIES yTRICOR TAB 48MG 00074612290 ABBOTT LABORATORIES yTRICOR TAB 145MG 00074612390 ABBOTT LABORATORIES ySODIUM CHLOR SOL 0.9% IRR 00074613822 ABBOTT LABORATORIES ySTERIL WATER SOL IRRIG 00074613903 ABBOTT LABORATORIES ySTERIL WATER SOL IRRIG 00074613922 ABBOTT LABORATORIES yRINGER'S IRR SOL 00074614009 ABBOTT LABORATORIES yPHYSIOSOL SOL IRRIGAT 00074614109 ABBOTT LABORATORIES yGLYCINE SOL 1.5% IRR 00074614236 ABBOTT LABORATORIES yACETIC ACID SOL 0.25%IRR 00074614322 ABBOTT LABORATORIES yABBOKINASE INJ 9000U 00074614502 ABBOTT LABORATORIES yOMNICEF SUS 250MG/5 00074615113 ABBOTT LABORATORIES yOMNICEF SUS 250MG/5 00074615160 ABBOTT LABORATORIES yDEPAKOTE TAB 125MG DR 00074621211 ABBOTT LABORATORIES yDEPAKOTE TAB 125MG DR 00074621213 ABBOTT LABORATORIES yDEPAKOTE TAB 250MG DR 00074621411 ABBOTT LABORATORIES yDEPAKOTE TAB 250MG DR 00074621413 ABBOTT LABORATORIES yDEPAKOTE TAB 250MG DR 00074621453 ABBOTT LABORATORIES yDEPAKOTE TAB 500MG DR 00074621511 ABBOTT LABORATORIES yDEPAKOTE TAB 500MG DR 00074621513 ABBOTT LABORATORIES yDEPAKOTE TAB 500MG DR 00074621553 ABBOTT LABORATORIES yERYTHROMYCIN TAB BS 500MG 00074622713 ABBOTT LABORATORIES yPCE TAB 333MG EC 00074629060 ABBOTT LABORATORIES yERYTHROMYCIN CAP 250MG EC 00074630113 ABBOTT LABORATORIES yERYTHROMYCIN CAP 250MG EC 00074630153 ABBOTT LABORATORIES yERYPED 200 SUS 200/5ML 00074630213 ABBOTT LABORATORIES yERYPED 200 SUS 200/5ML 00074630253 ABBOTT LABORATORIES yERYPED DRO 100/2.5 00074630350 ABBOTT LABORATORIES yERY-TAB TAB 250MG EC 00074630413 ABBOTT LABORATORIES yERY-TAB TAB 250MG EC 00074630453 ABBOTT LABORATORIES yERYPED 400 SUS 400/5ML 00074630513 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ERYPED 400 SUS 400/5ML 00074630553 ABBOTT LABORATORIES yE.E.S. 200 SUS 200/5ML 00074630613 ABBOTT LABORATORIES yE.E.S. 200 SUS 200/5ML 00074630616 ABBOTT LABORATORIES yERYTHROCIN TAB 500MG 00074631613 ABBOTT LABORATORIES yERY-TAB TAB 333MG EC 00074632013 ABBOTT LABORATORIES yERY-TAB TAB 333MG EC 00074632053 ABBOTT LABORATORIES yERY-TAB TAB 500MG EC 00074632113 ABBOTT LABORATORIES yERYTHROMYCIN TAB 250MG 00074632613 ABBOTT LABORATORIES yERYTHROMYCIN TAB 250MG 00074632653 ABBOTT LABORATORIES yERYTHROCIN INJ 1000MG 00074634205 ABBOTT LABORATORIES yERYTHROCIN TAB 250MG 00074634620 ABBOTT LABORATORIES yERYTHROCIN TAB 250MG 00074634653 ABBOTT LABORATORIES yERYTHROCIN INJ 500MG 00074636502 ABBOTT LABORATORIES yE.E.S. GRAN SUS 200/5ML 00074636902 ABBOTT LABORATORIES yE.E.S. GRAN SUS 200/5ML 00074636910 ABBOTT LABORATORIES yE.E.S. 400 SUS 400/5ML 00074637313 ABBOTT LABORATORIES yE.E.S. 400 SUS 400/5ML 00074637316 ABBOTT LABORATORIES yPENTOTHAL INJ 1GM 00074643501 ABBOTT LABORATORIES yGENGRAF CAP 25MG 00074646332 ABBOTT LABORATORIES yERYTHROM LAC INJ 500MG 00074647644 ABBOTT LABORATORIES yERYTHROCIN INJ 1000MG 00074647844 ABBOTT LABORATORIES yGENGRAF CAP 100MG 00074647932 ABBOTT LABORATORIES ySYNTHROID TAB 88MCG 00074659413 ABBOTT LABORATORIES ySYNTHROID TAB 88MCG 00074659419 ABBOTT LABORATORIES ySYNTHROID TAB 100MCG 00074662411 ABBOTT LABORATORIES ySYNTHROID TAB 100MCG 00074662413 ABBOTT LABORATORIES ySYNTHROID TAB 100MCG 00074662419 ABBOTT LABORATORIES yNORVIR CAP 100MG 00074663322 ABBOTT LABORATORIES yNORVIR CAP 100MG 00074663330 ABBOTT LABORATORIES ySOD BICARB INJ 8.4% 00074663734 ABBOTT LABORATORIES yPOT CHLORIDE INJ 2MEQ/ML 00074665106 ABBOTT LABORATORIES yPOT CHLORIDE INJ 2MEQ/ML 00074665305 ABBOTT LABORATORIES yMAGNESIUM SU INJ 40MG/ML 00074672903 ABBOTT LABORATORIES yMAGNESIUM SU INJ 40MG/ML 00074672909 ABBOTT LABORATORIES yKALETRA TAB 200-50MG 00074679922 ABBOTT LABORATORIES yPEGANONE TAB 250MG 00074690201 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENDRATE INJ 150MG/ML 00074694003 ABBOTT LABORATORIES ySYNTHROID TAB 125MCG 00074706811 ABBOTT LABORATORIES ySYNTHROID TAB 125MCG 00074706813 ABBOTT LABORATORIES ySYNTHROID TAB 125MCG 00074706819 ABBOTT LABORATORIES ySYNTHROID TAB 150MCG 00074706911 ABBOTT LABORATORIES ySYNTHROID TAB 150MCG 00074706913 ABBOTT LABORATORIES ySYNTHROID TAB 150MCG 00074706919 ABBOTT LABORATORIES ySYNTHROID TAB 175MCG 00074707013 ABBOTT LABORATORIES ySYNTHROID TAB 175MCG 00074707019 ABBOTT LABORATORIES yPOT CHLORIDE INJ 30MEQ 00074707626 ABBOTT LABORATORIES yFERO-FOLIC TAB -500 00074707930 ABBOTT LABORATORIES yDEXTROSE INJ 5% 00074710002 ABBOTT LABORATORIES yDEXTROSE INJ 5% 00074710067 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.9% 00074710102 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.9% 00074710167 ABBOTT LABORATORIES yIBERET-FOLIC TAB 500 CR 00074712530 ABBOTT LABORATORIES yDEPAKOTE ER TAB 500MG 00074712611 ABBOTT LABORATORIES yDEPAKOTE ER TAB 500MG 00074712613 ABBOTT LABORATORIES yDEPAKOTE ER TAB 500MG 00074712653 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.45% 00074713202 ABBOTT LABORATORIES ySODIUM CHLOR SOL 0.9% IRR 00074713806 ABBOTT LABORATORIES ySODIUM CHLOR SOL 0.9% IRR 00074713809 ABBOTT LABORATORIES ySODIUM CHLOR SOL 0.9% IRR 00074713836 ABBOTT LABORATORIES ySTERIL WATER SOL IRRIG 00074713906 ABBOTT LABORATORIES ySTERIL WATER SOL IRRIG 00074713909 ABBOTT LABORATORIES ySTERIL WATER SOL IRRIG 00074713936 ABBOTT LABORATORIES ySYNTHROID TAB 200MCG 00074714811 ABBOTT LABORATORIES ySYNTHROID TAB 200MCG 00074714813 ABBOTT LABORATORIES ySYNTHROID TAB 200MCG 00074714819 ABBOTT LABORATORIES ySYNTHROID TAB 300MCG 00074714913 ABBOTT LABORATORIES ySYNTHROID TAB 300MCG 00074714919 ABBOTT LABORATORIES yEES/SULFISOX SUS 200-600 00074715613 ABBOTT LABORATORIES yEES/SULFISOX SUS 200-600 00074715643 ABBOTT LABORATORIES yEES/SULFISOX SUS 200-600 00074715653 ABBOTT LABORATORIES yEPINEPHRINE INJ 1MG/ML 00074724101 ABBOTT LABORATORIES yGENGRAF SOL 100MG/ML 00074726950 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXTROSE INJ 50% 00074751716 ABBOTT LABORATORIES yTHEOPHYL/D5W INJ 2MG/ML 00074766823 ABBOTT LABORATORIES yMANNITOL INJ 20% 00074771503 ABBOTT LABORATORIES yHEP SOD/D5W INJ 100/ML 00074779362 ABBOTT LABORATORIES yK-TABS TAB 10MEQ CR 00074780413 ABBOTT LABORATORIES yK-TABS TAB 10MEQ CR 00074780419 ABBOTT LABORATORIES yMETRON/NACL INJ 500MG 00074781124 ABBOTT LABORATORIES yMETRON/NACL INJ 500MG 00074781137 ABBOTT LABORATORIES yD5W/NACL INJ 0.45% 00074792609 ABBOTT LABORATORIES yD5W/NACL INJ 0.9% 00074794103 ABBOTT LABORATORIES yD5W/NACL INJ 0.9% 00074794109 ABBOTT LABORATORIES ySODIUM CHLOR SOL 0.9% IRR 00074797208 ABBOTT LABORATORIES yGLYCINE SOL 1.5% IRR 00074797408 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.9% 00074798413 ABBOTT LABORATORIES ySOD CHLORIDE INJ 0.9% 00074798437 ABBOTT LABORATORIES yPEDIAZOLE SUS 200/600 00074803013 ABBOTT LABORATORIES yPEDIAZOLE SUS 200/600 00074803043 ABBOTT LABORATORIES yPEDIAZOLE SUS 200/600 00074803053 ABBOTT LABORATORIES yAMIDATE INJ 2MG/ML 00074806029 ABBOTT LABORATORIES yAMIDATE INJ 2MG/ML 00074806101 ABBOTT LABORATORIES yAMIDATE INJ 2MG/ML 00074806201 ABBOTT LABORATORIES yCALCIJEX INJ 1MCG/ML 00074811031 ABBOTT LABORATORIES yFENTANYL CIT INJ .05MG/ML 00074909320 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909332 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909335 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909336 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909338 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909428 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909431 ABBOTT LABORATORIES yFENTANYL CIT INJ 0.05MG/1 00074909461 ABBOTT LABORATORIES yLIDOCAINE INJ 1% 00074913705 ABBOTT LABORATORIES yVITAMIN K1 INJ 10MG/ML 00074915801 ABBOTT LABORATORIES ySYNTHROID TAB 112MCG 00074929613 ABBOTT LABORATORIES ySYNTHROID TAB 112MCG 00074929619 ABBOTT LABORATORIES yFUROSEMIDE INJ 10MG/ML 00074963104 ABBOTT LABORATORIES yLIPOSYN II INJ 20% 00074978901 ABBOTT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIPOSYN III INJ 20% 00074979101 ABBOTT LABORATORIES yISRADIPINE CAP 2.5MG 67767010801 ABRIKA PHARMACEUTICALS, LLLP yISRADIPINE CAP 5MG 67767010901 ABRIKA PHARMACEUTICALS, LLLP yNYSTATIN POW 100000 67767011215 ABRIKA PHARMACEUTICALS, LLLP yNYSTATIN POW 100000 67767011216 ABRIKA PHARMACEUTICALS, LLLP yNYSTATIN POW 100000 67767011217 ABRIKA PHARMACEUTICALS, LLLP yCIPROFLOXACN TAB 250MG 67767013701 ABRIKA PHARMACEUTICALS, LLLP yCIPROFLOXACN TAB 500MG 67767013801 ABRIKA PHARMACEUTICALS, LLLP yCIPROFLOXACN TAB 750MG 67767013911 ABRIKA PHARMACEUTICALS, LLLP yBETHANECHOL TAB 10MG 67767014401 ABRIKA PHARMACEUTICALS, LLLP yBETHANECHOL TAB 25MG 67767014501 ABRIKA PHARMACEUTICALS, LLLP yBETHANECHOL TAB 50MG 67767014601 ABRIKA PHARMACEUTICALS, LLLP yZANAFLEX TAB 2MG 10144059215 ACORDA THERAPEUTICS, INC. yZANAFLEX TAB 4MG 10144059415 ACORDA THERAPEUTICS, INC. yZANAFLEX CAP 2MG 10144060215 ACORDA THERAPEUTICS, INC. yZANAFLEX CAP 4MG 10144060415 ACORDA THERAPEUTICS, INC. yZANAFLEX CAP 6MG 10144060615 ACORDA THERAPEUTICS, INC. yACETAMIN TAB 325MG 00228110396 ACTAVIS yCHERRY SYP 00228123316 ACTAVIS yGLYCERIN LIQ 00228132102 ACTAVIS yGLYCERIN LIQ 00228132116 ACTAVIS yPEPPERMINT SOL SPIRIT 00228148501 ACTAVIS ySWEET OLIVE OIL 00228161501 ACTAVIS ySWEET OLIVE OIL 00228161502 ACTAVIS yTURPENTINE LIQ SPIRITS 00228163502 ACTAVIS yAPAP/CODEINE TAB 300-30MG 00228200110 ACTAVIS yAPAP/CODEINE TAB 300-30MG 00228200196 ACTAVIS yAPAP/CODEINE TAB 300-60MG 00228200350 ACTAVIS yPAREGORIC TIN 2MG/5ML 00228202016 ACTAVIS yFLURAZEPAM CAP 15MG 00228202110 ACTAVIS yFLURAZEPAM CAP 15MG 00228202150 ACTAVIS yFLURAZEPAM CAP 30MG 00228202210 ACTAVIS yFLURAZEPAM CAP 30MG 00228202250 ACTAVIS yBUT/ASA/CAFF TAB 00228202310 ACTAVIS yPHENOBARB TAB 15MG 00228202696 ACTAVIS yALPRAZOLAM TAB 0.25MG 00228202710 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALPRAZOLAM TAB 0.25MG 00228202750 ACTAVIS yALPRAZOLAM TAB 0.25MG 00228202796 ACTAVIS yPHENOBARB TAB 30MG 00228202896 ACTAVIS yALPRAZOLAM TAB 0.5MG 00228202910 ACTAVIS yALPRAZOLAM TAB 0.5MG 00228202950 ACTAVIS yALPRAZOLAM TAB 0.5MG 00228202996 ACTAVIS yALPRAZOLAM TAB 1MG 00228203110 ACTAVIS yALPRAZOLAM TAB 1MG 00228203150 ACTAVIS yALPRAZOLAM TAB 1MG 00228203196 ACTAVIS yALPRAZOLAM TAB 2MG 00228203910 ACTAVIS yALPRAZOLAM TAB 2MG 00228203950 ACTAVIS yDIAZEPAM TAB 2MG 00228205196 ACTAVIS yDIAZEPAM TAB 5MG 00228205210 ACTAVIS yDIAZEPAM TAB 5MG 00228205250 ACTAVIS yDIAZEPAM TAB 10MG 00228205310 ACTAVIS yDIAZEPAM TAB 10MG 00228205350 ACTAVIS yDIAZEPAM TAB 10MG 00228205396 ACTAVIS yLORAZEPAM TAB 0.5MG 00228205710 ACTAVIS yLORAZEPAM TAB 0.5MG 00228205750 ACTAVIS yLORAZEPAM TAB 1MG 00228205910 ACTAVIS yLORAZEPAM TAB 1MG 00228205950 ACTAVIS yLORAZEPAM TAB 2MG 00228206310 ACTAVIS yLORAZEPAM TAB 2MG 00228206350 ACTAVIS yLORAZEPAM TAB 2MG 00228206396 ACTAVIS yOXAZEPAM CAP 10MG 00228206710 ACTAVIS yOXAZEPAM CAP 10MG 00228206750 ACTAVIS yOXAZEPAM CAP 15MG 00228206910 ACTAVIS yOXAZEPAM CAP 15MG 00228206950 ACTAVIS yOXAZEPAM CAP 30MG 00228207310 ACTAVIS yTEMAZEPAM CAP 15MG 00228207610 ACTAVIS yTEMAZEPAM CAP 15MG 00228207650 ACTAVIS yTEMAZEPAM CAP 30MG 00228207710 ACTAVIS yTEMAZEPAM CAP 30MG 00228207750 ACTAVIS yCLORAZ DIPOT TAB 3.75MG 00228207810 ACTAVIS yCLORAZ DIPOT TAB 7.5MG 00228208110 ACTAVIS yCLORAZ DIPOT TAB 7.5MG 00228208150 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLORAZ DIPOT TAB 15MG 00228208310 ACTAVIS yPROPO-N/APAP TAB 100-650 00228208510 ACTAVIS yPROPO-N/APAP TAB 100-650 00228208550 ACTAVIS yALLOPURINOL TAB 300MG 00228210350 ACTAVIS yIBUPROFEN TAB 800MG 00228211110 ACTAVIS yIBUPROFEN TAB 400MG 00228212410 ACTAVIS yCLONIDINE TAB 0.1MG 00228212710 ACTAVIS yCLONIDINE TAB 0.1MG 00228212750 ACTAVIS yCLONIDINE TAB 0.2MG 00228212810 ACTAVIS yCLONIDINE TAB 0.2MG 00228212850 ACTAVIS yCLONIDINE TAB 0.2MG 00228212896 ACTAVIS yCLONIDINE TAB 0.3MG 00228212910 ACTAVIS yCARBAMAZEPIN TAB 200MG 00228214310 ACTAVIS yCARBAMAZEPIN TAB 200MG 00228214350 ACTAVIS yCARBAMAZEPIN TAB 200MG 00228214396 ACTAVIS yCHLORTHALID TAB 100MG 00228215710 ACTAVIS yDIPYRIDAMOLE TAB 50MG 00228218310 ACTAVIS yDIPYRIDAMOLE TAB 50MG 00228218396 ACTAVIS yDIPYRIDAMOLE TAB 75MG 00228218510 ACTAVIS yDIPYRIDAMOLE TAB 75MG 00228218596 ACTAVIS yDIPHENHYDRAM CAP 25MG 00228219196 ACTAVIS yDIPHENHYDRAM CAP 50MG 00228219210 ACTAVIS yHYDROCHLOROT TAB 25MG 00228222196 ACTAVIS yHYDROCHLOROT TAB 50MG 00228222296 ACTAVIS yMETRONIDAZOL TAB 250MG 00228225810 ACTAVIS yMETOCLOPRAM TAB 10MG 00228226910 ACTAVIS yMETOCLOPRAM TAB 10MG 00228226950 ACTAVIS yFENOPROFEN TAB 600MG 00228231710 ACTAVIS yFENOPROFEN TAB 600MG 00228231750 ACTAVIS yPROPRANOLOL TAB 10MG 00228232710 ACTAVIS yPROPRANOLOL TAB 10MG 00228232750 ACTAVIS yPROPRANOLOL TAB 20MG 00228232910 ACTAVIS yPROPRANOLOL TAB 20MG 00228232996 ACTAVIS yPROPRANOLOL TAB 40MG 00228233110 ACTAVIS yPROPRANOLOL TAB 40MG 00228233150 ACTAVIS yPREDNISONE TAB 20MG 00228233710 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PREDNISONE TAB 10MG 00228233810 ACTAVIS yPROPYLTHIOUR TAB 50MG 00228234810 ACTAVIS yQUINIDINE SU TAB 200MG 00228235610 ACTAVIS yPROPRAN/HCTZ TAB 40/25 00228235810 ACTAVIS yPROPRAN/HCTZ TAB 40/25 00228235850 ACTAVIS yPROPRAN/HCTZ TAB 80/25 00228236010 ACTAVIS yPROPRAN/HCTZ TAB 80/25 00228236050 ACTAVIS yPROPRAN/HCTZ TAB 80/25 00228236096 ACTAVIS ySPIRONOLACT TAB 25MG 00228238810 ACTAVIS yTRAZODONE TAB 100MG 00228244110 ACTAVIS yVALPROIC ACD CAP 250MG 00228245510 ACTAVIS yVERAPAMIL TAB 80MG 00228247310 ACTAVIS yVERAPAMIL TAB 80MG 00228247350 ACTAVIS yVERAPAMIL TAB 80MG 00228247396 ACTAVIS yVERAPAMIL TAB 120MG 00228247510 ACTAVIS yVERAPAMIL TAB 120MG 00228247550 ACTAVIS yVERAPAMIL TAB 120MG 00228247596 ACTAVIS yTOLMETIN SOD TAB 600MG 00228248010 ACTAVIS yTOLMETIN SOD TAB 600MG 00228248050 ACTAVIS yNIFEDIPINE CAP 10MG 00228249710 ACTAVIS yNIFEDIPINE CAP 10MG 00228249730 ACTAVIS yPRAZOSIN HCL CAP 1MG 00228250010 ACTAVIS yPRAZOSIN HCL CAP 1MG 00228250025 ACTAVIS yPRAZOSIN HCL CAP 1MG 00228250096 ACTAVIS yPRAZOSIN HCL CAP 2MG 00228250110 ACTAVIS yPRAZOSIN HCL CAP 2MG 00228250125 ACTAVIS yPRAZOSIN HCL CAP 5MG 00228250210 ACTAVIS yPRAZOSIN HCL CAP 5MG 00228250225 ACTAVIS yTOLMETIN SOD CAP 400MG 00228252010 ACTAVIS yTOLMETIN SOD CAP 400MG 00228252050 ACTAVIS yNAPROXEN TAB 250MG 00228252196 ACTAVIS yNIFEDIPINE CAP 20MG 00228253010 ACTAVIS yNIFEDIPINE CAP 20MG 00228253030 ACTAVIS yPINDOLOL TAB 10MG 00228253510 ACTAVIS yCARB/LEVO TAB 10-100MG 00228253810 ACTAVIS yCARB/LEVO TAB 10-100MG 00228253850 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARB/LEVO TAB 25-100MG 00228253910 ACTAVIS yCARB/LEVO TAB 25-100MG 00228253950 ACTAVIS yCARB/LEVO TAB 25-100MG 00228253996 ACTAVIS yCARB/LEVO TAB 25-250MG 00228254010 ACTAVIS yCARB/LEVO TAB 25-250MG 00228254050 ACTAVIS yCARB/LEVO TAB 25-250MG 00228254096 ACTAVIS yDICLOFENAC TAB 50MG EC 00228255006 ACTAVIS yDICLOFENAC TAB 50MG EC 00228255011 ACTAVIS yDICLOFENAC TAB 50MG EC 00228255096 ACTAVIS yDICLOFENAC TAB 75MG EC 00228255106 ACTAVIS yDICLOFENAC TAB 75MG EC 00228255111 ACTAVIS yDICLOFENAC TAB 75MG EC 00228255150 ACTAVIS yDICLOFENAC TAB 75MG EC 00228255196 ACTAVIS yGEMFIBROZIL TAB 600MG 00228255296 ACTAVIS yMETOPROLOL TAB 50MG 00228255496 ACTAVIS yMETOPROLOL TAB 100MG 00228255550 ACTAVIS yMETOPROLOL TAB 100MG 00228255596 ACTAVIS yINDAPAMIDE TAB 2.5MG 00228257111 ACTAVIS yINDAPAMIDE TAB 2.5MG 00228257196 ACTAVIS yDILTIAZEM CAP 180MG CD 00228257703 ACTAVIS yDILTIAZEM CAP 180MG CD 00228257709 ACTAVIS yDILTIAZEM CAP 180MG CD 00228257750 ACTAVIS yDILTIAZEM CAP 240MG CD 00228257803 ACTAVIS yDILTIAZEM CAP 240MG CD 00228257809 ACTAVIS yDILTIAZEM CAP 240MG CD 00228257850 ACTAVIS yDILTIAZEM CAP 300MG CD 00228257903 ACTAVIS yDILTIAZEM CAP 300MG CD 00228257909 ACTAVIS yDILTIAZEM CAP 300MG CD 00228257950 ACTAVIS yDILTIAZEM CAP 120MG CD 00228258803 ACTAVIS yDILTIAZEM CAP 120MG CD 00228258809 ACTAVIS yDILTIAZEM CAP 120MG CD 00228258850 ACTAVIS yINDAPAMIDE TAB 1.25MG 00228259711 ACTAVIS yINDAPAMIDE TAB 1.25MG 00228259796 ACTAVIS yETODOLAC TAB 400MG 00228259911 ACTAVIS yETODOLAC TAB 400MG 00228259950 ACTAVIS yACYCLOVIR CAP 200MG 00228260511 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACYCLOVIR TAB 400MG 00228260611 ACTAVIS yPENTOXIFYLLI TAB 400MG ER 00228261111 ACTAVIS yPENTOXIFYLLI TAB 400MG ER 00228261150 ACTAVIS yPENTOXIFYLLI TAB 400MG ER 00228261196 ACTAVIS yTICLOPIDINE TAB 250MG 00228261303 ACTAVIS yTICLOPIDINE TAB 250MG 00228261306 ACTAVIS yTICLOPIDINE TAB 250MG 00228261311 ACTAVIS yOXAPROZIN TAB 600MG 00228261411 ACTAVIS yOXAPROZIN TAB 600MG 00228261450 ACTAVIS yNAPROXEN DR TAB 375MG 00228261711 ACTAVIS yNAPROXEN DR TAB 500MG 00228261811 ACTAVIS yISOSORB MONO TAB 20MG 00228262011 ACTAVIS yISOSORB MONO TAB 10MG 00228263111 ACTAVIS yETODOLAC TAB 500MG 00228263211 ACTAVIS yLOVASTATIN TAB 10MG 00228263306 ACTAVIS yLOVASTATIN TAB 10MG 00228263350 ACTAVIS yLOVASTATIN TAB 20MG 00228263406 ACTAVIS yLOVASTATIN TAB 20MG 00228263450 ACTAVIS yLOVASTATIN TAB 40MG 00228263506 ACTAVIS yLOVASTATIN TAB 40MG 00228263550 ACTAVIS yGABAPENTIN TAB 600MG 00228263611 ACTAVIS yGABAPENTIN TAB 600MG 00228263650 ACTAVIS yGABAPENTIN TAB 800MG 00228263711 ACTAVIS yGABAPENTIN TAB 800MG 00228263750 ACTAVIS yAMOXICILLIN CHW 125MG 00228263911 ACTAVIS yAMOXICILLIN CHW 250MG 00228264011 ACTAVIS yAMOXICILLIN CHW 250MG 00228264025 ACTAVIS yFAMOTIDINE TAB 40MG 00228264103 ACTAVIS yFAMOTIDINE TAB 40MG 00228264111 ACTAVIS yFAMOTIDINE TAB 40MG 00228264196 ACTAVIS yDOXAZOSIN TAB 1MG 00228264211 ACTAVIS yDOXAZOSIN TAB 2MG 00228264311 ACTAVIS yDOXAZOSIN TAB 4MG 00228264411 ACTAVIS yDOXAZOSIN TAB 8MG 00228264511 ACTAVIS yBISOPRL/HCTZ TAB 2.5/6.25 00228265010 ACTAVIS yBISOPRL/HCTZ TAB 5/6.25MG 00228265110 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BISOPRL/HCTZ TAB 10/6.25 00228265203 ACTAVIS yFLUVOXAMINE TAB 50MG 00228265511 ACTAVIS yFLUVOXAMINE TAB 100MG 00228265611 ACTAVIS yMETFORMIN TAB 500MG 00228265711 ACTAVIS yMETFORMIN TAB 500MG 00228265750 ACTAVIS yENALAPRIL TAB 2.5MG 00228265811 ACTAVIS yENALAPRIL TAB 2.5MG 00228265896 ACTAVIS yENALAPRIL TAB 5MG 00228265911 ACTAVIS yENALAPRIL TAB 5MG 00228265996 ACTAVIS yENALAPRIL TAB 10MG 00228266011 ACTAVIS yENALAPRIL TAB 10MG 00228266096 ACTAVIS yENALAPRIL TAB 20MG 00228266111 ACTAVIS yENALAPRIL TAB 20MG 00228266196 ACTAVIS yGABAPENTIN CAP 100MG 00228266511 ACTAVIS yGABAPENTIN CAP 100MG 00228266550 ACTAVIS yGABAPENTIN CAP 300MG 00228266611 ACTAVIS yGABAPENTIN CAP 300MG 00228266650 ACTAVIS yGABAPENTIN CAP 400MG 00228266711 ACTAVIS yGABAPENTIN CAP 400MG 00228266750 ACTAVIS ySPIRONOLACT TAB 50MG 00228267211 ACTAVIS ySPIRONOLACT TAB 50MG 00228267250 ACTAVIS ySPIRONOLACT TAB 100MG 00228267311 ACTAVIS ySPIRONOLACT TAB 100MG 00228267350 ACTAVIS yFAMOTIDINE TAB 20MG 00228267903 ACTAVIS yFAMOTIDINE TAB 20MG 00228267911 ACTAVIS yFAMOTIDINE TAB 20MG 00228267996 ACTAVIS yAMOXICILLIN CAP 250MG 00228268811 ACTAVIS yAMOXICILLIN CAP 250MG 00228268851 ACTAVIS yAMOXICILLIN CAP 500MG 00228268911 ACTAVIS yAMOXICILLIN CAP 500MG 00228268951 ACTAVIS yFLUOXETINE CAP 10MG 00228270211 ACTAVIS yFLUOXETINE CAP 20MG 00228270311 ACTAVIS yFLUVOXAMINE TAB 25MG 00228270411 ACTAVIS yTRAMADOL HCL TAB 50MG 00228271411 ACTAVIS yTRAMADOL HCL TAB 50MG 00228271450 ACTAVIS yMETFORMIN TAB 850MG 00228271511 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METFORMIN TAB 850MG 00228271550 ACTAVIS yDICLOFENAC TAB 100MG ER 00228271711 ACTAVIS yMETFORMIN TAB 1000MG 00228271811 ACTAVIS yMETFORMIN TAB 1000MG 00228271850 ACTAVIS yMETFORMIN TAB 750MG ER 00228272811 ACTAVIS yMETFORMIN TAB 500MG ER 00228274011 ACTAVIS yTIZANIDINE TAB 4MG 00228274115 ACTAVIS yTIZANIDINE TAB 2MG 00228274215 ACTAVIS yDICLOFENAC TAB 50MG EC 00228274306 ACTAVIS yDICLOFENAC TAB 50MG EC 00228274311 ACTAVIS yDICLOFENAC TAB 50MG EC 00228274396 ACTAVIS yDICLOFENAC TAB 75MG EC 00228274406 ACTAVIS yDICLOFENAC TAB 75MG EC 00228274411 ACTAVIS yDICLOFENAC TAB 75MG EC 00228274450 ACTAVIS yDICLOFENAC TAB 75MG EC 00228274496 ACTAVIS yNAPROXEN DR TAB 375MG 00228274511 ACTAVIS yNAPROXEN DR TAB 500MG 00228274610 ACTAVIS yGLYB/METFORM TAB 1.25/250 00228275111 ACTAVIS yGLYB/METFORM TAB 2.5/500 00228275211 ACTAVIS yGLYB/METFORM TAB 2.5/500 00228275250 ACTAVIS yGLYB/METFORM TAB 5/500MG 00228275311 ACTAVIS yGLYB/METFORM TAB 5/500MG 00228275350 ACTAVIS yCITALOPRAM TAB 20MG 00228275650 ACTAVIS yCITALOPRAM TAB 40MG 00228275750 ACTAVIS yPENTOXIFYLLI TAB 400MG ER 00228276911 ACTAVIS yPENTOXIFYLLI TAB 400MG ER 00228276950 ACTAVIS yPENTOXIFYLLI TAB 400MG ER 00228276996 ACTAVIS yPILOCARPINE TAB 5MG 00228280111 ACTAVIS ySPIRONOLACT TAB 25MG 00228280311 ACTAVIS ySPIRONOLACT TAB 25MG 00228280350 ACTAVIS yPILOCARPINE TAB 7.5MG 00228283711 ACTAVIS yPHENTERMINE TAB 37.5MG 00228301611 ACTAVIS yPHENTERMINE TAB 37.5MG 00228301696 ACTAVIS yAPAP/CODEINE TAB 300-30MG 00228302010 ACTAVIS yAPAP/CODEINE TAB 300-30MG 00228302096 ACTAVIS yAPAP/CODEINE TAB 300-60MG 00228302110 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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APAP/CODEINE TAB 300-60MG 00228302150 ACTAVIS yAPAP/CODEINE TAB 300-60MG 00228305850 ACTAVIS yCLOTRIMAZOLE CRE 1% VAG 00472000741 ACTAVIS yCLOTRIMAZOLE CRE 1% VAG 00472000763 ACTAVIS yGUIATUSS DAC SOL 00472001116 ACTAVIS yGUIATUSS AC SYP 10-100/5 00472001204 ACTAVIS yGUIATUSS AC SYP 10-100/5 00472001216 ACTAVIS yGUIATUSS AC SYP 10-100/5 00472001228 ACTAVIS yAUROTO SOL OTIC 00472001699 ACTAVIS yFLUOXETINE LIQ 20MG/5ML 00472002104 ACTAVIS yCHLORHEX GLU SOL 0.12% 00472003616 ACTAVIS yMINOXIDIL SOL 2% MEN 00472006673 ACTAVIS yMINOXIDIL SOL 2% MEN 00472006675 ACTAVIS yPHENYTOIN SUS 125/5ML 00472006708 ACTAVIS yHYCOSIN EXP SYP 5-100/5 00472007716 ACTAVIS yACYCLOVIR SUS 200/5ML 00472008216 ACTAVIS yMINOXIDIL SOL 5% 00472009473 ACTAVIS yMINOXIDIL SOL 5% 00472009475 ACTAVIS yPROMETHAZINE SUP 25MG 00472009612 ACTAVIS yCAPSAICIN CRE 0.025% 00472010242 ACTAVIS yCAPSAICIN CRE 0.075% 00472010357 ACTAVIS yBROMANATE DM ELX 00472011294 ACTAVIS yBROMANATE DM ELX 00472011298 ACTAVIS yTRETINOIN CRE 0.025% 00472011720 ACTAVIS yTRETINOIN CRE 0.025% 00472011745 ACTAVIS yNYSTAT/TRIAM CRE 00472015015 ACTAVIS yNYSTAT/TRIAM CRE 00472015030 ACTAVIS yNYSTAT/TRIAM CRE 00472015060 ACTAVIS yNYSTAT/TRIAM OIN 00472015515 ACTAVIS yNYSTAT/TRIAM OIN 00472015530 ACTAVIS yNYSTAT/TRIAM OIN 00472015560 ACTAVIS yNYSTATIN CRE 100000 00472016315 ACTAVIS yNYSTATIN CRE 100000 00472016330 ACTAVIS yNYSTATIN OIN 100000 00472016615 ACTAVIS yNYSTATIN OIN 100000 00472016630 ACTAVIS yTRIPLE ANTIB OIN 00472017909 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIPLE ANTIB OIN 00472017916 ACTAVIS yTRIPLE ANTIB OIN 00472017934 ACTAVIS yTRIPLE ANTIB OIN 00472017956 ACTAVIS yPHENAZOPYRID TAB 100MG 00472019610 ACTAVIS yPHENAZOPYRID TAB 200MG 00472019710 ACTAVIS yLACTULOSE SYP 10GM/15 00472020808 ACTAVIS yLACTULOSE SYP 10GM/15 00472020816 ACTAVIS yLACTULOSE SYP 10GM/15 00472020832 ACTAVIS yVALPROIC ACD SYP 250/5ML 00472021016 ACTAVIS yPREDNISOLONE SYP 15MG/5ML 00472021208 ACTAVIS yPREDNISOLONE SYP 15MG/5ML 00472021216 ACTAVIS yCLOTRIMAZOLE CRE 1% 00472022041 ACTAVIS yCLOTRIMAZOLE CRE 1% 00472022063 ACTAVIS yPERMETHRIN CRE 5% 00472024260 ACTAVIS yPREDNISOLONE SYP 15MG/5ML 00472025008 ACTAVIS yPREDNISOLONE SYP 15MG/5ML 00472025016 ACTAVIS yHALOBETASOL OIN 0.05% 00472026115 ACTAVIS yHALOBETASOL OIN 0.05% 00472026150 ACTAVIS yTRIAMCINOLON CRE 0.1% 00472030105 ACTAVIS yTRIAMCINOLON CRE 0.1% 00472030115 ACTAVIS yTRIAMCINOLON CRE 0.1% 00472030116 ACTAVIS yTRIAMCINOLON CRE 0.1% 00472030180 ACTAVIS yTRIAMCINOLON OIN 0.1% 00472030615 ACTAVIS yTRIAMCINOLON OIN 0.1% 00472030680 ACTAVIS yHYDROCORT CRE 1% 00472032126 ACTAVIS yHYDROCORT CRE 2.5% 00472033716 ACTAVIS yHYDROCORT CRE 2.5% 00472033720 ACTAVIS yHYDROCORT CRE 2.5% 00472033730 ACTAVIS yHYDROCORT AC CRE 0.5% 00472033856 ACTAVIS yHYDROCORT/ CRE ALOE 1% 00472033942 ACTAVIS yHYDROCORT/ CRE ALOE 1% 00472033956 ACTAVIS yHYDROCORT/ CRE ALOE 1% 00472033957 ACTAVIS yHYDROCORT CRE 1% 00472034356 ACTAVIS yHYDROCORT OIN 1% 00472034556 ACTAVIS yBETAMETH VAL CRE 0.1% 00472037015 ACTAVIS yBETAMETH VAL CRE 0.1% 00472037045 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETAMETH VAL OIN 0.1% 00472037115 ACTAVIS yBETAMETH VAL OIN 0.1% 00472037145 ACTAVIS yBETAMETH VAL LOT 0.1% 00472037202 ACTAVIS yCLOTRIM/BETA CRE DIPROP 00472037915 ACTAVIS yCLOTRIM/BETA CRE DIPROP 00472037945 ACTAVIS yBETAMETH DIP CRE 0.05% 00472038015 ACTAVIS yBETAMETH DIP CRE 0.05% 00472038045 ACTAVIS yBETAMETH DIP OIN 0.05% 00472038115 ACTAVIS yBETAMETH DIP OIN 0.05% 00472038145 ACTAVIS yAUG BETAMET OIN 0.05% 00472038215 ACTAVIS yAUG BETAMET OIN 0.05% 00472038245 ACTAVIS yAUG BETAMET OIN 0.05% 00472038250 ACTAVIS yFLUOCINONIDE CRE -E 0.05% 00472039215 ACTAVIS yFLUOCINONIDE CRE -E 0.05% 00472039230 ACTAVIS yFLUOCINONIDE CRE -E 0.05% 00472039260 ACTAVIS yCLOBETASOL CRE 0.05% 00472040015 ACTAVIS yCLOBETASOL CRE 0.05% 00472040030 ACTAVIS yCLOBETASOL CRE 0.05% 00472040045 ACTAVIS yCLOBETASOL CRE 0.05% 00472040060 ACTAVIS yCLOBETASOL OIN 0.05% 00472040115 ACTAVIS yCLOBETASOL OIN 0.05% 00472040130 ACTAVIS yCLOBETASOL OIN 0.05% 00472040145 ACTAVIS yCLOBETASOL OIN 0.05% 00472040160 ACTAVIS yCLOBETASOL SOL 0.05% 00472040225 ACTAVIS yCLOBETASOL SOL 0.05% 00472040250 ACTAVIS yGUIATUSS SYP CF 00472041594 ACTAVIS yGUIATUSS SYP 100/5ML 00472041904 ACTAVIS yGUIATUSS SYP 100/5ML 00472041916 ACTAVIS yGUIATUSS SYP 100/5ML 00472041994 ACTAVIS yGUIATUSS SYP 100/5ML 00472041998 ACTAVIS yGUIATUSS CF SYP 00472042094 ACTAVIS yGUIATUSS PE SYP 30-100/5 00472042194 ACTAVIS yMETOCLOPRAM SYP 5MG/5ML 00472045416 ACTAVIS yHEMORRHOIDAL SUP -HC 25MG 00472051112 ACTAVIS yHEMORRHOIDAL SUP -HC 25MG 00472051124 ACTAVIS yCIMETIDINE SOL 300/5ML 00472051408 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIMETIDINE SOL 300/5ML 00472051416 ACTAVIS yLINDANE LOT 1% 00472057002 ACTAVIS yLINDANE LOT 1% 00472057016 ACTAVIS yLINDANE LOT 1% 00472057028 ACTAVIS yLINDANE SHA 1% 00472057202 ACTAVIS yLINDANE SHA 1% 00472057216 ACTAVIS yLINDANE SHA 1% 00472057228 ACTAVIS yAPAP ELX 160/5ML 00472064794 ACTAVIS yENTAC SOL 00472065016 ACTAVIS yTRIPLE SULFA CRE VAG 00472070078 ACTAVIS yBRONDELATE ELX 300-150 00472070928 ACTAVIS yBROMANATE ELX 2-12.5/5 00472071104 ACTAVIS yBROMANATE ELX 2-12.5/5 00472071116 ACTAVIS yBROMANATE ELX 2-12.5/5 00472071128 ACTAVIS yBROMANATE ELX 2-12.5/5 00472071194 ACTAVIS yBROMANATE ELX 2-12.5/5 00472071198 ACTAVIS yBROMANATE DM ELX 00472071294 ACTAVIS yBROMANATE DM ELX 00472071298 ACTAVIS yCARDEC-S SYP 4-60/5ML 00472072716 ACTAVIS yM-ZOLE 7 KIT DUAL PK 00472072919 ACTAVIS yMICONAZOLE CRE 2% 00472073041 ACTAVIS yMICONAZOLE CRE 2% 00472073052 ACTAVIS yMICONAZOLE CRE 2% 00472073063 ACTAVIS yCARDEC DM SYP 00472073104 ACTAVIS yCARDEC DM SYP 00472073116 ACTAVIS yCARDEC DM SYP 00472073128 ACTAVIS yCARDEC DM DRO 00472073331 ACTAVIS yMICONAZOLE CRE 2% 00472073514 ACTAVIS yMICONAZOLE CRE 2% 00472073526 ACTAVIS yMICONAZOLE CRE 2% 00472073542 ACTAVIS yMICONAZOLE CRE 2% 00472073556 ACTAVIS yCHLORPROMAZ CON 100MG/ML 00472074298 ACTAVIS yCODAMINE PED SYP 12.5-2.5 00472074816 ACTAVIS yCODAMINE SYP 25-5/5ML 00472074916 ACTAVIS yCROMOLYN SOD NEB 20MG/2ML 00472075021 ACTAVIS yCROMOLYN SOD NEB 20MG/2ML 00472075060 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IPRATROPIUM SOL INHAL 00472075123 ACTAVIS yIPRATROPIUM SOL INHAL 00472075130 ACTAVIS yIPRATROPIUM SOL INHAL 00472075160 ACTAVIS yCROMOLYN SOD NEB 20MG/2ML 00472075221 ACTAVIS yCROMOLYN SOD NEB 20MG/2ML 00472075260 ACTAVIS yIPRATROPIUM SOL INHAL 00472075323 ACTAVIS yIPRATROPIUM SOL INHAL 00472075330 ACTAVIS yIPRATROPIUM SOL INHAL 00472075360 ACTAVIS yCYPROHEPTAD SYP 2MG/5ML 00472075516 ACTAVIS yCYPROHEPTAD SYP 2MG/5ML 00472075528 ACTAVIS yHYDROXYZ HCL SYP 10MG/5ML 00472077116 ACTAVIS yHYDROXYZ HCL SYP 10MG/5ML 00472077128 ACTAVIS yMETHENAM MAN SUS 500/5ML 00472078316 ACTAVIS yMULTI-VIT/FE DRO 00472080095 ACTAVIS yNALDELATE SYP 00472080116 ACTAVIS yPAREGORIC TIN 2MG/5ML 00472080216 ACTAVIS yPAREGORIC TIN 2MG/5ML 00472080228 ACTAVIS yNALDELATE DRO PED 00472080931 ACTAVIS yALBUTEROL SYP 2MG/5ML 00472082516 ACTAVIS yFLUOCINONIDE SOL 0.05% 00472082902 ACTAVIS yALBUTEROL NEB 0.083% 00472083123 ACTAVIS yALBUTEROL NEB 0.083% 00472083130 ACTAVIS yALBUTEROL NEB 0.083% 00472083160 ACTAVIS yAMANTADINE SYP 50MG/5ML 00472083316 ACTAVIS yAMINOPHYLLIN SOL 105/5ML 00472087308 ACTAVIS yACETASOL SOL 2% OTIC 00472088099 ACTAVIS yACETASOL HC SOL OTIC 00472088282 ACTAVIS yTRI-VIT/FLUO DRO 0.25MG 00472089095 ACTAVIS yTRI-VIT/FLUO DRO 0.5MG 00472089495 ACTAVIS yDENATURED SOL ALCOHOL 00472091716 ACTAVIS yDIOCTO SYP 60/15ML 00472092416 ACTAVIS yDIOCTO SYP 60/15ML 00472092428 ACTAVIS yDIOCTO-C SYP 60-30/15 00472093016 ACTAVIS yDIOCTO-C SYP 60-30/15 00472093028 ACTAVIS yDIOCTO LIQ 150/15ML 00472093616 ACTAVIS yDIOCTO LIQ 150/15ML 00472093628 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DETUSSIN SOL 60-5/5ML 00472095816 ACTAVIS yERYTHROM ETH SUS 200/5ML 00472097116 ACTAVIS yDEXAMETHASON ELX 0.5/5ML 00472097208 ACTAVIS yDEXAMETHASON ELX 0.5/5ML 00472097233 ACTAVIS yERYTHROM ETH SUS 400/5ML 00472097416 ACTAVIS yERYTHROM ETH SUS 400/5ML 00472097433 ACTAVIS yERYTHROM EST SUS 125/5ML 00472097716 ACTAVIS yERYTHROM EST SUS 250/5ML 00472097916 ACTAVIS yCLINDAMYCIN SOL 1% 00472098791 ACTAVIS yCLINDAMYCIN SOL 1% 00472098792 ACTAVIS yLIDOCAINE SOL 2% VISC 00472099633 ACTAVIS yPOT CHLORIDE LIQ 10% SF 00472100016 ACTAVIS yPOT CHLORIDE LIQ 10% SF 00472100028 ACTAVIS yPOT CHLORIDE LIQ 20% SF 00472100116 ACTAVIS yNALDELATE SYP PED 00472100704 ACTAVIS yNALDELATE SYP PED 00472100716 ACTAVIS yPHENOBARB ELX 20MG/5ML 00472101516 ACTAVIS yPHENOBARB ELX 20MG/5ML 00472101528 ACTAVIS yHYDROMET SYP 5-1.5/5 00472103016 ACTAVIS yGUIATUSS DM SYP 100-10/5 00472103104 ACTAVIS yGUIATUSS DM SYP 100-10/5 00472103116 ACTAVIS yGUIATUSS DM SYP 100-10/5 00472103128 ACTAVIS yGUIATUSS DM SYP 100-10/5 00472103194 ACTAVIS yGUIATUSS DM SYP 100-10/5 00472103198 ACTAVIS yTUSSEX SYP 00472104004 ACTAVIS yBACITR ZINC OIN 500/GM 00472110516 ACTAVIS yBACITR ZINC OIN 500/GM 00472110534 ACTAVIS yBACITR ZINC OIN 500/GM 00472110556 ACTAVIS yPHENADEX DRO PED 00472114231 ACTAVIS yFEVERALL INF SUP 80MG 00472120006 ACTAVIS yFEVERALL INF SUP 80MG 00472120050 ACTAVIS yFEVERALL SUP 120MG 00472120106 ACTAVIS yFEVERALL SUP 120MG 00472120112 ACTAVIS yFEVERALL SUP 120MG 00472120150 ACTAVIS yFEVERALL SUP 325MG 00472120206 ACTAVIS yFEVERALL SUP 325MG 00472120212 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FEVERALL SUP 325MG 00472120250 ACTAVIS yFEVERALL SUP 650MG 00472120305 ACTAVIS yFEVERALL SUP 650MG 00472120312 ACTAVIS yFEVERALL SUP 650MG 00472120350 ACTAVIS yDYPHYLLIN-GG ELX 100-100 00472123816 ACTAVIS yNUCOTUSS EXP SYP PED 00472124016 ACTAVIS yERYTHROMYCIN SOL 2% 00472124492 ACTAVIS yNUCOTUSS SYP EXPECT 00472124516 ACTAVIS yIBUPROFEN SUS 100/5ML 00472127016 ACTAVIS yIBUPROFEN SUS 100/5ML 00472127094 ACTAVIS ySULFATRIM SUS 200-40/5 00472128416 ACTAVIS ySULFATRIM SUS 200-40/5 00472128506 ACTAVIS ySULFATRIM SUS 200-40/5 00472128509 ACTAVIS ySULFATRIM SUS 200-40/5 00472128516 ACTAVIS ySULFATRIM SUS 200-40/5 00472128533 ACTAVIS yNYSTATIN SUS 100000 00472132002 ACTAVIS yNYSTATIN SUS 100000 00472132016 ACTAVIS yHYDROCORT OIN 1% 00472132626 ACTAVIS yCONSTULOSE SOL 10GM/15 00472135808 ACTAVIS yCONSTULOSE SOL 10GM/15 00472135832 ACTAVIS yENULOSE SOL 10GM/15 00472136016 ACTAVIS yENULOSE SOL 10GM/15 00472136064 ACTAVIS yMETAPROTEREN NEB 0.4% 00472137348 ACTAVIS yMETAPROTEREN NEB 0.6% 00472137748 ACTAVIS yBETAMETH DIP LOT 0.05% 00472138202 ACTAVIS yAPAP ELX 160/5ML 00472141004 ACTAVIS yAPAP ELX 160/5ML 00472141016 ACTAVIS yAPAP ELX 160/5ML 00472141028 ACTAVIS yAPAP ELX 160/5ML 00472141094 ACTAVIS yAPAP DRO 80/0.8ML 00472141799 ACTAVIS yAPAP/CODEINE SOL 120-12/5 00472141904 ACTAVIS yAPAP/CODEINE SOL 120-12/5 00472141916 ACTAVIS yAPAP/CODEINE ELX 120-12/5 00472141928 ACTAVIS yTHEOPHYLLINE ELX 80/15ML 00472144416 ACTAVIS yTHIOTHIXENE CON 5MG/ML 00472145791 ACTAVIS yTHIOTHIXENE CON 5MG/ML 00472145794 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FERROUS SULF DRO 15/0.6ML 00472146995 ACTAVIS yPROMETHAZINE SYP 6.25/5ML 00472150404 ACTAVIS yPROMETHAZINE SYP 6.25/5ML 00472150408 ACTAVIS yPROMETHAZINE SYP 6.25/5ML 00472150416 ACTAVIS yDECOFED SYP 30MG/5ML 00472151704 ACTAVIS yDECOFED SYP 30MG/5ML 00472151716 ACTAVIS yDECOFED SYP 30MG/5ML 00472151794 ACTAVIS ySELENIUM SUL SHA 2.5% 00472153304 ACTAVIS yTHEOLATE ELX 150-90 00472154016 ACTAVIS y12 HR NASAL SPR 0.05% 00472159591 ACTAVIS yPROMETH/COD SYP 6.25-10 00472162704 ACTAVIS yPROMETH/COD SYP 6.25-10 00472162708 ACTAVIS yPROMETH/COD SYP 6.25-10 00472162716 ACTAVIS yPROMETH VC SYP 6.25-5/5 00472162808 ACTAVIS yPROMETH VC SYP 6.25-5/5 00472162816 ACTAVIS yPROMETH VC SYP 6.25-5/5 00472162828 ACTAVIS yPROMETH VC/ SYP CODEINE 00472162908 ACTAVIS yPROMETH VC/ SYP CODEINE 00472162916 ACTAVIS yPROMETH VC/ SYP CODEINE 00472162928 ACTAVIS yPROMETHAZINE SYP DM 00472163004 ACTAVIS yPROMETHAZINE SYP DM 00472163008 ACTAVIS yPROMETHAZINE SYP DM 00472163016 ACTAVIS yTRIACIN-C SYP 00472163304 ACTAVIS yTRIACIN-C SYP 00472163316 ACTAVIS yDIHISTINE DH LIQ 00472163904 ACTAVIS yDIHISTINE DH LIQ 00472163916 ACTAVIS yDIHISTINE DH LIQ 00472163928 ACTAVIS yDIHISTINE LIQ EXPECT 00472164004 ACTAVIS yBROMANATE DC SYP 00472164504 ACTAVIS yBROMANATE DC SYP 00472164516 ACTAVIS yBROMANATE DC SYP 00472164528 ACTAVIS yMICONAZOLE 7 SUP 100MG 00472173607 ACTAVIS yMICONAZOLE 3 SUP 200MG 00472173803 ACTAVIS yZINC OXIDE OIN 20% 00472180016 ACTAVIS yZINC OXIDE OIN 20% 00472180056 ACTAVIS yZINC OXIDE OIN 20% 00472180057 ACTAVIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIAPER RASH OIN 40% 00472180204 ACTAVIS yTOLNAFTATE CRE 1% 00472190015 ACTAVIS yFLUOCINONIDE CRE 0.05% 00472390115 ACTAVIS yFLUOCINONIDE CRE 0.05% 00472390130 ACTAVIS yFLUOCINONIDE CRE 0.05% 00472390160 ACTAVIS yLACTULOSE SOL 10GM/15 00472500060 ACTAVIS yLACTULOSE SOL 10GM/15 00472500160 ACTAVIS yPHENYTOIN SUS 125/5ML 00472500260 ACTAVIS yNYSTATIN SUS 100000 00472500360 ACTAVIS yMETOCLOPRAM SOL 10MG 00472500660 ACTAVIS yBISACODYL SUP 10MG 00472510012 ACTAVIS yPERMETHRIN LOT 1% 00472524267 ACTAVIS yPERMETHRIN LOT 1% 00472524269 ACTAVIS yM-ZOLE 3 KIT COMBO PK 00472731003 ACTAVIS yTRACLEER TAB 62.5MG 66215010106 ACTELION PHARMACEUTICALS U.S., INC. yTRACLEER TAB 125MG 66215010206 ACTELION PHARMACEUTICALS U.S., INC. yZAVESCA CAP 100MG 66215020118 ACTELION PHARMACEUTICALS U.S., INC. yZAVESCA CAP 100MG 66215020190 ACTELION PHARMACEUTICALS U.S., INC. yMUCINEX TAB 600MG ER 63824000810 ADAMS LABORATORIES, INC. yMUCINEX TAB 600MG ER 63824000820 ADAMS LABORATORIES, INC. yMUCINEX TAB 600MG ER 63824000840 ADAMS LABORATORIES, INC. yMUCINEX TAB 600MG ER 63824000850 ADAMS LABORATORIES, INC. yHUMIBID TAB 1200MG 63824002510 ADAMS LABORATORIES, INC. yHUMIBID TAB 1200MG 63824002520 ADAMS LABORATORIES, INC. yMUCINEX DM TAB 30-600ER 63824005620 ADAMS LABORATORIES, INC. yMUCINEX DM TAB 30-600ER 63824005640 ADAMS LABORATORIES, INC. yMUCINEX D TAB 60-600MG 63824005718 ADAMS LABORATORIES, INC. yMUCINEX D TAB 60-600MG 63824005736 ADAMS LABORATORIES, INC. yMUCINEX CHLD GRA 50MG 63824015312 ADAMS LABORATORIES, INC. yMUCINEX JR GRA 100MG 63824015412 ADAMS LABORATORIES, INC. yMUCINEX CHLD LIQ 100/5ML 63824017364 ADAMS LABORATORIES, INC. yKEFLEX SUS 125/5ML 11042011098 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX SUS 125/5ML 11042011099 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX SUS 250/5ML 11042011198 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX SUS 250/5ML 11042011199 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX CAP 250MG 11042011296 ADVANCIS PHARMACEUTICAL CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KEFLEX CAP 250MG 11042011297 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX CAP 500MG 11042011396 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX CAP 500MG 11042011397 ADVANCIS PHARMACEUTICAL CORPORATION yKEFLEX CAP 750MG 11042011540 ADVANCIS PHARMACEUTICAL CORPORATION yAEROHIST TAB 8-2.5MG 66440008251 AERO PHARMACEUTICALS, INC. yAEROKID SYP 66440011002 AERO PHARMACEUTICALS, INC. yAEROKID SYP 66440011003 AERO PHARMACEUTICALS, INC. yPRELONE SYP 15MG/5ML 66440015008 AERO PHARMACEUTICALS, INC. yPRELONE SYP 15MG/5ML 66440015016 AERO PHARMACEUTICALS, INC. yAEROTUSS 12 SUS 30MG/5ML 66440086908 AERO PHARMACEUTICALS, INC. yAEROHIST PLU TAB 8-20-2.5 66440237601 AERO PHARMACEUTICALS, INC. yAERO OTIC HC SOL 66440376701 AERO PHARMACEUTICALS, INC. yPOLYETH GLYC POW 3350 NF 10572081002 AFFORDABLE PHARMACEUTICALS, LLC yPOLYETH GLYC POW 3350 NF 10572081003 AFFORDABLE PHARMACEUTICALS, LLC yPOLYETH GLYC POW 3350 NF 10572081005 AFFORDABLE PHARMACEUTICALS, LLC yAKWA TEARS SOL OP 17478006012 AKORN INC yTEARS RENEWE SOL OP 17478006112 AKORN INC yAKWA TEARS OIN OP 17478006235 AKORN INC yTEARS RENEW OIN OP 17478006335 AKORN INC yERYTHROMYCIN OIN OP 17478007035 AKORN INC yAK-PENTOLATE SOL 1% OP 17478010012 AKORN INC yAK-PENTOLATE SOL 1% OP 17478010020 AKORN INC yTROPICACYL SOL 0.5% OP 17478010112 AKORN INC yTROPICACYL SOL 1% OP 17478010212 AKORN INC yAK-DILATE SOL 2.5% OP 17478020012 AKORN INC yAK-DILATE SOL 2.5% OP 17478020020 AKORN INC yAK-DILATE SOL 10% OP 17478020510 AKORN INC yATROPIN-CARE SOL 1% OP 17478021420 AKORN INC yNEO/BAC/POLY OIN OP 17478023535 AKORN INC yAK-POLY-BAC OIN OP 17478023835 AKORN INC yPROPARACAINE SOL 0.5% OP 17478026312 AKORN INC yGENTAK SOL 0.3% OP 17478028310 AKORN INC yGENTAK OIN 0.3% OP 17478028435 AKORN INC yAK-TOB SOL 0.3% OP 17478029010 AKORN INC yCROMOLYN SOD SOL 4% OP 17478029111 AKORN INC yORPHENADRINE INJ 30MG/ML 17478053802 AKORN INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SOD CHLORIDE OIN 5% OP 17478062235 AKORN INC ySOD CHLORIDE SOL 5% OP 17478062312 AKORN INC yTRIMETHOPRIM SOL POLYMYXN 17478070311 AKORN INC yLIDOCAINE GEL 2% JELLY 17478071110 AKORN INC yLIDOCAINE GEL 2% JELLY 17478071130 AKORN INC yOFLOXACIN SOL 0.3% 17478071310 AKORN INC yOFLOXACIN SOL 0.3% 17478071311 AKORN INC yCIPROFLOXACN SOL 0.3% OP 17478071410 AKORN INC yBRIMONIDINE SOL 0.2% OP 17478071510 AKORN INC yBRIMONIDINE SOL 0.2% OP 17478071511 AKORN INC yBRIMONIDINE SOL 0.2% OP 17478071512 AKORN INC yDILTIAZEM INJ 5MG/ML 17478093705 AKORN INC yDILTIAZEM INJ 5MG/ML 17478093710 AKORN INC yDILTIAZEM INJ 5MG/ML 17478093725 AKORN INC yNAPROXEN TAB 250MG 65162007610 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 250MG 65162007611 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 250MG 65162007650 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 375MG 65162007710 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 375MG 65162007711 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 375MG 65162007750 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 500MG 65162007810 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 500MG 65162007811 AKYMA PHARMACEUTICALS LLC yNAPROXEN TAB 500MG 65162007850 AKYMA PHARMACEUTICALS LLC yTIZANIDINE TAB 2MG 65162010611 AKYMA PHARMACEUTICALS LLC yTIZANIDINE TAB 2MG 65162010615 AKYMA PHARMACEUTICALS LLC yTIZANIDINE TAB 2MG 65162010650 AKYMA PHARMACEUTICALS LLC yCHLORPHENIR TAB 4MG 65162011610 AKYMA PHARMACEUTICALS LLC yCHLORPHENIR TAB 4MG 65162011611 AKYMA PHARMACEUTICALS LLC yCHLORPHENIR TAB 4MG 65162011624 AKYMA PHARMACEUTICALS LLC yTRAMADOL HCL TAB 50MG 65162012710 AKYMA PHARMACEUTICALS LLC yTRAMADOL HCL TAB 50MG 65162012711 AKYMA PHARMACEUTICALS LLC yTRAMADOL HCL TAB 50MG 65162012750 AKYMA PHARMACEUTICALS LLC yTIZANIDINE TAB 4MG 65162013811 AKYMA PHARMACEUTICALS LLC yTIZANIDINE TAB 4MG 65162013815 AKYMA PHARMACEUTICALS LLC yTIZANIDINE TAB 4MG 65162013850 AKYMA PHARMACEUTICALS LLC yDIPHENHYDRAM TAB 25MG 65162015610 AKYMA PHARMACEUTICALS LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIPHENHYDRAM TAB 25MG 65162015611 AKYMA PHARMACEUTICALS LLC yISONIAZID TAB 300MG 65162018203 AKYMA PHARMACEUTICALS LLC yISONIAZID TAB 300MG 65162018210 AKYMA PHARMACEUTICALS LLC yISONIAZID TAB 300MG 65162018211 AKYMA PHARMACEUTICALS LLC yISONIAZID TAB 300MG 65162018235 AKYMA PHARMACEUTICALS LLC yOXYBUTYNIN TAB 5MG 65162021060 AKYMA PHARMACEUTICALS LLC yCOLCHICINE TAB 0.6MG 65162022710 AKYMA PHARMACEUTICALS LLC yCOLCHICINE TAB 0.6MG 65162022711 AKYMA PHARMACEUTICALS LLC yASPIRIN TAB 81MG EC 65162024111 AKYMA PHARMACEUTICALS LLC yASPIRIN TAB 81MG EC 65162024116 AKYMA PHARMACEUTICALS LLC yRANITIDINE TAB 300MG 65162026010 AKYMA PHARMACEUTICALS LLC yRANITIDINE TAB 300MG 65162026025 AKYMA PHARMACEUTICALS LLC yMETRONIDAZOL TAB 250MG 65162030308 AKYMA PHARMACEUTICALS LLC yMETRONIDAZOL TAB 250MG 65162030328 AKYMA PHARMACEUTICALS LLC yMETRONIDAZOL TAB 500MG 65162030404 AKYMA PHARMACEUTICALS LLC yMETRONIDAZOL TAB 500MG 65162030414 AKYMA PHARMACEUTICALS LLC ySMZ/TMP DS TAB 800-160 65162031301 AKYMA PHARMACEUTICALS LLC ySMZ/TMP DS TAB 800-160 65162031302 AKYMA PHARMACEUTICALS LLC ySMZ/TMP DS TAB 800-160 65162031308 AKYMA PHARMACEUTICALS LLC ySMZ/TMP DS TAB 800-160 65162031314 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 325MG 65162035005 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 325MG 65162035010 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 325MG 65162035011 AKYMA PHARMACEUTICALS LLC yFOLIC ACID TAB 1MG 65162036110 AKYMA PHARMACEUTICALS LLC yFOLIC ACID TAB 1MG 65162036111 AKYMA PHARMACEUTICALS LLC yASPIRIN TAB 325MG EC 65162038211 AKYMA PHARMACEUTICALS LLC ySENNA CONCEN TAB 8.6MG 65162044010 AKYMA PHARMACEUTICALS LLC ySENNA CONCEN TAB 8.6MG 65162044011 AKYMA PHARMACEUTICALS LLC ySIMETHICONE CHW 80MG 65162044310 AKYMA PHARMACEUTICALS LLC yDIPHENHYDRAM CAP 25MG 65162051610 AKYMA PHARMACEUTICALS LLC yDIPHENHYDRAM CAP 25MG 65162051611 AKYMA PHARMACEUTICALS LLC yDIPHENHYDRAM CAP 50MG 65162051810 AKYMA PHARMACEUTICALS LLC yDIPHENHYDRAM CAP 50MG 65162051811 AKYMA PHARMACEUTICALS LLC yDOXYCYCL HYC CAP 100MG 65162052705 AKYMA PHARMACEUTICALS LLC yDOXYCYCL HYC CAP 100MG 65162052714 AKYMA PHARMACEUTICALS LLC yDOXYCYCL HYC CAP 100MG 65162052728 AKYMA PHARMACEUTICALS LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DOXYCYCL HYC CAP 100MG 65162052750 AKYMA PHARMACEUTICALS LLC yA-TAN 12X SUS 65162053086 AKYMA PHARMACEUTICALS LLC ySUCRALFATE TAB 1GM 65162054610 AKYMA PHARMACEUTICALS LLC ySUCRALFATE TAB 1GM 65162054650 AKYMA PHARMACEUTICALS LLC yPRIMIDONE TAB 250MG 65162054711 AKYMA PHARMACEUTICALS LLC yRHINACLEAR TAB DOSE PAC 65162055002 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 200MG 65162056505 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 200MG 65162056510 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 200MG 65162056511 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 200MG 65162056524 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 200MG 65162056550 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 400MG 65162056810 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 400MG 65162056850 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 600MG 65162056910 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 600MG 65162056950 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 800MG 65162057010 AKYMA PHARMACEUTICALS LLC yIBUPROFEN TAB 800MG 65162057050 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 500MG 65162060210 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 500MG 65162060211 AKYMA PHARMACEUTICALS LLC yACETAMIN CHW 80MG 65162060303 AKYMA PHARMACEUTICALS LLC yACETAMIN CHW 80MG 65162060310 AKYMA PHARMACEUTICALS LLC yANALGESIC TAB 65162060510 AKYMA PHARMACEUTICALS LLC yANALGESIC TAB 65162060511 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 500MG 65162060710 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 500MG 65162060711 AKYMA PHARMACEUTICALS LLC yACETAMIN TAB 500MG 65162060770 AKYMA PHARMACEUTICALS LLC yHYDROXYCHLOR TAB 200MG 65162061010 AKYMA PHARMACEUTICALS LLC yDOCUSATE CAL CAP 240MG 65162061310 AKYMA PHARMACEUTICALS LLC yDOCUSATE CAL CAP 240MG 65162061311 AKYMA PHARMACEUTICALS LLC yDOCUSATE SOD CAP 100MG 65162061410 AKYMA PHARMACEUTICALS LLC yDOCUSATE SOD CAP 100MG 65162061411 AKYMA PHARMACEUTICALS LLC yPRENATAL 1 TAB PLUS 1 65162063560 AKYMA PHARMACEUTICALS LLC yPRENATAL TAB PLUS 65162066810 AKYMA PHARMACEUTICALS LLC yPRENATAL TAB PLUS 65162066850 AKYMA PHARMACEUTICALS LLC yTANNATE PED SUS 65162075686 AKYMA PHARMACEUTICALS LLC yTANNATE PED SUS 65162075690 AKYMA PHARMACEUTICALS LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FOLPACE RX TAB 68220001890 ALAVEN PHARMACEUTICAL, LLC yHEXAFED TAB 4-60MG 68220002710 ALAVEN PHARMACEUTICAL, LLC yHEXAFLU TAB 2-45-650 68220003610 ALAVEN PHARMACEUTICAL, LLC yCALAFOL RX TAB 68220009090 ALAVEN PHARMACEUTICAL, LLC yNEVANAC SUS 0.1% 00065000203 ALCON LABORATORIES, INC. yOSMOGLYN SOL 50% 00065003508 ALCON LABORATORIES, INC. yNAPHCON SOL 0.012%OP 00065007801 ALCON LABORATORIES, INC. yNAPHCON-A SOL OP 00065008515 ALCON LABORATORIES, INC. yFLUORESCITE INJ 10% OP 00065009205 ALCON LABORATORIES, INC. yFLUORESCITE INJ 25% OP 00065009402 ALCON LABORATORIES, INC. yFLAREX SUS 0.1% OP 00065009605 ALCON LABORATORIES, INC. yPILOPINE HS GEL 4% OP 00065021535 ALCON LABORATORIES, INC. yBETOPTIC-S SUS 0.25% OP 00065024605 ALCON LABORATORIES, INC. yBETOPTIC-S SUS 0.25% OP 00065024610 ALCON LABORATORIES, INC. yBETOPTIC-S SUS 0.25% OP 00065024615 ALCON LABORATORIES, INC. yBETOPTIC-S SUS 0.25% OP 00065024620 ALCON LABORATORIES, INC. yTRAVATAN Z SOL 0.004% 00065026005 ALCON LABORATORIES, INC. yTRAVATAN Z SOL 0.004% 00065026025 ALCON LABORATORIES, INC. yTRAVATAN SOL 0.004% 00065026625 ALCON LABORATORIES, INC. yTRAVATAN SOL 0.004% 00065026634 ALCON LABORATORIES, INC. yPATANOL SOL 0.1% OP 00065027105 ALCON LABORATORIES, INC. yAZOPT SUS 1% OP 00065027505 ALCON LABORATORIES, INC. yAZOPT SUS 1% OP 00065027510 ALCON LABORATORIES, INC. yAZOPT SUS 1% OP 00065027515 ALCON LABORATORIES, INC. yEMADINE SOL 0.05% OP 00065032505 ALCON LABORATORIES, INC. yMYDFRIN SOL 2.5% OP 00065034203 ALCON LABORATORIES, INC. yALOMIDE SOL 0.1% OP 00065034510 ALCON LABORATORIES, INC. yMYDRIACYL SOL 1% OP 00065035503 ALCON LABORATORIES, INC. yCYCLOMYDRIL SOL OP 00065035902 ALCON LABORATORIES, INC. yCYCLOMYDRIL SOL OP 00065035905 ALCON LABORATORIES, INC. yCYCLOGYL SOL 0.5% OP 00065039515 ALCON LABORATORIES, INC. yCYCLOGYL SOL 1% OP 00065039602 ALCON LABORATORIES, INC. yCYCLOGYL SOL 1% OP 00065039605 ALCON LABORATORIES, INC. yCYCLOGYL SOL 1% OP 00065039615 ALCON LABORATORIES, INC. yCYCLOGYL SOL 2% OP 00065039702 ALCON LABORATORIES, INC. yCYCLOGYL SOL 2% OP 00065039705 ALCON LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CYCLOGYL SOL 2% OP 00065039715 ALCON LABORATORIES, INC. yTEARS NATURA SOL FREE OP 00065041625 ALCON LABORATORIES, INC. yTEARS NATURA SOL FREE OP 00065041636 ALCON LABORATORIES, INC. yTEARS NATURA SOL II OP 00065041815 ALCON LABORATORIES, INC. yTEARS NATURA SOL II OP 00065041830 ALCON LABORATORIES, INC. yBION TEARS SOL OP 00065041918 ALCON LABORATORIES, INC. yBION TEARS SOL OP 00065041928 ALCON LABORATORIES, INC. yTEARS NATURA OIN PM 00065042005 ALCON LABORATORIES, INC. yTEARS NATURA SOL FORTE 00065042615 ALCON LABORATORIES, INC. yTEARS NATURA SOL FORTE 00065042622 ALCON LABORATORIES, INC. yTEARS NATURA SOL FORTE 00065042623 ALCON LABORATORIES, INC. yTEARS NATURA SOL FORTE 00065042630 ALCON LABORATORIES, INC. ySYSTANE FREE GEL 00065042815 ALCON LABORATORIES, INC. ySYSTANE SOL 00065042915 ALCON LABORATORIES, INC. ySYSTANE SOL 00065042921 ALCON LABORATORIES, INC. ySYSTANE SOL 00065042930 ALCON LABORATORIES, INC. ySYSTANE PF SOL 00065043132 ALCON LABORATORIES, INC. ySYSTANE PF SOL 00065043156 ALCON LABORATORIES, INC. yEYE STREAM SOL OP 00065053001 ALCON LABORATORIES, INC. yEYE STREAM SOL OP 00065053004 ALCON LABORATORIES, INC. yVEXOL SUS 1% OP 00065062703 ALCON LABORATORIES, INC. yVEXOL SUS 1% OP 00065062707 ALCON LABORATORIES, INC. yMAXITROL OIN 0.1% OP 00065063136 ALCON LABORATORIES, INC. yTOBREX SOL 0.3% OP 00065064305 ALCON LABORATORIES, INC. yTOBREX OIN 0.3% OP 00065064435 ALCON LABORATORIES, INC. yNATACYN SUS 5% OP 00065064515 ALCON LABORATORIES, INC. yTOBRADEX SUS OP 00065064705 ALCON LABORATORIES, INC. yTOBRADEX SUS OP 00065064710 ALCON LABORATORIES, INC. yTOBRADEX SUS OP 00065064725 ALCON LABORATORIES, INC. yTOBRADEX OIN OP 00065064835 ALCON LABORATORIES, INC. yCILOXAN OIN 0.3% OP 00065065435 ALCON LABORATORIES, INC. yCILOXAN SOL 0.3% OP 00065065605 ALCON LABORATORIES, INC. yIOPIDINE SOL 1% OP 00065066010 ALCON LABORATORIES, INC. yIOPIDINE SOL 0.5% OP 00065066505 ALCON LABORATORIES, INC. yIOPIDINE SOL 0.5% OP 00065066510 ALCON LABORATORIES, INC. yATROPINE SUL SOL 1% OP 00065070212 ALCON LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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PILOCARPINE SOL 1% OP 00065072812 ALCON LABORATORIES, INC. yTETRACAINE SOL 0.5% OP 00065074112 ALCON LABORATORIES, INC. yPILOCARPINE SOL 2% OP 00065075212 ALCON LABORATORIES, INC. yPILOCARPINE SOL 4% OP 00065075612 ALCON LABORATORIES, INC. yVIGAMOX DRO 0.5% 00065401303 ALCON LABORATORIES, INC. yCIPRO HC SUS OTIC 00065853110 ALCON LABORATORIES, INC. yCIPRODEX SUS 0.3-0.1% 00065853302 ALCON LABORATORIES, INC. yALCAINE SOL 0.5% OP 00998001615 ALCON LABORATORIES, INC. yNAPHCON SOL 0.012%OP 00998007815 ALCON LABORATORIES, INC. yISOPTO CARP SOL 1% OP 00998020315 ALCON LABORATORIES, INC. yISOPTO CARP SOL 2% OP 00998020415 ALCON LABORATORIES, INC. yISOPTO CARP SOL 4% OP 00998020615 ALCON LABORATORIES, INC. yISO CARBACHO SOL 1.5% OP 00998022315 ALCON LABORATORIES, INC. yISO CARBACHO SOL 3% OP 00998022515 ALCON LABORATORIES, INC. yISO ATROPINE SOL 1% OP 00998030305 ALCON LABORATORIES, INC. yISO ATROPINE SOL 1% OP 00998030315 ALCON LABORATORIES, INC. yISO HOMATROP SOL 2% OP 00998031105 ALCON LABORATORIES, INC. yISO HOMATROP SOL 5% OP 00998031505 ALCON LABORATORIES, INC. yISO HOMATROP SOL 5% OP 00998031515 ALCON LABORATORIES, INC. yISO HYOSCINE SOL 0.25% OP 00998033105 ALCON LABORATORIES, INC. yISO HYOSCINE SOL 0.25% OP 00998033115 ALCON LABORATORIES, INC. yMYDFRIN SOL 2.5% OP 00998034205 ALCON LABORATORIES, INC. yMYDRIACYL SOL 1% OP 00998035515 ALCON LABORATORIES, INC. yISOPTO TEARS SOL 0.5% OP 00998040815 ALCON LABORATORIES, INC. yTEARS NATURA SOL FORTE 00998041315 ALCON LABORATORIES, INC. yTEARS NATURA SOL FORTE 00998041330 ALCON LABORATORIES, INC. yMAXIDEX SUS 0.1% OP 00998061505 ALCON LABORATORIES, INC. yMAXIDEX SUS 0.1% OP 00998061515 ALCON LABORATORIES, INC. yMAXITROL SUS 0.1% OP 00998063006 ALCON LABORATORIES, INC. yECONOPRED PL SUS 1% OP 00998063705 ALCON LABORATORIES, INC. yECONOPRED PL SUS 1% OP 00998063710 ALCON LABORATORIES, INC. yPOLY-PRED SUS OP 00023002805 ALLERGAN INC yTAZORAC GEL 0.1% 00023004203 ALLERGAN INC yTAZORAC GEL 0.1% 00023004210 ALLERGAN INC yPRED-G S.O.P OIN OP 00023006604 ALLERGAN INC yPRED-G SUS OP 00023010602 ALLERGAN INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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PRED-G SUS OP 00023010605 ALLERGAN INC yPRED-G SUS OP 00023010610 ALLERGAN INC yCHLOROPTIC OIN S.O.P 1% 00023030104 ALLERGAN INC yLACRI-LUBE OIN S.O.P. 00023031204 ALLERGAN INC yLACRI-LUBE OIN S.O.P. 00023031207 ALLERGAN INC yBLEPHAMIDE OIN S.O.P. 00023031304 ALLERGAN INC yFML S.O.P. OIN 0.1% OP 00023031604 ALLERGAN INC yREFRESH PLUS SOL 0.5% OP 00023040330 ALLERGAN INC yREFRESH PLUS SOL 0.5% OP 00023040350 ALLERGAN INC yREFRESH PLUS SOL 0.5% OP 00023040370 ALLERGAN INC yREFRESH SOL OP 00023050601 ALLERGAN INC yREFRESH SOL OP 00023050650 ALLERGAN INC yRELIEF SOL EYE DROP 00023050701 ALLERGAN INC yERYMAX SOL 2% 00023054002 ALLERGAN INC yERYMAX SOL 2% 00023054004 ALLERGAN INC yREFRESH-PM OIN OP 00023066704 ALLERGAN INC yMAXIFLOR CRE 0.05% 00023076630 ALLERGAN INC yMAXIFLOR CRE 0.05% 00023076660 ALLERGAN INC yMAXIFLOR OIN 0.05% 00023077030 ALLERGAN INC yMAXIFLOR OIN 0.05% 00023077060 ALLERGAN INC yREFRESH TEAR SOL 0.5% OP 00023079815 ALLERGAN INC yREFRESH TEAR SOL 0.5% OP 00023079830 ALLERGAN INC yFLUOROPLEX CRE 1% 00023081230 ALLERGAN INC yBOTOX INJ 100UNIT 00023114501 ALLERGAN INC yACULAR SOL 0.5% OP 00023218103 ALLERGAN INC yACULAR SOL 0.5% OP 00023218105 ALLERGAN INC yACULAR SOL 0.5% OP 00023218110 ALLERGAN INC yNAFTIN CRE 1% 00023412615 ALLERGAN INC yNAFTIN CRE 1% 00023412630 ALLERGAN INC yNAFTIN CRE 1% 00023412660 ALLERGAN INC yERYGEL GEL 2% 00023431230 ALLERGAN INC yERYGEL GEL 2% 00023431260 ALLERGAN INC yBETAGAN SOL 0.5% OP 00023438502 ALLERGAN INC yBETAGAN SOL 0.5% OP 00023438505 ALLERGAN INC yBETAGAN SOL 0.5% OP 00023438510 ALLERGAN INC yBETAGAN SOL 0.5% OP 00023438515 ALLERGAN INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETAGAN SOL 0.25% OP 00023452605 ALLERGAN INC yBETAGAN SOL 0.25% OP 00023452610 ALLERGAN INC yCELLUVISC SOL 1% OP 00023455430 ALLERGAN INC yNAFTIN GEL 1% 00023477020 ALLERGAN INC yNAFTIN GEL 1% 00023477040 ALLERGAN INC yNAFTIN GEL 1% 00023477060 ALLERGAN INC yREFRESH PLUS SOL 0.5% OP 00023548730 ALLERGAN INC yREFRESH PLUS SOL 0.5% OP 00023548750 ALLERGAN INC yPOLYTRIM SOL OP 00023782410 ALLERGAN INC yELIMITE CRE 5% 00023791560 ALLERGAN INC yTAZORAC GEL 0.05% 00023833503 ALLERGAN INC yTAZORAC GEL 0.05% 00023833510 ALLERGAN INC yAZELEX CRE 20% 00023869430 ALLERGAN INC yAZELEX CRE 20% 00023869450 ALLERGAN INC yALOCRIL SOL 2% 00023884205 ALLERGAN INC yACULAR PF SOL 0.5% OP 00023905504 ALLERGAN INC yTAZORAC CRE 0.05% 00023915515 ALLERGAN INC yTAZORAC CRE 0.05% 00023915530 ALLERGAN INC yTAZORAC CRE 0.05% 00023915560 ALLERGAN INC yTAZORAC CRE 0.1% 00023915615 ALLERGAN INC yTAZORAC CRE 0.1% 00023915630 ALLERGAN INC yTAZORAC CRE 0.1% 00023915660 ALLERGAN INC yRESTASIS EMU 0.05% 00023916332 ALLERGAN INC yALPHAGAN P SOL 0.15% 00023917705 ALLERGAN INC yALPHAGAN P SOL 0.15% 00023917710 ALLERGAN INC yALPHAGAN P SOL 0.15% 00023917715 ALLERGAN INC yLUMIGAN SOL 0.03% 00023918703 ALLERGAN INC yLUMIGAN SOL 0.03% 00023918705 ALLERGAN INC yLUMIGAN SOL 0.03% 00023918707 ALLERGAN INC yELESTAT DRO 0.05% 00023920105 ALLERGAN INC yREFRESH SOL 1% 00023920515 ALLERGAN INC yREFRESH SOL 1% 00023920530 ALLERGAN INC yPROPINE SOL 0.1% OP 00023920810 ALLERGAN INC yPROPINE SOL 0.1% OP 00023920815 ALLERGAN INC yZYMAR DRO 0.3% 00023921805 ALLERGAN INC yBOTOX COSMET INJ 100UNIT 00023923201 ALLERGAN INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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REFRESH ENDU DRO 1-1% 00023923520 ALLERGAN INC yAVAGE CRE 0.1% 00023923630 ALLERGAN INC yACULAR LS SOL 0.4% 00023927705 ALLERGAN INC yALPHAGAN P SOL 0.1% 00023932105 ALLERGAN INC yALPHAGAN P SOL 0.1% 00023932110 ALLERGAN INC yALPHAGAN P SOL 0.1% 00023932115 ALLERGAN INC yBLEPH-10 SOL 10% OP 11980001103 ALLERGAN INC yBLEPH-10 SOL 10% OP 11980001105 ALLERGAN INC yBLEPHAMIDE SUS OP 11980002205 ALLERGAN INC yBLEPHAMIDE SUS OP 11980002210 ALLERGAN INC yOPHTHETIC SOL 0.5% OP 11980004815 ALLERGAN INC yEPIFRIN SOL 2% OP 11980005815 ALLERGAN INC yGENOPTIC SOL 0.3% OP 11980011701 ALLERGAN INC yEPIFRIN SOL 1% OP 11980012215 ALLERGAN INC yALBALON SOL LIQUIFLM 11980015415 ALLERGAN INC yPRED MILD SUS 0.12% OP 11980017405 ALLERGAN INC yPRED MILD SUS 0.12% OP 11980017410 ALLERGAN INC yPRED FORTE SUS 1% OP 11980018001 ALLERGAN INC yPRED FORTE SUS 1% OP 11980018005 ALLERGAN INC yPRED FORTE SUS 1% OP 11980018010 ALLERGAN INC yPRED FORTE SUS 1% OP 11980018015 ALLERGAN INC yFML LIQUIFLM SUS 0.1% OP 11980021101 ALLERGAN INC yFML LIQUIFLM SUS 0.1% OP 11980021105 ALLERGAN INC yFML LIQUIFLM SUS 0.1% OP 11980021110 ALLERGAN INC yFML LIQUIFLM SUS 0.1% OP 11980021115 ALLERGAN INC yFML FORTE SUS 0.25% OP 11980022802 ALLERGAN INC yFML FORTE SUS 0.25% OP 11980022805 ALLERGAN INC yFML FORTE SUS 0.25% OP 11980022810 ALLERGAN INC yFML FORTE SUS 0.25% OP 11980022815 ALLERGAN INC yFML-S SUS LIQUIFLM 11980042205 ALLERGAN INC yFML-S SUS LIQUIFLM 11980042210 ALLERGAN INC yOCUFLOX SOL 0.3% OP 11980077905 ALLERGAN INC yOCUFLOX SOL 0.3% OP 11980077910 ALLERGAN INC yOCUFEN SOL 0.03% OP 11980080103 ALLERGAN INC yRONDEC-DM DRO 3.5-1-3 68188005003 ALLIANT PHARMACEUTICALS, INC. yRONDEC-DM SYP 68188005104 ALLIANT PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RONDEC-DM SYP 68188005116 ALLIANT PHARMACEUTICALS, INC. yRONDEC DRO 68188006003 ALLIANT PHARMACEUTICALS, INC. yRONDEC SYP 68188006104 ALLIANT PHARMACEUTICALS, INC. yRONDEC SYP 68188006116 ALLIANT PHARMACEUTICALS, INC. yMETHYLIN CHW 2.5MG 68188013201 ALLIANT PHARMACEUTICALS, INC. yMETHYLIN CHW 5MG 68188013501 ALLIANT PHARMACEUTICALS, INC. yMETHYLIN CHW 10MG 68188013701 ALLIANT PHARMACEUTICALS, INC. yORAPRED ODT TAB 10MG 68188048002 ALLIANT PHARMACEUTICALS, INC. yORAPRED ODT TAB 15MG 68188048202 ALLIANT PHARMACEUTICALS, INC. yORAPRED ODT TAB 30MG 68188048402 ALLIANT PHARMACEUTICALS, INC. yMETHYLIN SOL 5MG/5ML 68188088150 ALLIANT PHARMACEUTICALS, INC. yMETHYLIN SOL 10MG/5ML 68188088250 ALLIANT PHARMACEUTICALS, INC. yLINDANE SHA 1% 68188093190 ALLIANT PHARMACEUTICALS, INC. yLINDANE LOT 1% 68188093590 ALLIANT PHARMACEUTICALS, INC. yGEONE (G-1) CAP 59743000401 ALPHAGEN LABORATORIES, INC. yGG 200 NR TAB 200MG 59743001901 ALPHAGEN LABORATORIES, INC. yCOTUSS-V SYP 5-100/5 59743002016 ALPHAGEN LABORATORIES, INC. yHYOSCYAMINE TAB 0.125MG 59743002601 ALPHAGEN LABORATORIES, INC. yD-AMINE-SR CAP 8-120 CR 59743005301 ALPHAGEN LABORATORIES, INC. yD-AMINE-SR CAP 8-120 CR 59743005305 ALPHAGEN LABORATORIES, INC. yAZO-GESIC TAB 95MG 59743011530 ALPHAGEN LABORATORIES, INC. yALTEX-PSE TAB 120-600 59743015901 ALPHAGEN LABORATORIES, INC. yALTEX-PSE TAB 120-600 59743015905 ALPHAGEN LABORATORIES, INC. yKADIAN CAP 20MG CR 63857032206 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 20MG CR 63857032211 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 50MG CR 63857032306 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 50MG CR 63857032311 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 100MG CR 63857032406 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 100MG CR 63857032411 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 30MG CR 63857032506 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 30MG CR 63857032511 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 60MG CR 63857032606 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 60MG CR 63857032611 ALPHARMA BRANDED PRODUCTS DIVISION, INC yKADIAN CAP 80MG 63857041211 ALPHARMA BRANDED PRODUCTS DIVISION, INC yINFANTAIRE DRO 80/0.8ML 59390000113 ALTAIRE PHARMACEUTICALS, INC yINFANTAIRE DRO 80/0.8ML 59390000118 ALTAIRE PHARMACEUTICALS, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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APRA ELX 160/5ML 59390000235 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000505 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000510 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000513 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000535 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000541 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000546 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP DM 59390000547 ALTAIRE PHARMACEUTICALS, INC yALTAFED SYP 1.25-30 59390000805 ALTAIRE PHARMACEUTICALS, INC yALTAFED SYP 1.25-30 59390000810 ALTAIRE PHARMACEUTICALS, INC yALTAFED SYP 1.25-30 59390000813 ALTAIRE PHARMACEUTICALS, INC yALTAFED SYP 1.25-30 59390000835 ALTAIRE PHARMACEUTICALS, INC yALTAFED SYP 1.25-30 59390000846 ALTAIRE PHARMACEUTICALS, INC yALTAFED SYP 1.25-30 59390000847 ALTAIRE PHARMACEUTICALS, INC ySEUDAFAIRE SYP COUGH 59390000935 ALTAIRE PHARMACEUTICALS, INC ySEUDAFAIRE SYP COUGH 59390000941 ALTAIRE PHARMACEUTICALS, INC yALTAMINIC SYP 2-12.5/5 59390001035 ALTAIRE PHARMACEUTICALS, INC yALTAMINIC SYP 2-12.5/5 59390001041 ALTAIRE PHARMACEUTICALS, INC yALTAMINIC DM SYP 59390001135 ALTAIRE PHARMACEUTICALS, INC yMULTIMINIC SYP 59390001235 ALTAIRE PHARMACEUTICALS, INC yPEDI-ATRIC LIQ CGH/COLD 59390001535 ALTAIRE PHARMACEUTICALS, INC yPEDI-ATRIC LIQ NITEREST 59390001635 ALTAIRE PHARMACEUTICALS, INC yACNE-CLEAR GEL 10% 59390003022 ALTAIRE PHARMACEUTICALS, INC yALTASEPTIC SPR 59390004317 ALTAIRE PHARMACEUTICALS, INC yINSTACORT 10 GEL 1% 59390004901 ALTAIRE PHARMACEUTICALS, INC yINSTACORT 10 GEL 1% 59390004917 ALTAIRE PHARMACEUTICALS, INC yANTACID I SUS 59390005013 ALTAIRE PHARMACEUTICALS, INC yANTACID I SUS 59390005018 ALTAIRE PHARMACEUTICALS, INC yANTACID I SUS 59390005045 ALTAIRE PHARMACEUTICALS, INC yANTACID II SUS 59390005113 ALTAIRE PHARMACEUTICALS, INC yANTACID II SUS 59390005118 ALTAIRE PHARMACEUTICALS, INC yANTACID II SUS 59390005145 ALTAIRE PHARMACEUTICALS, INC yANTACID III SUS 59390005213 ALTAIRE PHARMACEUTICALS, INC yANTACID III SUS 59390005218 ALTAIRE PHARMACEUTICALS, INC yANTACID III SUS 59390005245 ALTAIRE PHARMACEUTICALS, INC yTRIPLE ANTIB OIN PLUS 59390005614 ALTAIRE PHARMACEUTICALS, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIPLE ANTIB OIN PLUS 59390005617 ALTAIRE PHARMACEUTICALS, INC yMILK OF MAGN SUS 59390005713 ALTAIRE PHARMACEUTICALS, INC yMILK OF MAGN SUS 59390005718 ALTAIRE PHARMACEUTICALS, INC yMILK OF MAGN SUS 59390005745 ALTAIRE PHARMACEUTICALS, INC yMILK OF MAGN SUS 59390005746 ALTAIRE PHARMACEUTICALS, INC yANTACID IV SUS PLUS 59390005813 ALTAIRE PHARMACEUTICALS, INC yANTACID IV SUS PLUS 59390005818 ALTAIRE PHARMACEUTICALS, INC yANTACID IV SUS PLUS 59390005845 ALTAIRE PHARMACEUTICALS, INC yFUNGI GUARD SOL 1% 59390006218 ALTAIRE PHARMACEUTICALS, INC yALTARYL SYP 12.5/5ML 59390006505 ALTAIRE PHARMACEUTICALS, INC yALTARYL SYP 12.5/5ML 59390006510 ALTAIRE PHARMACEUTICALS, INC yALTARYL SYP 12.5/5ML 59390006513 ALTAIRE PHARMACEUTICALS, INC yALTARYL SYP 12.5/5ML 59390006535 ALTAIRE PHARMACEUTICALS, INC yALTARYL SYP 12.5/5ML 59390006546 ALTAIRE PHARMACEUTICALS, INC yALTARYL SYP 12.5/5ML 59390006547 ALTAIRE PHARMACEUTICALS, INC yTRIPLE ANTIB OIN PLUS MAX 59390009617 ALTAIRE PHARMACEUTICALS, INC yALTARUSSIN SYP 100/5ML 59390009835 ALTAIRE PHARMACEUTICALS, INC yGONIOTAIRE SOL 2.5% OP 59390018213 ALTAIRE PHARMACEUTICALS, INC yFLUORESCEIN INJ 25% OP 59390018702 ALTAIRE PHARMACEUTICALS, INC yFLUORESCEIN INJ 10% OP 59390018805 ALTAIRE PHARMACEUTICALS, INC yHOMATROPAIRE SOL 5% OP 59390019205 ALTAIRE PHARMACEUTICALS, INC yFLUORESCEIN INJ 10% OP 59390019905 ALTAIRE PHARMACEUTICALS, INC yFLUORESCEIN INJ 25% OP 59390020002 ALTAIRE PHARMACEUTICALS, INC yFLUCAINE SOL 0.25-0.5 59390020505 ALTAIRE PHARMACEUTICALS, INC yALTAFLUOR SOL 0.25-0.4 59390020605 ALTAIRE PHARMACEUTICALS, INC yCONCERTA TAB 18MG 17314585002 ALZA CORPORATION yCONCERTA TAB 36MG 17314585102 ALZA CORPORATION yCONCERTA TAB 54MG 17314585202 ALZA CORPORATION yCONCERTA TAB 27MG 17314585302 ALZA CORPORATION yDITROPAN XL TAB 5MG 17314850001 ALZA CORPORATION yDITROPAN XL TAB 10MG 17314850101 ALZA CORPORATION yDITROPAN XL TAB 15MG 17314850201 ALZA CORPORATION yDITROPAN TAB 5MG 17314920001 ALZA CORPORATION yDITROPAN SYP 5MG/5ML 17314920104 ALZA CORPORATION yURISPAS TAB 100MG 17314922001 ALZA CORPORATION yELMIRON CAP 100MG 17314930001 ALZA CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NEUTRA-PHOS POW 17314931102 ALZA CORPORATION yNEUTRA-PHOS POW -K 17314931302 ALZA CORPORATION yPOLYCITRA-K POW CRYSTALS 17314932001 ALZA CORPORATION yPOLYCITRA-K SOL 17314932101 ALZA CORPORATION yPOLYCITRA SYP 17314932201 ALZA CORPORATION yPOLYCITRA-LC SOL 17314932301 ALZA CORPORATION yBICITRA SOL 17314933001 ALZA CORPORATION yMYCELEX TRO 10MG 17314940001 ALZA CORPORATION yMYCELEX TRO 10MG 17314940002 ALZA CORPORATION yMYCELEX TRO 10MG 17314940003 ALZA CORPORATION yDOXIL INJ 2MG/ML 17314960001 ALZA CORPORATION yDOXIL INJ 2MG/ML 17314960002 ALZA CORPORATION yAMBIFED-G TAB 60-1000M 66870001201 AMBI PHARMACEUTICALS, INC. yAMBIFED-G DM TAB 66870001501 AMBI PHARMACEUTICALS, INC. yMAXIPHEN TAB 66870001901 AMBI PHARMACEUTICALS, INC. yMAXIPHEN DM TAB 66870002001 AMBI PHARMACEUTICALS, INC. yMAXIPHEN-G TAB 66870002501 AMBI PHARMACEUTICALS, INC. yMAXIPHEN-G TAB DM 66870002601 AMBI PHARMACEUTICALS, INC. yMAXIPHEN ADT TAB 66870003001 AMBI PHARMACEUTICALS, INC. yAMERIFED LIQ 4-80MG/5 66870003201 AMBI PHARMACEUTICALS, INC. yAMERITUSS AD LIQ 10-3-15 66870003401 AMBI PHARMACEUTICALS, INC. yAMERIFED DM SYP 66870003501 AMBI PHARMACEUTICALS, INC. yAMBI 45/800 TAB 66870011501 AMBI PHARMACEUTICALS, INC. yAMBI 45/800/ TAB 30 66870011601 AMBI PHARMACEUTICALS, INC. yAMBI 5/15/ LIQ 100 66870011701 AMBI PHARMACEUTICALS, INC. yAMBI 80/700 TAB 66870011801 AMBI PHARMACEUTICALS, INC. yAMBI 80/700/ TAB 40 66870011901 AMBI PHARMACEUTICALS, INC. yAMBI 1000/55 TAB 66870012001 AMBI PHARMACEUTICALS, INC. yAMBI 60/580 TAB 66870012101 AMBI PHARMACEUTICALS, INC. yAMBI 60/580/ TAB 30 66870012201 AMBI PHARMACEUTICALS, INC. yAMBI 80/780 TAB 66870021801 AMBI PHARMACEUTICALS, INC. yAMBI 80/780/ TAB 40 66870021901 AMBI PHARMACEUTICALS, INC. yMAXINATE TAB 66870060101 AMBI PHARMACEUTICALS, INC. yTIME-HIST QD TAB 66870070101 AMBI PHARMACEUTICALS, INC. yAMBI 1000/5 TAB 66870071301 AMBI PHARMACEUTICALS, INC. yAMBI 40/1000 TAB 66870091901 AMBI PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMBI 40/1000 TAB /60 66870092001 AMBI PHARMACEUTICALS, INC. yISOMETH/APAP CAP DICHLOR 62584013900 AMERICAN HEALTH PACKAGING yISOMETH/APAP CAP DICHLOR 62584013901 AMERICAN HEALTH PACKAGING yISOMETH/APAP CAP DICHLOR 62584013918 AMERICAN HEALTH PACKAGING yLEVOTHYROXIN TAB 25MCG 62584014601 AMERICAN HEALTH PACKAGING yLEVOTHYROXIN TAB 50MCG 62584015401 AMERICAN HEALTH PACKAGING yLEVOTHYROXIN TAB 75MCG 62584015501 AMERICAN HEALTH PACKAGING yCEPHALEXIN CAP 250MG 62584023501 AMERICAN HEALTH PACKAGING yCEPHALEXIN CAP 500MG 62584023601 AMERICAN HEALTH PACKAGING yAMOXICILLIN CAP 250MG 62584023701 AMERICAN HEALTH PACKAGING yAMOXICILLIN CAP 500MG 62584023801 AMERICAN HEALTH PACKAGING yRANITIDINE TAB 150MG 62584025201 AMERICAN HEALTH PACKAGING yRANITIDINE TAB 150MG 62584025285 AMERICAN HEALTH PACKAGING yRANITIDINE TAB 300MG 62584025385 AMERICAN HEALTH PACKAGING yMETFORMIN TAB 500MG 62584025901 AMERICAN HEALTH PACKAGING yMETFORMIN TAB 500MG 62584025985 AMERICAN HEALTH PACKAGING yMETFORMIN TAB 850MG 62584033201 AMERICAN HEALTH PACKAGING yCLONIDINE TAB 0.2MG 62584033901 AMERICAN HEALTH PACKAGING yMETFORMIN TAB 1000MG 62584045201 AMERICAN HEALTH PACKAGING yMETFORMIN TAB 1000MG 62584045285 AMERICAN HEALTH PACKAGING yATENOLOL TAB 50MG 62584046701 AMERICAN HEALTH PACKAGING yATENOLOL TAB 50MG 62584046785 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 15MG 62584055601 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 30MG 62584055701 AMERICAN HEALTH PACKAGING yTRAMADOL HCL TAB 50MG 62584055901 AMERICAN HEALTH PACKAGING yCARBAMAZEPIN CHW 100MG 62584063901 AMERICAN HEALTH PACKAGING yCLONIDINE TAB 0.1MG 62584065701 AMERICAN HEALTH PACKAGING yCLONIDINE TAB 0.3MG 62584065901 AMERICAN HEALTH PACKAGING yDOCUSATE CAL CAP 240MG 62584068201 AMERICAN HEALTH PACKAGING yDOCUSATE SOD CAP 100MG 62584068301 AMERICAN HEALTH PACKAGING yDOCUSATE SOD CAP 100MG 62584068385 AMERICAN HEALTH PACKAGING yDOCUSATE SOD CAP 250MG 62584068401 AMERICAN HEALTH PACKAGING yALLOPURINOL TAB 300MG 62584071301 AMERICAN HEALTH PACKAGING yATENOLOL TAB 100MG 62584071501 AMERICAN HEALTH PACKAGING yQUININE SULF TAB 260MG 62584074000 AMERICAN HEALTH PACKAGING yQUININE SULF TAB 260MG 62584074001 AMERICAN HEALTH PACKAGING y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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QUININE SULF TAB 260MG 62584074005 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 400MG 62584074601 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 400MG 62584074685 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 600MG 62584074701 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 600MG 62584074733 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 600MG 62584074785 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 800MG 62584074801 AMERICAN HEALTH PACKAGING yIBUPROFEN TAB 800MG 62584074885 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 10MG 62584084201 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 10MG 62584084285 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 20MG 62584084301 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 20MG 62584084333 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 20MG 62584084385 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 40MG 62584084401 AMERICAN HEALTH PACKAGING yPROPRANOLOL TAB 80MG 62584084501 AMERICAN HEALTH PACKAGING yFOLIC ACID TAB 1MG 62584089701 AMERICAN HEALTH PACKAGING yFOLIC ACID TAB 1MG 62584089785 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 120MG CD 62584097401 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 120MG CD 62584097430 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 120MG CD 62584097485 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 120MG CD 62584097490 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 180MG CD 62584097501 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 180MG CD 62584097530 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 180MG CD 62584097585 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 180MG CD 62584097590 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 240MG CD 62584097601 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 240MG CD 62584097630 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 240MG CD 62584097685 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 240MG CD 62584097690 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 300MG CD 62584097701 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 300MG CD 62584097730 AMERICAN HEALTH PACKAGING yDILTIAZEM CAP 300MG CD 62584097790 AMERICAN HEALTH PACKAGING yWARFARIN TAB 2MG 62584098401 AMERICAN HEALTH PACKAGING yALLOPURINOL TAB 100MG 62584098801 AMERICAN HEALTH PACKAGING yALLOPURINOL TAB 100MG 62584098885 AMERICAN HEALTH PACKAGING yDIGOXIN TAB 0.125MG 62584098901 AMERICAN HEALTH PACKAGING y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIGOXIN TAB 0.125MG 62584098985 AMERICAN HEALTH PACKAGING yDIGOXIN TAB 0.25MG 62584099001 AMERICAN HEALTH PACKAGING yDIGOXIN TAB 0.25MG 62584099085 AMERICAN HEALTH PACKAGING yWARFARIN TAB 5MG 62584099401 AMERICAN HEALTH PACKAGING yWARFARIN TAB 5MG 62584099477 AMERICAN HEALTH PACKAGING ySUCRALFATE TAB 1GM 68084000101 AMERICAN HEALTH PACKAGING yTIZANIDINE TAB 4MG 68084001301 AMERICAN HEALTH PACKAGING yTIZANIDINE TAB 4MG 68084001385 AMERICAN HEALTH PACKAGING yFUROSEMIDE TAB 20MG 68084001401 AMERICAN HEALTH PACKAGING yFUROSEMIDE TAB 20MG 68084001485 AMERICAN HEALTH PACKAGING yFUROSEMIDE TAB 40MG 68084001601 AMERICAN HEALTH PACKAGING yFUROSEMIDE TAB 40MG 68084001685 AMERICAN HEALTH PACKAGING yFUROSEMIDE TAB 80MG 68084001701 AMERICAN HEALTH PACKAGING yFUROSEMIDE TAB 80MG 68084001785 AMERICAN HEALTH PACKAGING yALPRAZOLAM TAB 0.25MG 68084001801 AMERICAN HEALTH PACKAGING yALPRAZOLAM TAB 0.25MG 68084001885 AMERICAN HEALTH PACKAGING yALPRAZOLAM TAB 0.5MG 68084001901 AMERICAN HEALTH PACKAGING yALPRAZOLAM TAB 0.5MG 68084001985 AMERICAN HEALTH PACKAGING yALPRAZOLAM TAB 1MG 68084002001 AMERICAN HEALTH PACKAGING yALPRAZOLAM TAB 1MG 68084002085 AMERICAN HEALTH PACKAGING yWARFARIN TAB 2.5MG 68084002701 AMERICAN HEALTH PACKAGING yBUSPIRONE TAB 5MG 68084002801 AMERICAN HEALTH PACKAGING yBUSPIRONE TAB 10MG 68084002901 AMERICAN HEALTH PACKAGING yBUSPIRONE TAB 15MG 68084003001 AMERICAN HEALTH PACKAGING yNORTRIPTYLIN CAP 10MG 68084003101 AMERICAN HEALTH PACKAGING yNORTRIPTYLIN CAP 25MG 68084003201 AMERICAN HEALTH PACKAGING yBACLOFEN TAB 10MG 68084003801 AMERICAN HEALTH PACKAGING yBACLOFEN TAB 10MG 68084003885 AMERICAN HEALTH PACKAGING yBACLOFEN TAB 20MG 68084003901 AMERICAN HEALTH PACKAGING yBACLOFEN TAB 20MG 68084003985 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 10MG 68084004401 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 10MG 68084004405 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 10MG 68084004430 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 10MG 68084004485 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 10MG 68084004490 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 20MG 68084004500 AMERICAN HEALTH PACKAGING y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAROXETINE TAB 20MG 68084004501 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 20MG 68084004505 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 20MG 68084004530 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 20MG 68084004585 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 20MG 68084004590 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 30MG 68084004601 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 30MG 68084004605 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 30MG 68084004630 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 30MG 68084004685 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 30MG 68084004690 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 40MG 68084004701 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 40MG 68084004705 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 40MG 68084004730 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 40MG 68084004785 AMERICAN HEALTH PACKAGING yPAROXETINE TAB 40MG 68084004790 AMERICAN HEALTH PACKAGING ySENNA PLUS TAB 8.6-50MG 68084005001 AMERICAN HEALTH PACKAGING yLISINOPRIL TAB 2.5MG 68084005801 AMERICAN HEALTH PACKAGING yLISINOPRIL TAB 5MG 68084006001 AMERICAN HEALTH PACKAGING yLISINOPRIL TAB 10MG 68084006101 AMERICAN HEALTH PACKAGING yLISINOPRIL TAB 20MG 68084006201 AMERICAN HEALTH PACKAGING yLISINOPRIL TAB 40MG 68084006401 AMERICAN HEALTH PACKAGING yNEPHROCAPS CAP 68084006501 AMERICAN HEALTH PACKAGING yNEPHROCAPS CAP 68084006585 AMERICAN HEALTH PACKAGING yCIPROFLOXACN TAB 250MG 68084006901 AMERICAN HEALTH PACKAGING yCIPROFLOXACN TAB 500MG 68084007001 AMERICAN HEALTH PACKAGING yCIPROFLOXACN TAB 750MG 68084007101 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 100MG 68084007901 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 100MG 68084007908 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 100MG 68084007965 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 100MG 68084007990 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 300MG 68084008001 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 300MG 68084008008 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 300MG 68084008065 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 300MG 68084008090 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 400MG 68084008101 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 400MG 68084008108 AMERICAN HEALTH PACKAGING y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GABAPENTIN CAP 400MG 68084008165 AMERICAN HEALTH PACKAGING yGABAPENTIN CAP 400MG 68084008190 AMERICAN HEALTH PACKAGING yHYDROCHLOROT TAB 25MG 68084008601 AMERICAN HEALTH PACKAGING yHYDROCHLOROT TAB 50MG 68084008701 AMERICAN HEALTH PACKAGING yLORAZEPAM TAB 0.5MG 68084008801 AMERICAN HEALTH PACKAGING yLORAZEPAM TAB 1MG 68084008901 AMERICAN HEALTH PACKAGING yLORAZEPAM TAB 2MG 68084009001 AMERICAN HEALTH PACKAGING yMETOCLOPRAM TAB 10MG 68084009101 AMERICAN HEALTH PACKAGING yCARB/LEVO TAB 10-100MG 68084009201 AMERICAN HEALTH PACKAGING yCARB/LEVO TAB 25-100MG 68084009301 AMERICAN HEALTH PACKAGING yCARB/LEVO TAB 25-250MG 68084009401 AMERICAN HEALTH PACKAGING yBETHANECHOL TAB 25MG 68084011001 AMERICAN HEALTH PACKAGING yBUT/ASA/CAF/ CAP COD 30MG 68084011400 AMERICAN HEALTH PACKAGING yBUT/ASA/CAF/ CAP COD 30MG 68084011405 AMERICAN HEALTH PACKAGING yGUAIFENESIN TAB /DM ER 68084011500 AMERICAN HEALTH PACKAGING yQUININE SULF CAP 325MG 68084011630 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 15MG 68084011901 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 15MG 68084011906 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 15MG 68084011930 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 30MG 68084012001 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 30MG 68084012006 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 30MG 68084012030 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 45MG 68084012101 AMERICAN HEALTH PACKAGING yMIRTAZAPINE TAB 45MG 68084012130 AMERICAN HEALTH PACKAGING yGABAPENTIN TAB 600MG 68084012201 AMERICAN HEALTH PACKAGING yGABAPENTIN TAB 800MG 68084012301 AMERICAN HEALTH PACKAGING yOMEPRAZOLE CAP 20MG 68084012801 AMERICAN HEALTH PACKAGING yMETRONIDAZOL TAB 250MG 68084013001 AMERICAN HEALTH PACKAGING yLOVASTATIN TAB 10MG 68084013101 AMERICAN HEALTH PACKAGING yLOVASTATIN TAB 20MG 68084013201 AMERICAN HEALTH PACKAGING yLOVASTATIN TAB 40MG 68084013301 AMERICAN HEALTH PACKAGING yGLYB/METFORM TAB 1.25/250 68084013601 AMERICAN HEALTH PACKAGING yGLYB/METFORM TAB 2.5/500 68084013701 AMERICAN HEALTH PACKAGING yGLYB/METFORM TAB 5/500MG 68084013801 AMERICAN HEALTH PACKAGING yTRAMADL/APAP TAB 68084013901 AMERICAN HEALTH PACKAGING yPROMETHAZINE TAB 25MG 68084015501 AMERICAN HEALTH PACKAGING y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROMETHAZINE TAB 50MG 68084015601 AMERICAN HEALTH PACKAGING yALBUMIN HUM INJ 25% 52769025105 AMERICAN RED CROSS yALBUMIN HUM INJ 25% 52769025110 AMERICAN RED CROSS yPANGLOBULIN SOL 6GM 52769041706 AMERICAN RED CROSS yPANGLOBULIN SOL 12GM 52769041812 AMERICAN RED CROSS yALBUMIN HUM INJ 5% 52769045025 AMERICAN RED CROSS yALBUMIN HUM INJ 5% 52769045050 AMERICAN RED CROSS yALBUMIN HUM INJ 25% 52769045105 AMERICAN RED CROSS yALBUMIN HUM INJ 25% 52769045110 AMERICAN RED CROSS yMONARC-M INJ 250-1100 52769046001 AMERICAN RED CROSS yPOLYGAM S/D SOL 2.5GM 52769047172 AMERICAN RED CROSS yPOLYGAM S/D SOL 5GM 52769047175 AMERICAN RED CROSS yPOLYGAM S/D SOL 10GM 52769047180 AMERICAN RED CROSS yIMMUNE GLOBU INJ HUMAN 52769057622 AMERICAN RED CROSS yCYANOCOBALAM INJ 1000MCG 00517003125 AMERICAN REGENT LABORATORIES, INC. yCYANOCOBALAM INJ 1000MCG 00517003225 AMERICAN REGENT LABORATORIES, INC. yNEOSTIG METH INJ 1MG/ML 00517003325 AMERICAN REGENT LABORATORIES, INC. yNEOSTIG METH INJ 0.5MG/ML 00517003425 AMERICAN REGENT LABORATORIES, INC. yATROPINE SUL INJ 1MG/ML 00517010125 AMERICAN REGENT LABORATORIES, INC. yCYANOCOBALAM INJ 1000MCG 00517013001 AMERICAN REGENT LABORATORIES, INC. yCYANOCOBALAM INJ 1000MCG 00517013005 AMERICAN REGENT LABORATORIES, INC. yDEXPANTHENOL INJ 250MG/ML 00517013125 AMERICAN REGENT LABORATORIES, INC. yCALCITRIOL INJ 1MCG/ML 00517013225 AMERICAN REGENT LABORATORIES, INC. yDEXFERRUM INJ 50MG/ML 00517013410 AMERICAN REGENT LABORATORIES, INC. yDEXFERRUM INJ 50MG/ML 00517023410 AMERICAN REGENT LABORATORIES, INC. yPHENYLEPHRIN INJ 10MG/ML 00517029925 AMERICAN REGENT LABORATORIES, INC. yMETHYLENE BL INJ 1% 00517030110 AMERICAN REGENT LABORATORIES, INC. yMETHYLENE BL INJ 1% 00517031010 AMERICAN REGENT LABORATORIES, INC. yMETHYLENE BL INJ 1% 00517037271 AMERICAN REGENT LABORATORIES, INC. yMETHYLENE BL INJ 1% 00517037370 AMERICAN REGENT LABORATORIES, INC. yINDIGO CARMI INJ 8MG/ML 00517037510 AMERICAN REGENT LABORATORIES, INC. yATROPINE SUL INJ 0.4MG/ML 00517040125 AMERICAN REGENT LABORATORIES, INC. yPHENYLEPHRIN INJ 10MG/ML 00517040525 AMERICAN REGENT LABORATORIES, INC. yVASOPRESSIN INJ 20UNT/ML 00517041010 AMERICAN REGENT LABORATORIES, INC. yVASOPRESSIN INJ 10/0.5ML 00517051025 AMERICAN REGENT LABORATORIES, INC. yLIDOCAINE INJ 1% 00517062525 AMERICAN REGENT LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIDOCAINE INJ 2% 00517062625 AMERICAN REGENT LABORATORIES, INC. ySOD BICARB INJ 7.5% 00517063925 AMERICAN REGENT LABORATORIES, INC. ySOD CHLORIDE INJ 0.9%BACT 00517064825 AMERICAN REGENT LABORATORIES, INC. yBACTER WATER INJ BENZ ALC 00517066225 AMERICAN REGENT LABORATORIES, INC. yATROPINE SUL INJ 0.4/0.5 00517080525 AMERICAN REGENT LABORATORIES, INC. yHYDRALAZINE INJ 20MG/ML 00517090125 AMERICAN REGENT LABORATORIES, INC. yHYDRALAZINE INJ 20MG/ML 00517091125 AMERICAN REGENT LABORATORIES, INC. yATROPINE SUL INJ 1MG/ML 00517101025 AMERICAN REGENT LABORATORIES, INC. ySOD THIOSULF INJ 10% 00517101905 AMERICAN REGENT LABORATORIES, INC. yVASOPRESSIN INJ 20UNT/ML 00517102025 AMERICAN REGENT LABORATORIES, INC. yLEVOCARNITIN INJ 200MG/ML 00517104525 AMERICAN REGENT LABORATORIES, INC. yEPINEPHRINE INJ 1MG/ML 00517107125 AMERICAN REGENT LABORATORIES, INC. yEPINEPHRINE INJ 1MG/ML 00517113001 AMERICAN REGENT LABORATORIES, INC. yEPINEPHRINE INJ 1MG/ML 00517113005 AMERICAN REGENT LABORATORIES, INC. yDOPAMINE INJ 160MG/ML 00517130525 AMERICAN REGENT LABORATORIES, INC. ySOD BICARB INJ 8.4% 00517155025 AMERICAN REGENT LABORATORIES, INC. yDOPAMINE INJ 40MG/ML 00517180525 AMERICAN REGENT LABORATORIES, INC. yDOPAMINE INJ 80MG/ML 00517190525 AMERICAN REGENT LABORATORIES, INC. yNUTRILYTE II INJ 00517200025 AMERICAN REGENT LABORATORIES, INC. yNUTRILYTE II INJ 00517202025 AMERICAN REGENT LABORATORIES, INC. yL-CYSTEINE INJ 50MG/ML 00517205005 AMERICAN REGENT LABORATORIES, INC. yPOT ACETATE INJ 2MEQ/ML 00517205325 AMERICAN REGENT LABORATORIES, INC. yCYSTEINE HCL INJ 50MG/ML 00517206425 AMERICAN REGENT LABORATORIES, INC. ySOD ACETATE INJ 2MEQ/ML 00517209625 AMERICAN REGENT LABORATORIES, INC. yPOT PHOSPHAT INJ 3MM/ML 00517230525 AMERICAN REGENT LABORATORIES, INC. yPOT PHOSPHAT INJ 3MM/ML 00517231525 AMERICAN REGENT LABORATORIES, INC. yVENOFER INJ 20MG/ML 00517234010 AMERICAN REGENT LABORATORIES, INC. yVENOFER INJ 20MG/ML 00517234025 AMERICAN REGENT LABORATORIES, INC. yPOT PHOSPHAT INJ 3MM/ML 00517235025 AMERICAN REGENT LABORATORIES, INC. yPOT ACETATE INJ 2MEQ/ML 00517240025 AMERICAN REGENT LABORATORIES, INC. ySOD ACETATE INJ 2MEQ/ML 00517250025 AMERICAN REGENT LABORATORIES, INC. yCAFFEINE/SOD INJ BENZOATE 00517250210 AMERICAN REGENT LABORATORIES, INC. yMAGNESIUM SU INJ 50% 00517260225 AMERICAN REGENT LABORATORIES, INC. yMAGNESIUM SU INJ 50% 00517261025 AMERICAN REGENT LABORATORIES, INC. yMAGNESIUM SU INJ 50% 00517265025 AMERICAN REGENT LABORATORIES, INC. yCALCIUM CL INJ 10% 00517271025 AMERICAN REGENT LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SOD CHLORIDE INJ 4MEQ/ML 00517290025 AMERICAN REGENT LABORATORIES, INC. ySOD CHLORIDE INJ 4MEQ/ML 00517293025 AMERICAN REGENT LABORATORIES, INC. ySTERIL WATER INJ 00517300525 AMERICAN REGENT LABORATORIES, INC. ySTERIL WATER INJ 00517301025 AMERICAN REGENT LABORATORIES, INC. ySTERIL WATER INJ 00517302025 AMERICAN REGENT LABORATORIES, INC. ySTERIL WATER INJ 00517305025 AMERICAN REGENT LABORATORIES, INC. yMORRHUAT SOD INJ 5% 00517306501 AMERICAN REGENT LABORATORIES, INC. yNUTRILYTE INJ 00517310025 AMERICAN REGENT LABORATORIES, INC. yNUTRILYTE INJ 00517312025 AMERICAN REGENT LABORATORIES, INC. ySOD PHOSPHAT INJ 3MM/ML 00517340525 AMERICAN REGENT LABORATORIES, INC. ySOD PHOSPHAT INJ 3MM/ML 00517341525 AMERICAN REGENT LABORATORIES, INC. ySOD PHOSPHAT INJ 3MM/ML 00517345025 AMERICAN REGENT LABORATORIES, INC. yAMINOPHYLLIN INJ 25MG/ML 00517381025 AMERICAN REGENT LABORATORIES, INC. yAMINOPHYLLIN INJ 25MG/ML 00517382025 AMERICAN REGENT LABORATORIES, INC. yCALCIUM GLUC INJ 10% 00517390025 AMERICAN REGENT LABORATORIES, INC. yCALCIUM GLUC INJ 10% 00517391025 AMERICAN REGENT LABORATORIES, INC. yCALCIUM GLUC INJ 10% 00517395025 AMERICAN REGENT LABORATORIES, INC. yPAPAVERINE SOL 30MG/ML 00517400225 AMERICAN REGENT LABORATORIES, INC. yPAPAVERINE SOL 30MG/ML 00517401001 AMERICAN REGENT LABORATORIES, INC. yMANNITOL INJ 25% 00517405025 AMERICAN REGENT LABORATORIES, INC. yHYDROXYZ HCL INJ 25MG/ML 00517420125 AMERICAN REGENT LABORATORIES, INC. yGLYCOPYRROL INJ 0.2MG/ML 00517460125 AMERICAN REGENT LABORATORIES, INC. yGLYCOPYRROL INJ 0.2MG/ML 00517460225 AMERICAN REGENT LABORATORIES, INC. yGLYCOPYRROL INJ 0.2MG/ML 00517460525 AMERICAN REGENT LABORATORIES, INC. yGLYCOPYRROL INJ 0.2MG/ML 00517462025 AMERICAN REGENT LABORATORIES, INC. yNITROGLYCER INJ 5MG/ML 00517481025 AMERICAN REGENT LABORATORIES, INC. yDEXAMETH PHO INJ 4MG/ML 00517490125 AMERICAN REGENT LABORATORIES, INC. yDEXAMETH PHO INJ 4MG/ML 00517490525 AMERICAN REGENT LABORATORIES, INC. yDEXAMETH PHO INJ 4MG/ML 00517493025 AMERICAN REGENT LABORATORIES, INC. ySOD THIOSULF INJ 25% 00517501901 AMERICAN REGENT LABORATORIES, INC. ySOD ACETATE INJ 4MEQ/ML 00517502325 AMERICAN REGENT LABORATORIES, INC. yPOT ACETATE INJ 4MEQ/ML 00517502425 AMERICAN REGENT LABORATORIES, INC. yMAGNESIUM CL INJ 20% 00517503401 AMERICAN REGENT LABORATORIES, INC. yASCORBIC ACD INJ 500MG/ML 00517505001 AMERICAN REGENT LABORATORIES, INC. yVERAPAMIL INJ 2.5MG/ML 00517540225 AMERICAN REGENT LABORATORIES, INC. yHYDROXYZ HCL INJ 50MG/ML 00517560125 AMERICAN REGENT LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROXYZ HCL INJ 50MG/ML 00517560225 AMERICAN REGENT LABORATORIES, INC. yHYDROXYZ HCL INJ 50MG/ML 00517561025 AMERICAN REGENT LABORATORIES, INC. yFUROSEMIDE INJ 10MG/ML 00517570225 AMERICAN REGENT LABORATORIES, INC. yFUROSEMIDE INJ 10MG/ML 00517570425 AMERICAN REGENT LABORATORIES, INC. yFUROSEMIDE INJ 10MG/ML 00517571025 AMERICAN REGENT LABORATORIES, INC. yZINC SULFATE INJ 1MG/ML 00517611025 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-4 INJ NEONATAL 00517620225 AMERICAN REGENT LABORATORIES, INC. yCOPPER SULF INJ 0.4MG/ML 00517621025 AMERICAN REGENT LABORATORIES, INC. yCHROMIUM CL INJ 4MCG/ML 00517631025 AMERICAN REGENT LABORATORIES, INC. yMANGANESE SU INJ 0.1MG/ML 00517641025 AMERICAN REGENT LABORATORIES, INC. ySELENIUM INJ 40MCG/ML 00517651025 AMERICAN REGENT LABORATORIES, INC. yAMMON MOLYBD INJ 25MCG/ML 00517661025 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-4 INJ CONC 00517720125 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-4 INJ CONC 00517721025 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-4 INJ 00517741025 AMERICAN REGENT LABORATORIES, INC. yACETYLCYST SOL 10% 00517750425 AMERICAN REGENT LABORATORIES, INC. yACETYLCYST SOL 10% 00517751003 AMERICAN REGENT LABORATORIES, INC. yACETYLCYST SOL 20% 00517760425 AMERICAN REGENT LABORATORIES, INC. yACETYLCYST SOL 20% 00517761003 AMERICAN REGENT LABORATORIES, INC. yACETYLCYST SOL 20% 00517763003 AMERICAN REGENT LABORATORIES, INC. yZINC SULFATE INJ 5MG/ML 00517810525 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-5 INJ CONC 00517820125 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-5 INJ 00517821025 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-5 INJ REGULAR 00517851025 AMERICAN REGENT LABORATORIES, INC. yALCOHOL INJ 98% 00517857110 AMERICAN REGENT LABORATORIES, INC. yALCOHOL INJ 98% 00517857510 AMERICAN REGENT LABORATORIES, INC. yMETHYLDOPATE INJ 250/5ML 00517890510 AMERICAN REGENT LABORATORIES, INC. yAMINOCAPR AC INJ 250MG/ML 00517912025 AMERICAN REGENT LABORATORIES, INC. yMULTITRACE-4 INJ PED 00517920325 AMERICAN REGENT LABORATORIES, INC. yTRACE ELEM 4 INJ PED 00517931025 AMERICAN REGENT LABORATORIES, INC. yDROPERIDOL INJ 2.5MG/ML 00517970210 AMERICAN REGENT LABORATORIES, INC. yDROPERIDOL INJ 2.5MG/ML 00517970225 AMERICAN REGENT LABORATORIES, INC. yAMERICERIN CRE 63921013004 AMERIDERM LABORATORIES, LTD yAMERICERIN CRE 63921013016 AMERIDERM LABORATORIES, LTD yAMERIPHOR OIN 63921014004 AMERIDERM LABORATORIES, LTD yAMERIPHOR OIN 63921014016 AMERIDERM LABORATORIES, LTD y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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DERMAFIX OIN 63921040004 AMERIDERM LABORATORIES, LTD yDERMAFIX SPR 63921041004 AMERIDERM LABORATORIES, LTD yWOUND GEL GEL 63921042003 AMERIDERM LABORATORIES, LTD yPERISHIELD OIN 63921050004 AMERIDERM LABORATORIES, LTD yANESTACON GEL 2% JELLY 61451030001 AMERIFIT PHARMA, INC. yURISED TAB 61451218301 AMERIFIT PHARMA, INC. yCYSTOSPAZ TAB 0.15MG 61451222501 AMERIFIT PHARMA, INC. yB & O 15-A SUP SUPPRETT 61451501507 AMERIFIT PHARMA, INC. yB & O 16-A SUP SUPPRETT 61451501607 AMERIFIT PHARMA, INC. yAQUACHLORAL SUP 325MG 61451600507 AMERIFIT PHARMA, INC. yAQUACHLORAL SUP 650MG 61451601007 AMERIFIT PHARMA, INC. yARANESP INJ 25MCG 55513000201 AMGEN USA yARANESP INJ 25MCG 55513000204 AMGEN USA yARANESP INJ 40MCG 55513000301 AMGEN USA yARANESP INJ 40MCG 55513000304 AMGEN USA yARANESP INJ 60MCG 55513000401 AMGEN USA yARANESP INJ 60MCG 55513000404 AMGEN USA yARANESP INJ 100MCG 55513000501 AMGEN USA yARANESP INJ 100MCG 55513000504 AMGEN USA yARANESP INJ 200MCG 55513000601 AMGEN USA yARANESP INJ 25MCG/ML 55513001001 AMGEN USA yARANESP INJ 25MCG/ML 55513001004 AMGEN USA yARANESP INJ 40MCG/ML 55513001101 AMGEN USA yARANESP INJ 40MCG/ML 55513001104 AMGEN USA yARANESP INJ 60MCG/ML 55513001201 AMGEN USA yARANESP INJ 60MCG/ML 55513001204 AMGEN USA yARANESP INJ 100MCG 55513001301 AMGEN USA yARANESP INJ 100MCG 55513001304 AMGEN USA yARANESP INJ 200MCG 55513001401 AMGEN USA yARANESP INJ 200MCG 55513001404 AMGEN USA yARANESP INJ 300MCG 55513001501 AMGEN USA yARANESP INJ 40MCG 55513002101 AMGEN USA yARANESP INJ 40MCG 55513002104 AMGEN USA yARANESP INJ 60MCG 55513002301 AMGEN USA yARANESP INJ 60MCG 55513002304 AMGEN USA yARANESP INJ 100MCG 55513002501 AMGEN USA y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ARANESP INJ 100MCG 55513002504 AMGEN USA yARANESP INJ 150MCG 55513002701 AMGEN USA yARANESP INJ 150MCG 55513002704 AMGEN USA yARANESP INJ 200MCG 55513002801 AMGEN USA yARANESP INJ 500MCG 55513003201 AMGEN USA yARANESP INJ 40MCG 55513003701 AMGEN USA yARANESP INJ 40MCG 55513003704 AMGEN USA yARANESP INJ 60MCG 55513003901 AMGEN USA yARANESP INJ 60MCG 55513003904 AMGEN USA yARANESP INJ 100MCG 55513004101 AMGEN USA yARANESP INJ 100MCG 55513004104 AMGEN USA yARANESP INJ 150MCG 55513004301 AMGEN USA yARANESP INJ 150MCG 55513004304 AMGEN USA yARANESP INJ 200MCG 55513004401 AMGEN USA yARANESP INJ 300MCG 55513004601 AMGEN USA yARANESP INJ 500MCG 55513004801 AMGEN USA yARANESP INJ 150MCG 55513005301 AMGEN USA yARANESP INJ 150MCG 55513005304 AMGEN USA yARANESP INJ 150MCG 55513005401 AMGEN USA yARANESP INJ 150MCG 55513005404 AMGEN USA yARANESP INJ 25MCG 55513005701 AMGEN USA yARANESP INJ 25MCG 55513005704 AMGEN USA yARANESP INJ 25MCG 55513005801 AMGEN USA yARANESP INJ 25MCG 55513005804 AMGEN USA ySENSIPAR TAB 30MG 55513007330 AMGEN USA ySENSIPAR TAB 60MG 55513007430 AMGEN USA ySENSIPAR TAB 90MG 55513007530 AMGEN USA yARANESP INJ 25MCG 55513009001 AMGEN USA yARANESP INJ 40MCG 55513009101 AMGEN USA yARANESP INJ 60MCG 55513009201 AMGEN USA yARANESP INJ 100MCG 55513009301 AMGEN USA yARANESP INJ 150MCG 55513009401 AMGEN USA yARANESP INJ 200MCG 55513009501 AMGEN USA yARANESP INJ 300MCG 55513009601 AMGEN USA yARANESP INJ 500MCG 55513009701 AMGEN USA yARANESP INJ 300MCG 55513011001 AMGEN USA y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ARANESP INJ 300MCG 55513011101 AMGEN USA yEPOGEN INJ 2000/ML 55513012601 AMGEN USA yEPOGEN INJ 2000/ML 55513012610 AMGEN USA yEPOGEN INJ 10000/ML 55513014401 AMGEN USA yEPOGEN INJ 10000/ML 55513014410 AMGEN USA yEPOGEN INJ 4000/ML 55513014801 AMGEN USA yEPOGEN INJ 4000/ML 55513014810 AMGEN USA yKINERET INJ 55513017701 AMGEN USA yKINERET INJ 55513017728 AMGEN USA yNEULASTA INJ 6MG/0.6M 55513019001 AMGEN USA yNEUPOGEN INJ 480/0.8 55513020901 AMGEN USA yNEUPOGEN INJ 480/0.8 55513020910 AMGEN USA yEPOGEN INJ 3000/ML 55513026701 AMGEN USA yEPOGEN INJ 3000/ML 55513026710 AMGEN USA yEPOGEN INJ 10000/ML 55513028301 AMGEN USA yEPOGEN INJ 10000/ML 55513028310 AMGEN USA yEPOGEN INJ 20000/ML 55513047801 AMGEN USA yEPOGEN INJ 20000/ML 55513047810 AMGEN USA yKEPIVANCE INJ 6.25MG 55513052001 AMGEN USA yKEPIVANCE INJ 6.25MG 55513052006 AMGEN USA yNEUPOGEN INJ 300MCG 55513053001 AMGEN USA yNEUPOGEN INJ 300MCG 55513053010 AMGEN USA yNEUPOGEN INJ 480MCG 55513054601 AMGEN USA yNEUPOGEN INJ 480MCG 55513054610 AMGEN USA yEPOGEN INJ 40000/ML 55513082301 AMGEN USA yEPOGEN INJ 40000/ML 55513082310 AMGEN USA yNEUPOGEN INJ 300/0.5 55513092401 AMGEN USA yNEUPOGEN INJ 300/0.5 55513092410 AMGEN USA yVECTIBIX INJ 100MG 55513095401 AMGEN USA yVECTIBIX INJ 200MG 55513095501 AMGEN USA yVECTIBIX INJ 400MG 55513095601 AMGEN USA yENBREL INJ 25MG 58406042534 AMGEN/IMMUNEX yENBREL INJ 25MG 58406042541 AMGEN/IMMUNEX yENBREL INJ 50MG/ML 58406043501 AMGEN/IMMUNEX yENBREL INJ 50MG/ML 58406043504 AMGEN/IMMUNEX yENBREL INJ 50MG/ML 58406044501 AMGEN/IMMUNEX y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENBREL INJ 50MG/ML 58406044504 AMGEN/IMMUNEX yNOVANTRONE INJ 2MG/ML 58406064003 AMGEN/IMMUNEX yNOVANTRONE INJ 2MG/ML 58406064005 AMGEN/IMMUNEX yNOVANTRONE INJ 2MG/ML 58406064007 AMGEN/IMMUNEX yMULT VIT-BET CHW /FL 1MG 52152000102 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW /FL 1MG 52152000105 AMIDE PHARMACEUTICAL INC. yTRI-VITA BET CHW /FLUORID 52152000202 AMIDE PHARMACEUTICAL INC. yTRI-VITA BET CHW /FLUORID 52152000205 AMIDE PHARMACEUTICAL INC. yPHENAZOPYRID TAB 100MG 52152000302 AMIDE PHARMACEUTICAL INC. yPHENAZOPYRID TAB 100MG 52152000305 AMIDE PHARMACEUTICAL INC. yPHENAZOPYRID TAB 200MG 52152000402 AMIDE PHARMACEUTICAL INC. yPHENAZOPYRID TAB 200MG 52152000405 AMIDE PHARMACEUTICAL INC. yISOXSUPRINE TAB 10MG 52152000905 AMIDE PHARMACEUTICAL INC. yISOXSUPRINE TAB 20MG 52152001004 AMIDE PHARMACEUTICAL INC. yISOXSUPRINE TAB 20MG 52152001005 AMIDE PHARMACEUTICAL INC. yDEXCHLORPHEN TAB 4MG CR 52152001402 AMIDE PHARMACEUTICAL INC. yDEXCHLORPHEN TAB 6MG CR 52152001502 AMIDE PHARMACEUTICAL INC. yCHLORD/CLIDI CAP 5-2.5MG 52152001802 AMIDE PHARMACEUTICAL INC. yCHLORD/CLIDI CAP 5-2.5MG 52152001804 AMIDE PHARMACEUTICAL INC. yCHLORD/CLIDI CAP 5-2.5MG 52152001805 AMIDE PHARMACEUTICAL INC. yAMIGESIC TAB 500MG 52152001902 AMIDE PHARMACEUTICAL INC. yAMIGESIC TAB 500MG 52152001904 AMIDE PHARMACEUTICAL INC. yAMIGESIC TAB 750MG 52152002002 AMIDE PHARMACEUTICAL INC. yAMIGESIC TAB 750MG 52152002004 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW FL 0.5MG 52152003102 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW FL 0.5MG 52152003105 AMIDE PHARMACEUTICAL INC. yYOHIMBINE TAB 5.4MG 52152003202 AMIDE PHARMACEUTICAL INC. yYOHIMBINE TAB 5.4MG 52152003205 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW FL/IRON 52152003702 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW FL/IRON 52152003802 AMIDE PHARMACEUTICAL INC. yOXYCOD/APAP CAP 5-500MG 52152004102 AMIDE PHARMACEUTICAL INC. yMULT FOL 500 TAB CR 52152004814 AMIDE PHARMACEUTICAL INC. yCHLORZOXAZON TAB 250MG 52152005302 AMIDE PHARMACEUTICAL INC. yCHLORZOXAZON TAB 250MG 52152005305 AMIDE PHARMACEUTICAL INC. yURSODIOL CAP 300MG 52152006002 AMIDE PHARMACEUTICAL INC. yURSODIOL CAP 300MG 52152006003 AMIDE PHARMACEUTICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VITAPLEX TAB 52152007602 AMIDE PHARMACEUTICAL INC. yVITAPLEX TAB 52152007604 AMIDE PHARMACEUTICAL INC. yVITAPLEX TAB PLUS 52152007702 AMIDE PHARMACEUTICAL INC. yVITAPLEX TAB PLUS 52152007704 AMIDE PHARMACEUTICAL INC. yVITA CON CAP FORTE 52152007802 AMIDE PHARMACEUTICAL INC. yVITA CON CAP FORTE 52152007804 AMIDE PHARMACEUTICAL INC. yVITA CON CAP 52152007805 AMIDE PHARMACEUTICAL INC. yCHO MAG TRIS TAB 500MG 52152008402 AMIDE PHARMACEUTICAL INC. yCHO MAG TRIS TAB 750MG 52152008502 AMIDE PHARMACEUTICAL INC. yCHO MAG TRIS TAB 1000MG 52152008602 AMIDE PHARMACEUTICAL INC. yNALTREXONE TAB 50MG 52152010502 AMIDE PHARMACEUTICAL INC. yNALTREXONE TAB 50MG 52152010530 AMIDE PHARMACEUTICAL INC. yMETHENAM MAN TAB 0.5GM 52152011102 AMIDE PHARMACEUTICAL INC. yMETHENAM MAN TAB 0.5GM 52152011105 AMIDE PHARMACEUTICAL INC. yMETHENAM MAN TAB 1GM 52152011202 AMIDE PHARMACEUTICAL INC. yMETHENAM MAN TAB 1GM 52152011205 AMIDE PHARMACEUTICAL INC. yBELLAMINE S TAB 52152011502 AMIDE PHARMACEUTICAL INC. yBELLAMINE S TAB 52152011505 AMIDE PHARMACEUTICAL INC. yMECLIZINE CHW 25MG 52152011702 AMIDE PHARMACEUTICAL INC. yMECLIZINE CHW 25MG 52152011705 AMIDE PHARMACEUTICAL INC. yGUANFACINE TAB 1MG 52152011802 AMIDE PHARMACEUTICAL INC. yGUANFACINE TAB 1MG 52152011804 AMIDE PHARMACEUTICAL INC. yGUANFACINE TAB 2MG 52152011902 AMIDE PHARMACEUTICAL INC. yGUANFACINE TAB 2MG 52152011904 AMIDE PHARMACEUTICAL INC. ySOD FLUORIDE CHW 0.5MG 52152012705 AMIDE PHARMACEUTICAL INC. ySOD FLUORIDE CHW 1MG 52152012805 AMIDE PHARMACEUTICAL INC. yAMITEX PSE TAB 120-600 52152013002 AMIDE PHARMACEUTICAL INC. yAMITEX PSE TAB 120-600 52152013004 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 1.5MG 52152013302 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 3MG 52152013402 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 3MG 52152013404 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 3MG 52152013405 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 6MG 52152013502 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 6MG 52152013504 AMIDE PHARMACEUTICAL INC. yGLYBURID MCR TAB 6MG 52152013505 AMIDE PHARMACEUTICAL INC. yCARISOPRODOL TAB 350MG 52152013602 AMIDE PHARMACEUTICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARISOPRODOL TAB 350MG 52152013604 AMIDE PHARMACEUTICAL INC. yCARISOPRODOL TAB 350MG 52152013605 AMIDE PHARMACEUTICAL INC. yCARISOPR/ASA TAB 200-325 52152013702 AMIDE PHARMACEUTICAL INC. yCARISOPR/ASA TAB 200-325 52152013704 AMIDE PHARMACEUTICAL INC. yCARISOPRODOL TAB ASA/COD 52152013802 AMIDE PHARMACEUTICAL INC. yAMIBID DM TAB 30-600CR 52152013902 AMIDE PHARMACEUTICAL INC. yAMIBID DM TAB 30-600CR 52152013903 AMIDE PHARMACEUTICAL INC. yAMIBID DM TAB 30-600CR 52152013904 AMIDE PHARMACEUTICAL INC. yHYDROCODONE/ TAB HOMATROP 52152014002 AMIDE PHARMACEUTICAL INC. yHYOSCYAMINE TAB 0.125MG 52152014302 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW FL0.25MG 52152015002 AMIDE PHARMACEUTICAL INC. yMULT VIT-BET CHW FL0.25MG 52152015005 AMIDE PHARMACEUTICAL INC. yHYOSCYAMINE SUB 0.125MG 52152015502 AMIDE PHARMACEUTICAL INC. yHYOSCYAMINE TAB 0.375 SR 52152015602 AMIDE PHARMACEUTICAL INC. yMEPERIDINE TAB 100MG 52152015702 AMIDE PHARMACEUTICAL INC. yMEPERIDINE TAB 50MG 52152015802 AMIDE PHARMACEUTICAL INC. yPHENTERMINE TAB 37.5MG 52152015902 AMIDE PHARMACEUTICAL INC. yPHENTERMINE TAB 37.5MG 52152015905 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 30MG 52152016002 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 30MG 52152016005 AMIDE PHARMACEUTICAL INC. yOXYCODONE TAB 5MG 52152016502 AMIDE PHARMACEUTICAL INC. yOXYCODONE TAB 5MG 52152016511 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 37.5MG 52152016702 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 37.5MG 52152016705 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 15MG 52152017002 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 15MG 52152017005 AMIDE PHARMACEUTICAL INC. yPRENATAL RX TAB 52152017104 AMIDE PHARMACEUTICAL INC. yPRENATAL RX TAB 52152017120 AMIDE PHARMACEUTICAL INC. yCODEINE/GG TAB 10-300 52152017202 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 30MG 52152017302 AMIDE PHARMACEUTICAL INC. yPHENTERMINE CAP 30MG 52152017305 AMIDE PHARMACEUTICAL INC. yPRENATAL Z TAB ADV FORM 52152017711 AMIDE PHARMACEUTICAL INC. yPRENATAL PLS TAB /IRON 52152017802 AMIDE PHARMACEUTICAL INC. yPRENATAL PLS TAB /IRON 52152017804 AMIDE PHARMACEUTICAL INC. yBETAXOLOL TAB 10MG 52152017902 AMIDE PHARMACEUTICAL INC. yBETAXOLOL TAB 20MG 52152018002 AMIDE PHARMACEUTICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIMETHOBENZ CAP 300MG 52152018502 AMIDE PHARMACEUTICAL INC. yOXYCODONE CAP 5MG 52152018702 AMIDE PHARMACEUTICAL INC. yMEPERIDINE/ CAP PROMETH 52152019002 AMIDE PHARMACEUTICAL INC. yLOXAPINE CAP 5MG 52152019102 AMIDE PHARMACEUTICAL INC. yLOXAPINE CAP 10MG 52152019202 AMIDE PHARMACEUTICAL INC. yLOXAPINE CAP 25MG 52152019302 AMIDE PHARMACEUTICAL INC. yLOXAPINE CAP 50MG 52152019402 AMIDE PHARMACEUTICAL INC. yPENTAZOCINE/ TAB NALOXONE 52152021102 AMIDE PHARMACEUTICAL INC. yPENTAZOCINE/ TAB NALOXONE 52152021104 AMIDE PHARMACEUTICAL INC. yPENTA/APAP TAB 25-650MG 52152021302 AMIDE PHARMACEUTICAL INC. yOXYCODONE TAB 15MG 52152021402 AMIDE PHARMACEUTICAL INC. yOXYCODONE TAB 30MG 52152021502 AMIDE PHARMACEUTICAL INC. yCARBETAPEN/ TAB CHLORPHN 52152021602 AMIDE PHARMACEUTICAL INC. yRIFAMPIN CAP 300MG 52152021730 AMIDE PHARMACEUTICAL INC. yDANTROLENE CAP 25MG 52152021902 AMIDE PHARMACEUTICAL INC. yDANTROLENE CAP 50MG 52152022002 AMIDE PHARMACEUTICAL INC. yDANTROLENE CAP 100MG 52152022102 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 5MG 52152022202 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 5MG 52152022204 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 10MG 52152022302 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 10MG 52152022304 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 15MG 52152022402 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 15MG 52152022403 AMIDE PHARMACEUTICAL INC. yBUSPIRONE TAB 15MG 52152022422 AMIDE PHARMACEUTICAL INC. yMIRTAZAPINE TAB 15MG 52152022630 AMIDE PHARMACEUTICAL INC. yMIRTAZAPINE TAB 30MG 52152022730 AMIDE PHARMACEUTICAL INC. yTIZANIDINE TAB 4MG 52152023404 AMIDE PHARMACEUTICAL INC. yTIZANIDINE TAB 4MG 52152023421 AMIDE PHARMACEUTICAL INC. yTIZANIDINE TAB 2MG 52152023604 AMIDE PHARMACEUTICAL INC. yTIZANIDINE TAB 2MG 52152023621 AMIDE PHARMACEUTICAL INC. yQUINARETIC TAB 10/12.5 52152023808 AMIDE PHARMACEUTICAL INC. yQUINARETIC TAB 10/12.5 52152023830 AMIDE PHARMACEUTICAL INC. yQUINARETIC TAB 20/12.5 52152023908 AMIDE PHARMACEUTICAL INC. yQUINARETIC TAB 20/12.5 52152023930 AMIDE PHARMACEUTICAL INC. yQUINARETIC TAB 20-25MG 52152024008 AMIDE PHARMACEUTICAL INC. yQUINARETIC TAB 20-25MG 52152024030 AMIDE PHARMACEUTICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GUAIFENESIN TAB /DM ER 52152024602 AMIDE PHARMACEUTICAL INC. yPRENATAL FOR TAB 28-1MG 52152024802 AMIDE PHARMACEUTICAL INC. yPRENATAL FOR TAB 28-1MG 52152024804 AMIDE PHARMACEUTICAL INC. yCILOSTAZOL TAB 100MG 52152025001 AMIDE PHARMACEUTICAL INC. yAMI-TEX LA TAB 30-600MG 52152025302 AMIDE PHARMACEUTICAL INC. yMIRTAZAPINE TAB 15MG ODT 52152025418 AMIDE PHARMACEUTICAL INC. yMIRTAZAPINE TAB 30MG ODT 52152025518 AMIDE PHARMACEUTICAL INC. yMIRTAZAPINE TAB 45MG ODT 52152025618 AMIDE PHARMACEUTICAL INC. yHYDROMORPHON TAB 8MG 52152026002 AMIDE PHARMACEUTICAL INC. yISRADIPINE CAP 2.5MG 52152026301 AMIDE PHARMACEUTICAL INC. yISRADIPINE CAP 5MG 52152026401 AMIDE PHARMACEUTICAL INC. yDIPYRIDAMOLE TAB 25MG 52152026502 AMIDE PHARMACEUTICAL INC. yDIPYRIDAMOLE TAB 25MG 52152026505 AMIDE PHARMACEUTICAL INC. yDIPYRIDAMOLE TAB 50MG 52152026602 AMIDE PHARMACEUTICAL INC. yDIPYRIDAMOLE TAB 50MG 52152026605 AMIDE PHARMACEUTICAL INC. yDIPYRIDAMOLE TAB 75MG 52152026702 AMIDE PHARMACEUTICAL INC. yDIPYRIDAMOLE TAB 75MG 52152026705 AMIDE PHARMACEUTICAL INC. yMELOXICAM TAB 7.5MG 52152028502 AMIDE PHARMACEUTICAL INC. yMELOXICAM TAB 15MG 52152028602 AMIDE PHARMACEUTICAL INC. yTRIMIPRAMINE CAP 25MG 52152029308 AMIDE PHARMACEUTICAL INC. yTRIMIPRAMINE CAP 25MG 52152029330 AMIDE PHARMACEUTICAL INC. yTRIMIPRAMINE CAP 50MG 52152029408 AMIDE PHARMACEUTICAL INC. yTRIMIPRAMINE CAP 50MG 52152029430 AMIDE PHARMACEUTICAL INC. yCYCLOBENZAPR TAB 5MG 52152030102 AMIDE PHARMACEUTICAL INC. yCYCLOBENZAPR TAB 10MG 52152030202 AMIDE PHARMACEUTICAL INC. yCYCLOBENZAPR TAB 10MG 52152030205 AMIDE PHARMACEUTICAL INC. yAMANTADINE CAP 100MG 52152030902 AMIDE PHARMACEUTICAL INC. yAMANTADINE CAP 100MG 52152030904 AMIDE PHARMACEUTICAL INC. yHYDROXYZ HCL TAB 10MG 52152031102 AMIDE PHARMACEUTICAL INC. yHYDROXYZ HCL TAB 10MG 52152031105 AMIDE PHARMACEUTICAL INC. yHYDROXYZ HCL TAB 25MG 52152031202 AMIDE PHARMACEUTICAL INC. yHYDROXYZ HCL TAB 25MG 52152031205 AMIDE PHARMACEUTICAL INC. yHYDROXYZ HCL TAB 50MG 52152031302 AMIDE PHARMACEUTICAL INC. yHYDROXYZ HCL TAB 50MG 52152031305 AMIDE PHARMACEUTICAL INC. yORPHENADRINE TAB 100MG ER 52152034002 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 10MG 52152034102 AMIDE PHARMACEUTICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DESIPRAMINE TAB 25MG 52152034202 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 25MG 52152034204 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 25MG 52152034205 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 50MG 52152034302 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 50MG 52152034304 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 50MG 52152034305 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 75MG 52152034402 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 75MG 52152034404 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 100MG 52152034502 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 100MG 52152034504 AMIDE PHARMACEUTICAL INC. yDESIPRAMINE TAB 150MG 52152034650 AMIDE PHARMACEUTICAL INC. ySYMLIN INJ 0.6MG/ML 66780011001 AMYLIN PHARMACEUTICALS, INC. yBYETTA INJ 5MCG 66780021007 AMYLIN PHARMACEUTICALS, INC. yBYETTA INJ 10MCG 66780021008 AMYLIN PHARMACEUTICALS, INC. yPINK BISMUTH SUS 262/15ML 62559021108 ANIP ACQUISITION COMPANY yPINK BISMUTH SUS 525/15ML 62559021208 ANIP ACQUISITION COMPANY yANTACID SUS ANTI-GAS 62559061102 ANIP ACQUISITION COMPANY yANTACID SUS ANTI-GAS 62559061202 ANIP ACQUISITION COMPANY yANTACID SUS REG 62559112102 ANIP ACQUISITION COMPANY yANTACID REG SUS STRENGTH 62559152102 ANIP ACQUISITION COMPANY yMILK OF MAGN SUS 400/5ML 62559191101 ANIP ACQUISITION COMPANY yMILK OF MAGN SUS 400/5ML 62559192102 ANIP ACQUISITION COMPANY yMILK OF MAGN SUS 400/5ML 62559193102 ANIP ACQUISITION COMPANY yGAS RELIEF DRO 20/0.3ML 62559261109 ANIP ACQUISITION COMPANY yIODINE SOLN SOL 10% 62559280008 ANIP ACQUISITION COMPANY yTOLNAFTATE POW 1% 62559290009 ANIP ACQUISITION COMPANY yVIRATAN-DM SUS 62559574106 ANIP ACQUISITION COMPANY yVIRATAN-DM CHW 25-30-25 62559574200 ANIP ACQUISITION COMPANY yBROMPHENIRAM SUS 12MG/5ML 62559629104 ANIP ACQUISITION COMPANY yBROMPHENIRAM CHW 12MG 62559629306 ANIP ACQUISITION COMPANY yBROMPHEN/PE SUS TANN 62559633106 ANIP ACQUISITION COMPANY yCAPTOPRIL TAB 25MG 60505000406 APOTEX CORP. yCAPTOPRIL TAB 50MG 60505000506 APOTEX CORP. yCAPTOPRIL TAB 100MG 60505000606 APOTEX CORP. yDILT-CD CAP 120MG 60505000704 APOTEX CORP. yDILT-CD CAP 180MG 60505000804 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DILT-CD CAP 240MG 60505000904 APOTEX CORP. yDILT-CD CAP 300MG 60505001004 APOTEX CORP. yDILT-XR CAP 120MG 60505001406 APOTEX CORP. yDILT-XR CAP 120MG 60505001408 APOTEX CORP. yDILT-XR CAP 180MG 60505001506 APOTEX CORP. yDILT-XR CAP 180MG 60505001508 APOTEX CORP. yDILT-XR CAP 240MG 60505001606 APOTEX CORP. yDILT-XR CAP 240MG 60505001608 APOTEX CORP. yCIMETIDINE TAB 300MG 60505001904 APOTEX CORP. yCIMETIDINE TAB 300MG 60505001906 APOTEX CORP. yCIMETIDINE TAB 400MG 60505002004 APOTEX CORP. yCIMETIDINE TAB 400MG 60505002006 APOTEX CORP. yCIMETIDINE TAB 400MG 60505002008 APOTEX CORP. yCIMETIDINE TAB 800MG 60505002103 APOTEX CORP. yCIMETIDINE TAB 800MG 60505002107 APOTEX CORP. yRANITIDINE TAB 150MG 60505002504 APOTEX CORP. yRANITIDINE TAB 150MG 60505002506 APOTEX CORP. yRANITIDINE TAB 150MG 60505002508 APOTEX CORP. yRANITIDINE TAB 300MG 60505002602 APOTEX CORP. yRANITIDINE TAB 300MG 60505002603 APOTEX CORP. yRANITIDINE TAB 300MG 60505002607 APOTEX CORP. yPENTOXIFYLLI TAB 400MG ER 60505003306 APOTEX CORP. yPENTOXIFYLLI TAB 400MG ER 60505003307 APOTEX CORP. yPENTOXIFYLLI TAB 400MG ER 60505003308 APOTEX CORP. yGEMFIBROZIL TAB 600MG 60505003400 APOTEX CORP. yGEMFIBROZIL TAB 600MG 60505003401 APOTEX CORP. yGEMFIBROZIL TAB 600MG 60505003402 APOTEX CORP. yGEMFIBROZIL TAB 600MG 60505003404 APOTEX CORP. yGEMFIBROZIL TAB 600MG 60505003408 APOTEX CORP. yETODOLAC CAP 200MG 60505003901 APOTEX CORP. yETODOLAC CAP 300MG 60505004001 APOTEX CORP. yETODOLAC TAB 400MG 60505004101 APOTEX CORP. yACYCLOVIR CAP 200MG 60505004206 APOTEX CORP. ySELEGILINE CAP 5MG 60505005501 APOTEX CORP. ySELEGILINE CAP 5MG 60505005502 APOTEX CORP. yOMEPRAZOLE CAP 20MG 60505006500 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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OMEPRAZOLE CAP 20MG 60505006501 APOTEX CORP. yOMEPRAZOLE CAP 20MG 60505006502 APOTEX CORP. yOMEPRAZOLE CAP 20MG 60505006508 APOTEX CORP. yCLONAZEPAM TAB 0.5MG 60505006601 APOTEX CORP. yCLONAZEPAM TAB 0.5MG 60505006603 APOTEX CORP. yCLONAZEPAM TAB 2MG 60505006801 APOTEX CORP. ySOTALOL HCL TAB 80MG 60505008000 APOTEX CORP. ySOTALOL HCL TAB 160MG 60505008100 APOTEX CORP. ySOTALOL HCL TAB 240MG 60505008200 APOTEX CORP. yPAROXETINE TAB 20MG 60505008301 APOTEX CORP. yPAROXETINE TAB 20MG 60505008302 APOTEX CORP. yPAROXETINE TAB 20MG 60505008304 APOTEX CORP. yPAROXETINE TAB 30MG 60505008401 APOTEX CORP. yPAROXETINE TAB 30MG 60505008402 APOTEX CORP. yPAROXETINE TAB 30MG 60505008404 APOTEX CORP. yKETOCONAZOLE TAB 200MG 60505009200 APOTEX CORP. yKETOCONAZOLE TAB 200MG 60505009202 APOTEX CORP. yDOXAZOSIN TAB 2MG 60505009400 APOTEX CORP. yDOXAZOSIN TAB 2MG 60505009401 APOTEX CORP. yDOXAZOSIN TAB 2MG 60505009408 APOTEX CORP. yDOXAZOSIN TAB 4MG 60505009500 APOTEX CORP. yDOXAZOSIN TAB 4MG 60505009501 APOTEX CORP. yDOXAZOSIN TAB 4MG 60505009505 APOTEX CORP. yDOXAZOSIN TAB 4MG 60505009508 APOTEX CORP. yDOXAZOSIN TAB 8MG 60505009600 APOTEX CORP. yDOXAZOSIN TAB 8MG 60505009601 APOTEX CORP. yDOXAZOSIN TAB 8MG 60505009608 APOTEX CORP. yPAROXETINE TAB 10MG 60505009701 APOTEX CORP. yPAROXETINE TAB 10MG 60505009702 APOTEX CORP. yPAROXETINE TAB 10MG 60505009704 APOTEX CORP. yPAROXETINE TAB 40MG 60505010101 APOTEX CORP. yPAROXETINE TAB 40MG 60505010102 APOTEX CORP. yPAROXETINE TAB 40MG 60505010104 APOTEX CORP. yETODOLAC TAB 500MG 60505010201 APOTEX CORP. yGABAPENTIN CAP 100MG 60505011201 APOTEX CORP. yGABAPENTIN CAP 100MG 60505011207 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GABAPENTIN CAP 100MG 60505011208 APOTEX CORP. yGABAPENTIN CAP 400MG 60505011401 APOTEX CORP. yGABAPENTIN CAP 400MG 60505011405 APOTEX CORP. yGABAPENTIN CAP 400MG 60505011407 APOTEX CORP. yTERAZOSIN CAP 1MG 60505011500 APOTEX CORP. yTERAZOSIN CAP 1MG 60505011505 APOTEX CORP. yTERAZOSIN CAP 2MG 60505011600 APOTEX CORP. yTERAZOSIN CAP 2MG 60505011605 APOTEX CORP. yTERAZOSIN CAP 2MG 60505011607 APOTEX CORP. yTERAZOSIN CAP 5MG 60505011700 APOTEX CORP. yTERAZOSIN CAP 5MG 60505011705 APOTEX CORP. yTERAZOSIN CAP 5MG 60505011707 APOTEX CORP. yTERAZOSIN CAP 10MG 60505011800 APOTEX CORP. yTERAZOSIN CAP 10MG 60505011805 APOTEX CORP. yFLUCONAZOLE TAB 100MG 60505012001 APOTEX CORP. yFLUCONAZOLE TAB 150MG 60505012103 APOTEX CORP. yFLUCONAZOLE TAB 200MG 60505012201 APOTEX CORP. yCARB/LEVO SR TAB 25/100 60505013100 APOTEX CORP. yCARB/LEVO SR TAB 25/100 60505013101 APOTEX CORP. yCARB/LEVO SR TAB 50-200MG 60505013200 APOTEX CORP. yCARB/LEVO SR TAB 50-200MG 60505013201 APOTEX CORP. yCYCLOSPORINE CAP 25MG 60505013300 APOTEX CORP. yCYCLOSPORINE CAP 100MG 60505013400 APOTEX CORP. yDICLOFEN POT TAB 50MG 60505013500 APOTEX CORP. yGLIPIZIDE TAB 5MG 60505014100 APOTEX CORP. yGLIPIZIDE TAB 5MG 60505014101 APOTEX CORP. yGLIPIZIDE TAB 5MG 60505014102 APOTEX CORP. yGLIPIZIDE TAB 10MG 60505014200 APOTEX CORP. yGLIPIZIDE TAB 10MG 60505014201 APOTEX CORP. yGLIPIZIDE TAB 10MG 60505014202 APOTEX CORP. yOMEPRAZOLE CAP 10MG 60505014500 APOTEX CORP. yOMEPRAZOLE CAP 10MG 60505014501 APOTEX CORP. yOMEPRAZOLE CAP 10MG 60505014502 APOTEX CORP. yLORATADINE TAB 10MG 60505014701 APOTEX CORP. yLORATADINE TAB 10MG 60505014708 APOTEX CORP. yCIMETIDINE TAB 200MG 60505014900 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BUPROPION TAB 100MG 60505015705 APOTEX CORP. yBUPROPION TAB 100MG 60505015709 APOTEX CORP. yBUPROPION TAB 75MG 60505015805 APOTEX CORP. yBUPROPION TAB 75MG 60505015809 APOTEX CORP. yFLUVOXAMINE TAB 25MG 60505016401 APOTEX CORP. yFLUVOXAMINE TAB 50MG 60505016501 APOTEX CORP. yFLUVOXAMINE TAB 100MG 60505016601 APOTEX CORP. yTRAMADOL HCL TAB 50MG 60505017105 APOTEX CORP. yOXAPROZIN TAB 600MG 60505017600 APOTEX CORP. yOXAPROZIN TAB 600MG 60505017601 APOTEX CORP. yCARBAMAZEPIN TAB 200MG 60505018300 APOTEX CORP. yCARBAMAZEPIN TAB 200MG 60505018301 APOTEX CORP. yLISINOPRIL TAB 2.5MG 60505018400 APOTEX CORP. yLISINOPRIL TAB 2.5MG 60505018401 APOTEX CORP. yLISINOPRIL TAB 5MG 60505018500 APOTEX CORP. yLISINOPRIL TAB 5MG 60505018501 APOTEX CORP. yLISINOPRIL TAB 5MG 60505018509 APOTEX CORP. yLISINOPRIL TAB 10MG 60505018600 APOTEX CORP. yLISINOPRIL TAB 10MG 60505018601 APOTEX CORP. yLISINOPRIL TAB 10MG 60505018607 APOTEX CORP. yLISINOPRIL TAB 10MG 60505018609 APOTEX CORP. yLISINOPRIL TAB 20MG 60505018700 APOTEX CORP. yLISINOPRIL TAB 20MG 60505018701 APOTEX CORP. yLISINOPRIL TAB 20MG 60505018707 APOTEX CORP. yLISINOPRIL TAB 20MG 60505018709 APOTEX CORP. yLISINOPRIL TAB 40MG 60505018900 APOTEX CORP. yLISINOPRIL TAB 40MG 60505018901 APOTEX CORP. yLISINOPRIL TAB 40MG 60505018908 APOTEX CORP. yMETFORMIN TAB 500MG 60505019000 APOTEX CORP. yMETFORMIN TAB 500MG 60505019001 APOTEX CORP. yMETFORMIN TAB 500MG 60505019004 APOTEX CORP. yMETFORMIN TAB 850MG 60505019100 APOTEX CORP. yMETFORMIN TAB 850MG 60505019101 APOTEX CORP. yMETFORMIN TAB 850MG 60505019104 APOTEX CORP. yMETFORMIN TAB 1000MG 60505019200 APOTEX CORP. yMETFORMIN TAB 1000MG 60505019201 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METFORMIN TAB 1000MG 60505019204 APOTEX CORP. yLISINOP/HCTZ TAB 10-12.5 60505020503 APOTEX CORP. yLISINOP/HCTZ TAB 20-12.5 60505020603 APOTEX CORP. yLISINOP/HCTZ TAB 20-25MG 60505020703 APOTEX CORP. ySOTALOL AF TAB 80MG 60505022201 APOTEX CORP. ySOTALOL AF TAB 120MG 60505022301 APOTEX CORP. ySOTALOL AF TAB 160MG 60505022401 APOTEX CORP. yNIZATIDINE CAP 150MG 60505023004 APOTEX CORP. yNIZATIDINE CAP 300MG 60505023101 APOTEX CORP. yTORSEMIDE TAB 20MG 60505023401 APOTEX CORP. yTIZANIDINE TAB 2MG 60505025102 APOTEX CORP. yTIZANIDINE TAB 2MG 60505025103 APOTEX CORP. yTIZANIDINE TAB 4MG 60505025202 APOTEX CORP. yTIZANIDINE TAB 4MG 60505025203 APOTEX CORP. yCLOPIDOGREL TAB 75MG 60505025301 APOTEX CORP. yCLOPIDOGREL TAB 75MG 60505025302 APOTEX CORP. yCLOPIDOGREL TAB 75MG 60505025303 APOTEX CORP. yCLOPIDOGREL TAB 75MG 60505025304 APOTEX CORP. yDESMOPRESSIN TAB 0.1MG 60505025701 APOTEX CORP. yDESMOPRESSIN TAB 0.2MG 60505025801 APOTEX CORP. yMETFORMIN TAB 500MG ER 60505026001 APOTEX CORP. yMETFORMIN TAB 500MG ER 60505026002 APOTEX CORP. yBENAZEPRIL TAB 5MG 60505026501 APOTEX CORP. yBENAZEPRIL TAB 10MG 60505026601 APOTEX CORP. yBENAZEPRIL TAB 10MG 60505026605 APOTEX CORP. yBENAZEPRIL TAB 20MG 60505026701 APOTEX CORP. yBENAZEPRIL TAB 40MG 60505026801 APOTEX CORP. yBENAZEPRIL TAB 40MG 60505026805 APOTEX CORP. yFLUOXETINE SOL 20MG/5ML 60505035201 APOTEX CORP. yCYCLOSPORINE SOL MODIFIED 60505035401 APOTEX CORP. yMEGESTROL AC SUS 40MG/ML 60505036801 APOTEX CORP. yTIMOLOL MAL SOL 0.5% OP 60505055102 APOTEX CORP. yTIMOLOL MAL SOL 0.5% OP 60505055103 APOTEX CORP. yTIMOLOL MAL SOL 0.5% OP 60505055104 APOTEX CORP. yTIMOLOL MAL SOL 0.25% OP 60505055202 APOTEX CORP. yTIMOLOL MAL SOL 0.25% OP 60505055203 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TIMOLOL MAL SOL 0.25% OP 60505055204 APOTEX CORP. yLEVOBUNOLOL SOL 0.5% OP 60505055301 APOTEX CORP. yLEVOBUNOLOL SOL 0.5% OP 60505055302 APOTEX CORP. yLEVOBUNOLOL SOL 0.5% OP 60505055303 APOTEX CORP. yKETOTIFEN SOL FUMARATE 60505056901 APOTEX CORP. yBUTORPHANOL INJ 1MG/ML 60505065800 APOTEX CORP. yBUTORPHANOL INJ 2MG/ML 60505065900 APOTEX CORP. yBUTORPHANOL INJ 2MG/ML 60505066000 APOTEX CORP. yFLUPHENAZ DE INJ 25MG/ML 60505066402 APOTEX CORP. yCEFTRIAXONE INJ 10GM 60505067905 APOTEX CORP. yCEFTRIAXONE INJ 1GM 60505067908 APOTEX CORP. yCEFTRIAXONE INJ 2GM 60505067909 APOTEX CORP. yHALOPER DEC INJ 50MG/ML 60505070201 APOTEX CORP. yHALOPER DEC INJ 100MG/ML 60505070301 APOTEX CORP. yDIPYRIDAMOLE INJ 5MG/ML 60505071500 APOTEX CORP. yDIPYRIDAMOLE INJ 5MG/ML 60505071501 APOTEX CORP. yLABETALOL INJ 5MG/ML 60505071700 APOTEX CORP. yLABETALOL INJ 5MG/ML 60505071701 APOTEX CORP. yMILRINONE INJ 1MG/ML 60505071800 APOTEX CORP. yMILRINONE INJ 1MG/ML 60505071801 APOTEX CORP. yAMIODARONE INJ 50MG/ML 60505072200 APOTEX CORP. yAMIODARONE INJ 50MG/ML 60505072201 APOTEX CORP. yHALOPER LAC INJ 5MG/ML 60505072703 APOTEX CORP. yCEFAZOLIN INJ 1GM 60505074904 APOTEX CORP. yCEFAZOLIN INJ 1GM 60505074905 APOTEX CORP. yCEFTRIAXONE INJ 250MG 60505075000 APOTEX CORP. yCEFTRIAXONE INJ 250MG 60505075004 APOTEX CORP. yCEFTRIAXONE INJ 500MG 60505075100 APOTEX CORP. yCEFTRIAXONE INJ 500MG 60505075104 APOTEX CORP. yCEFTRIAXONE INJ 1GM 60505075200 APOTEX CORP. yCEFTRIAXONE INJ 1GM 60505075204 APOTEX CORP. yCEFTRIAXONE INJ 2GM 60505075300 APOTEX CORP. yCEFTRIAXONE INJ 2GM 60505075304 APOTEX CORP. yCEFOXITIN INJ 1GM 60505075905 APOTEX CORP. yCEFOXITIN INJ 2GM 60505076005 APOTEX CORP. yCEFOXITIN INJ 10GM 60505076104 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CROMOLYN SOD NEB 20MG/2ML 60505080201 APOTEX CORP. yCROMOLYN SOD NEB 20MG/2ML 60505080202 APOTEX CORP. yIPRATROPIUM SOL INHAL 60505080601 APOTEX CORP. yBUTORPHANOL SOL 10MG/ML 60505081301 APOTEX CORP. yDESMOPRESSIN SPR 0.01% 60505081500 APOTEX CORP. yIPRATROPIUM SPR 0.03% 60505082601 APOTEX CORP. yIPRATROPIUM SPR 0.06% 60505082701 APOTEX CORP. yCIPROFLOXACN SOL 0.3% OP 60505100001 APOTEX CORP. yCEFUROXIME TAB 500MG 60505120100 APOTEX CORP. yCEFUROXIME TAB 500MG 60505120103 APOTEX CORP. yCEFUROXIME TAB 250MG 60505120200 APOTEX CORP. yCEFUROXIME TAB 250MG 60505120203 APOTEX CORP. yCIPROFLOXACN TAB 250MG 60505130801 APOTEX CORP. yCIPROFLOXACN TAB 500MG 60505130901 APOTEX CORP. yCIPROFLOXACN TAB 500MG 60505130907 APOTEX CORP. yCIPROFLOXACN TAB 750MG 60505131004 APOTEX CORP. yMETFORMIN TAB 750MG ER 60505132901 APOTEX CORP. yLEFLUNOMIDE TAB 10MG 60505250201 APOTEX CORP. yLEFLUNOMIDE TAB 10MG 60505250203 APOTEX CORP. yLEFLUNOMIDE TAB 20MG 60505250301 APOTEX CORP. yLEFLUNOMIDE TAB 20MG 60505250303 APOTEX CORP. yLITHIUM CARB CAP 300MG 60505250401 APOTEX CORP. yLITHIUM CARB CAP 300MG 60505250402 APOTEX CORP. yLITHIUM CARB CAP 300MG 60505250403 APOTEX CORP. yFOSINOPRIL TAB 10MG 60505251002 APOTEX CORP. yFOSINOPRIL TAB 10MG 60505251004 APOTEX CORP. yFOSINOPRIL TAB 20MG 60505251102 APOTEX CORP. yFOSINOPRIL TAB 20MG 60505251104 APOTEX CORP. yFOSINOPRIL TAB 40MG 60505251202 APOTEX CORP. yFOSINOPRIL TAB 40MG 60505251208 APOTEX CORP. yALLOPURINOL TAB 100MG 60505251602 APOTEX CORP. yALLOPURINOL TAB 300MG 60505251702 APOTEX CORP. yCITALOPRAM TAB 10MG 60505251801 APOTEX CORP. yCITALOPRAM TAB 10MG 60505251803 APOTEX CORP. yCITALOPRAM TAB 10MG 60505251804 APOTEX CORP. yCITALOPRAM TAB 20MG 60505251901 APOTEX CORP. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CITALOPRAM TAB 20MG 60505251903 APOTEX CORP. yCITALOPRAM TAB 20MG 60505251904 APOTEX CORP. yCILOSTAZOL TAB 100MG 60505252201 APOTEX CORP. yZONISAMIDE CAP 25MG 60505254501 APOTEX CORP. yZONISAMIDE CAP 50MG 60505254601 APOTEX CORP. yZONISAMIDE CAP 100MG 60505254701 APOTEX CORP. yGABAPENTIN TAB 600MG 60505255101 APOTEX CORP. yGABAPENTIN TAB 800MG 60505255201 APOTEX CORP. yMELOXICAM TAB 7.5MG 60505255301 APOTEX CORP. ySELEGILINE TAB 5MG 60505343801 APOTEX CORP. ySELEGILINE TAB 5MG 60505343803 APOTEX CORP. ySELEGILINE TAB 5MG 60505343804 APOTEX CORP. ySELEGILINE TAB 5MG 60505343808 APOTEX CORP. yACYCLOVIR TAB 400MG 60505530601 APOTEX CORP. yACYCLOVIR TAB 800MG 60505530701 APOTEX CORP. yMETAPROTEREN SYP 10MG/5ML 60505580209 APOTEX CORP. yOXYBUTYNIN SYP 5MG/5ML 60505600809 APOTEX CORP. ySUMYCIN SYP 125/5ML 59772081505 APOTHECON, INC. yCHOLESTYRAM POW 4GM LITE 59772558902 APOTHECON, INC. yCAPTOPRIL TAB 12.5MG 59772704504 APOTHECON, INC. yCAPTOPRIL TAB 12.5MG 59772704505 APOTHECON, INC. yCAPTOPRIL TAB 12.5MG 59772704506 APOTHECON, INC. yCAPTOPRIL TAB 25MG 59772704602 APOTHECON, INC. yCAPTOPRIL TAB 25MG 59772704604 APOTHECON, INC. yCAPTOPRIL TAB 25MG VHA 59772704605 APOTHECON, INC. yCAPTOPRIL TAB 50MG 59772704704 APOTHECON, INC. yCEFADROXIL CAP 500MG 59772727103 APOTHECON, INC. yHC VALERATE CRE 0.2% 59772810004 APOTHECON, INC. yHC VALERATE CRE 0.2% 59772810005 APOTHECON, INC. yHC VALERATE CRE 0.2% 59772810007 APOTHECON, INC. yBACTRIM TAB 400-80MG 13310014501 AR SCIENTIFIC, INC. yBACTRIM DS TAB 800-160 13310014601 AR SCIENTIFIC, INC. yQUALAQUIN CAP 324MG 13310015307 AR SCIENTIFIC, INC. yALBUTEROL AER 90MCG 17270072101 ARMSTRONG PHARMACEUTICALS yVESICARE TAB 5MG 51248015001 ASTELLAS yVESICARE TAB 5MG 51248015003 ASTELLAS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VESICARE TAB 5MG 51248015052 ASTELLAS yVESICARE TAB 10MG 51248015101 ASTELLAS yVESICARE TAB 10MG 51248015103 ASTELLAS yVESICARE TAB 10MG 51248015152 ASTELLAS yPROGRAF CAP 0.5MG 00469060773 ASTELLAS PHARMA US, INC. yPROGRAF CAP 1MG 00469061711 ASTELLAS PHARMA US, INC. yPROGRAF CAP 1MG 00469061773 ASTELLAS PHARMA US, INC. yPROGRAF CAP 5MG 00469065711 ASTELLAS PHARMA US, INC. yPROGRAF CAP 5MG 00469065773 ASTELLAS PHARMA US, INC. yADENOSCAN INJ 3MG/ML 00469087120 ASTELLAS PHARMA US, INC. yADENOSCAN INJ 3MG/ML 00469087130 ASTELLAS PHARMA US, INC. yPROGRAF INJ 5MG/ML 00469301601 ASTELLAS PHARMA US, INC. yAMBISOME INJ 50MG 00469305130 ASTELLAS PHARMA US, INC. yMYCAMINE INJ 100MG 00469321110 ASTELLAS PHARMA US, INC. yMYCAMINE INJ 50MG 00469325010 ASTELLAS PHARMA US, INC. yPROTOPIC OIN 0.03% 00469520111 ASTELLAS PHARMA US, INC. yPROTOPIC OIN 0.03% 00469520130 ASTELLAS PHARMA US, INC. yPROTOPIC OIN 0.03% 00469520160 ASTELLAS PHARMA US, INC. yPROTOPIC OIN 0.1% 00469520211 ASTELLAS PHARMA US, INC. yPROTOPIC OIN 0.1% 00469520230 ASTELLAS PHARMA US, INC. yPROTOPIC OIN 0.1% 00469520260 ASTELLAS PHARMA US, INC. yCEFIZOX/D5W INJ 1GM 00469722001 ASTELLAS PHARMA US, INC. yCEFIZOX/D5W INJ 2GM 00469722102 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 1GM 00469725101 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 1GM 00469725201 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 2GM 00469725302 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 2GM 00469725402 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 10GM 00469725510 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 1GM 00469727101 ASTELLAS PHARMA US, INC. yCEFIZOX INJ 2GM 00469727202 ASTELLAS PHARMA US, INC. yADENOCARD INJ 6MG/2ML 00469823412 ASTELLAS PHARMA US, INC. yADENOCARD INJ 12MG/4ML 00469823414 ASTELLAS PHARMA US, INC. yLEXXEL TAB 5-5MG 00186000131 ASTRAZENECA LP yLEXXEL TAB 5-5MG 00186000168 ASTRAZENECA LP yLEXXEL TAB 5-2.5MG 00186000231 ASTRAZENECA LP yATACAND TAB 4MG 00186000431 ASTRAZENECA LP y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ATACAND TAB 8MG 00186000831 ASTRAZENECA LP yATACAND TAB 16MG 00186001628 ASTRAZENECA LP yATACAND TAB 16MG 00186001631 ASTRAZENECA LP yATACAND TAB 16MG 00186001654 ASTRAZENECA LP yATACAND TAB 32MG 00186003228 ASTRAZENECA LP yATACAND TAB 32MG 00186003231 ASTRAZENECA LP yATACAND TAB 32MG 00186003254 ASTRAZENECA LP yXYLOCAINE INJ 1% 00186011001 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186011201 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186011291 ASTRAZENECA LP yXYLO-MPF/EPI INJ 1% 00186011401 ASTRAZENECA LP yXYLO-MPF/EPI INJ 1% 00186011412 ASTRAZENECA LP yXYLO-MPF/EPI INJ 1% 00186011491 ASTRAZENECA LP yXYLO/EPI 1%- INJ 1:100000 00186011501 ASTRAZENECA LP yXYLO/EPI 1%- INJ 1:100000 00186011512 ASTRAZENECA LP yXYLOCAINE INJ 2% 00186012001 ASTRAZENECA LP yXYLO-MPF/EPI INJ 2% 00186012201 ASTRAZENECA LP yXYLO-MPF/EPI INJ 2% 00186012212 ASTRAZENECA LP yXYLO-MPF/EPI INJ 2% 00186012291 ASTRAZENECA LP yXYLO/EPI INJ 2% 00186012501 ASTRAZENECA LP yXYLOCAINE INJ 0.5% 00186013501 ASTRAZENECA LP yXYLOCAINE INJ MPF 0.5% 00186013701 ASTRAZENECA LP yXYLO/EPI INJ 0.5% 00186014001 ASTRAZENECA LP yXYLOCAINE INJ 1% 00186014501 ASTRAZENECA LP yXYLO/EPI 1%- INJ 1:100000 00186015001 ASTRAZENECA LP yXYLOCAINE INJ 2% 00186015501 ASTRAZENECA LP yXYLO/EPI INJ 2% 00186016001 ASTRAZENECA LP yATACAND HCT TAB 16-12.5 00186016228 ASTRAZENECA LP yATACAND HCT TAB 16-12.5 00186016254 ASTRAZENECA LP yXYLOCAINE INJ 2% 00186017014 ASTRAZENECA LP yXYLO/EPI INJ 2% 00186017514 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186021003 ASTRAZENECA LP yXYLO/DEXTROS INJ 1.5-7.5% 00186021203 ASTRAZENECA LP yXYLOCAINE INJ -MPF 2% 00186021503 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186023003 ASTRAZENECA LP yXYLOCAINE INJ -MPF 4% 00186023503 ASTRAZENECA LP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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XYLOCAINE INJ -MPF 2% 00186024113 ASTRAZENECA LP yXYLOCAINE INJ -MPF 2% 00186024213 ASTRAZENECA LP yXYLOCAINE INJ 2% 00186024312 ASTRAZENECA LP yXYLO-MPF/EPI INJ 2% 00186025002 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186025502 ASTRAZENECA LP yXYLO-MPF/EPI INJ 1% 00186026002 ASTRAZENECA LP yXYLOCAINE INJ 1% 00186027512 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186027613 ASTRAZENECA LP yXYLOCAINE INJ -MPF 1% 00186027713 ASTRAZENECA LP yXYLOCAINE SOL 4% 00186032001 ASTRAZENECA LP yATACAND HCT TAB 32-12.5 00186032228 ASTRAZENECA LP yATACAND HCT TAB 32-12.5 00186032254 ASTRAZENECA LP yXYLOCAINE GEL 2% 00186033001 ASTRAZENECA LP yXYLOCAINE GEL 2% 00186033036 ASTRAZENECA LP yXYLOCAINE SOL 2% VISC 00186036001 ASTRAZENECA LP yXYLOCAINE SOL 2% VISC 00186036011 ASTRAZENECA LP yPOLOCAINE INJ 1% 00186041001 ASTRAZENECA LP yPOLOCAINE INJ -MPF 1% 00186041201 ASTRAZENECA LP yPLENDIL TAB 2.5MG CR 00186045028 ASTRAZENECA LP yPLENDIL TAB 2.5MG CR 00186045058 ASTRAZENECA LP yPLENDIL TAB 5MG CR 00186045128 ASTRAZENECA LP yPLENDIL TAB 5MG CR 00186045158 ASTRAZENECA LP yPLENDIL TAB 10MG CR 00186045228 ASTRAZENECA LP yPLENDIL TAB 10MG CR 00186045258 ASTRAZENECA LP yPRILOSEC CAP 10MG CR 00186060631 ASTRAZENECA LP yPRILOSEC CAP 10MG CR 00186060682 ASTRAZENECA LP yENTOCORT EC CAP 3MG/24HR 00186070210 ASTRAZENECA LP yPRILOSEC CAP 20MG CR 00186074231 ASTRAZENECA LP yPRILOSEC CAP 20MG CR 00186074282 ASTRAZENECA LP yPRILOSEC CAP 40MG CR 00186074331 ASTRAZENECA LP yPRILOSEC CAP 40MG CR 00186074368 ASTRAZENECA LP yPRILOSEC CAP 40MG CR 00186074382 ASTRAZENECA LP yPULMICORT INH 200MCG 00186091542 ASTRAZENECA LP ySENSORCAINE INJ MPF0.25% 00186103001 ASTRAZENECA LP ySENSORCAINE INJ MPF0.25% 00186103012 ASTRAZENECA LP ySENSORCAINE INJ 0.25% 00186103101 ASTRAZENECA LP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SENSORCAINE INJ -MPF/EPI 00186103201 ASTRAZENECA LP ySENSORCAINE INJ -MPF/EPI 00186103212 ASTRAZENECA LP ySENSORCAINE INJ MPF 0.5% 00186103301 ASTRAZENECA LP ySENSORCAINE INJ -MPF/EPI 00186103401 ASTRAZENECA LP ySENSORCAINE INJ 0.5% 00186103501 ASTRAZENECA LP ySENSORCAINE INJ MPF0.75% 00186103701 ASTRAZENECA LP ySENSORCAINE INJ MPF0.75% 00186103702 ASTRAZENECA LP ySENSORCAINE INJ MPF0.75% 00186103712 ASTRAZENECA LP ySENSORCAINE INJ -MPF/EPI 00186103801 ASTRAZENECA LP yRHINOCORT SUS AQUA 00186107008 ASTRAZENECA LP yTOPROL XL TAB 25MG 00186108805 ASTRAZENECA LP yTOPROL XL TAB 25MG 00186108839 ASTRAZENECA LP yTOPROL XL TAB 50MG 00186109005 ASTRAZENECA LP yTOPROL XL TAB 50MG 00186109039 ASTRAZENECA LP yTOPROL XL TAB 50MG 00186109050 ASTRAZENECA LP yTOPROL XL TAB 100MG 00186109205 ASTRAZENECA LP yTOPROL XL TAB 100MG 00186109239 ASTRAZENECA LP yTOPROL XL TAB 200MG 00186109405 ASTRAZENECA LP yASTRAMORPH INJ 0.5MG/ML 00186115002 ASTRAZENECA LP yASTRAMORPH INJ 1MG/ML 00186115102 ASTRAZENECA LP yASTRAMORPH INJ 0.5MG/ML 00186115212 ASTRAZENECA LP yASTRAMORPH INJ 1MG/ML 00186115312 ASTRAZENECA LP yASTRAMORPH INJ 0.5MG/ML 00186115903 ASTRAZENECA LP yASTRAMORPH INJ 1MG/ML 00186116003 ASTRAZENECA LP yEMLA KIT TEGADERM 00186151501 ASTRAZENECA LP yEMLA KIT TEGADERM 00186151503 ASTRAZENECA LP yEMLA CRE 00186151601 ASTRAZENECA LP yFOSCAVIR INJ 24MG/ML 00186190601 ASTRAZENECA LP yPULMICORT SUS 0.25MG/2 00186198804 ASTRAZENECA LP yPULMICORT SUS 0.5MG/2 00186198904 ASTRAZENECA LP yNEXIUM CAP 20MG 00186502031 ASTRAZENECA LP yNEXIUM CAP 20MG 00186502054 ASTRAZENECA LP yNEXIUM CAP 20MG 00186502082 ASTRAZENECA LP yNEXIUM CAP 20MG 00186502228 ASTRAZENECA LP yNEXIUM CAP 40MG 00186504031 ASTRAZENECA LP yNEXIUM CAP 40MG 00186504054 ASTRAZENECA LP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NEXIUM CAP 40MG 00186504082 ASTRAZENECA LP yNEXIUM CAP 40MG 00186504228 ASTRAZENECA LP yNEXIUM I.V. SOL 20MG 00186602001 ASTRAZENECA LP yNEXIUM I.V. SOL 40MG 00186604001 ASTRAZENECA LP yELAVIL TAB 75MG 00310004210 ASTRAZENECA LP yELAVIL TAB 100MG 00310004310 ASTRAZENECA LP yTENORMIN TAB 100MG 00310010110 ASTRAZENECA LP yTENORMIN TAB 50MG 00310010510 ASTRAZENECA LP yTENORMIN TAB 25MG 00310010710 ASTRAZENECA LP yTENORMIN INJ 5MG/10ML 00310010810 ASTRAZENECA LP yTENORETIC TAB -50 00310011510 ASTRAZENECA LP yTENORETIC TAB -100 00310011710 ASTRAZENECA LP yZESTRIL TAB 5MG 00310013010 ASTRAZENECA LP yZESTRIL TAB 5MG 00310013039 ASTRAZENECA LP yZESTRIL TAB 10MG 00310013110 ASTRAZENECA LP yZESTRIL TAB 20MG 00310013210 ASTRAZENECA LP yZESTRIL TAB 30MG 00310013310 ASTRAZENECA LP yZESTRIL TAB 40MG 00310013410 ASTRAZENECA LP yZESTRIL TAB 2.5MG 00310013510 ASTRAZENECA LP yZESTORETIC TAB 10/12.5 00310014110 ASTRAZENECA LP yZESTORETIC TAB 20-12.5 00310014210 ASTRAZENECA LP yZESTORETIC TAB 20-25MG 00310014510 ASTRAZENECA LP yARIMIDEX TAB 1MG 00310020130 ASTRAZENECA LP yARIMIDEX TAB 1MG 00310020150 ASTRAZENECA LP yZOMIG SPR 5MG 00310020860 ASTRAZENECA LP yZOMIG ZMT TAB 2.5 MG 00310020920 ASTRAZENECA LP yZOMIG TAB 2.5MG 00310021020 ASTRAZENECA LP yZOMIG TAB 5MG 00310021125 ASTRAZENECA LP yZOMIG ZMT TAB 5MG 00310021321 ASTRAZENECA LP ySEROQUEL TAB 100MG 00310027110 ASTRAZENECA LP ySEROQUEL TAB 100MG 00310027139 ASTRAZENECA LP ySEROQUEL TAB 200MG 00310027210 ASTRAZENECA LP ySEROQUEL TAB 200MG 00310027239 ASTRAZENECA LP ySEROQUEL TAB 300MG 00310027439 ASTRAZENECA LP ySEROQUEL TAB 300MG 00310027460 ASTRAZENECA LP ySEROQUEL TAB 25MG 00310027510 ASTRAZENECA LP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SEROQUEL TAB 25MG 00310027534 ASTRAZENECA LP ySEROQUEL TAB 25MG 00310027539 ASTRAZENECA LP ySEROQUEL TAB 50MG 00310027810 ASTRAZENECA LP ySEROQUEL TAB 50MG 00310027834 ASTRAZENECA LP ySEROQUEL TAB 50MG 00310027839 ASTRAZENECA LP ySEROQUEL TAB 400MG 00310027910 ASTRAZENECA LP ySEROQUEL TAB 400MG 00310027939 ASTRAZENECA LP yDIPRIVAN INJ 10MG/ML 00310030011 ASTRAZENECA LP yDIPRIVAN INJ 10MG/ML 00310030022 ASTRAZENECA LP yDIPRIVAN INJ 10MG/ML 00310030050 ASTRAZENECA LP yDIPRIVAN INJ 10MG/ML 00310030061 ASTRAZENECA LP yDIPRIVAN INJ 10MG/ML 00310030064 ASTRAZENECA LP yDIPRIVAN INJ 10MG/ML 00310030065 ASTRAZENECA LP yMERREM INJ 1GM 00310032130 ASTRAZENECA LP yMERREM INJ 1GM 00310032165 ASTRAZENECA LP yMERREM INJ 500MG 00310032520 ASTRAZENECA LP yMERREM INJ 500MG 00310032564 ASTRAZENECA LP yCEFOTAN INJ 1GM/10ML 00310037610 ASTRAZENECA LP yCEFOTAN INJ 2GM/20ML 00310037720 ASTRAZENECA LP yACCOLATE TAB 10MG 00310040160 ASTRAZENECA LP yACCOLATE TAB 20MG 00310040239 ASTRAZENECA LP yACCOLATE TAB 20MG 00310040260 ASTRAZENECA LP yIRESSA TAB 250MG 00310048230 ASTRAZENECA LP yNOLVADEX TAB 10MG 00310060060 ASTRAZENECA LP yNOLVADEX TAB 20MG 00310060430 ASTRAZENECA LP yCASODEX TAB 50MG 00310070510 ASTRAZENECA LP yCASODEX TAB 50MG 00310070530 ASTRAZENECA LP yCASODEX TAB 50MG 00310070539 ASTRAZENECA LP yFASLODEX INJ 125MG 00310072025 ASTRAZENECA LP yFASLODEX INJ 250MG 00310072050 ASTRAZENECA LP yCRESTOR TAB 10MG 00310075139 ASTRAZENECA LP yCRESTOR TAB 10MG 00310075190 ASTRAZENECA LP yCRESTOR TAB 20MG 00310075239 ASTRAZENECA LP yCRESTOR TAB 20MG 00310075290 ASTRAZENECA LP yCRESTOR TAB 40MG 00310075430 ASTRAZENECA LP yCRESTOR TAB 5MG 00310075590 ASTRAZENECA LP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZOLADEX IMP 3.6MG 00310095036 ASTRAZENECA LP yZOLADEX IMP 10.8MG 00310095130 ASTRAZENECA LP yZOLADEX IMP 10.8MG 00310096130 ASTRAZENECA LP yDYNEX TAB 90-1200 66813003301 ATHLON PHARMACEUTICALS, INC. yDYNEX VR CAP 66813003401 ATHLON PHARMACEUTICALS, INC. yLEVALL G CAP 90-400MG 66813003501 ATHLON PHARMACEUTICALS, INC. yDYNEX LA TAB 66813003601 ATHLON PHARMACEUTICALS, INC. yDYNEX 12 SUS 66813003816 ATHLON PHARMACEUTICALS, INC. yDOLGIC LQ ELX 66813007316 ATHLON PHARMACEUTICALS, INC. yDOLGIC PLUS TAB 66813007401 ATHLON PHARMACEUTICALS, INC. yLEVALL LIQ 66813017916 ATHLON PHARMACEUTICALS, INC. yLEVALL-12 SUS 30-30MG 66813018004 ATHLON PHARMACEUTICALS, INC. yBROVEX SR CAP 9-90MG 66813027101 ATHLON PHARMACEUTICALS, INC. yBROVEX SUS 12MG/5ML 66813027204 ATHLON PHARMACEUTICALS, INC. yBROVEX CT CHW 12MG 66813027360 ATHLON PHARMACEUTICALS, INC. yBROVEX-D SUS 12-20MG 66813027416 ATHLON PHARMACEUTICALS, INC. yPERLOXX TAB 10/300MG 66813081001 ATHLON PHARMACEUTICALS, INC. yPERLOXX TAB 2.5/300 66813082501 ATHLON PHARMACEUTICALS, INC. yPERLOXX TAB 7.5/300 66813087501 ATHLON PHARMACEUTICALS, INC. yVOPAC TAB 650-30MG 66813092201 ATHLON PHARMACEUTICALS, INC. yDYNEX HD LIQ 45-6-200 66813093316 ATHLON PHARMACEUTICALS, INC. yLEVALL 5.0 LIQ 66813093916 ATHLON PHARMACEUTICALS, INC. yBROVEX HC LIQ 30-3-2.5 66813094016 ATHLON PHARMACEUTICALS, INC. ySYMTAN SUS 66813098016 ATHLON PHARMACEUTICALS, INC. ySYMTAN A SUS 66813098216 ATHLON PHARMACEUTICALS, INC. yATUSS NX SYP 59702000316 ATLEY PHARMACEUTICALS INC yPEDIOX LIQ 4MG/5ML 59702004004 ATLEY PHARMACEUTICALS INC yQDALL AR CAP 12MG 59702011101 ATLEY PHARMACEUTICALS INC yQDALL CAP 12-100MG 59702011201 ATLEY PHARMACEUTICALS INC yPEDIOX CHW 2-15MG 59702015201 ATLEY PHARMACEUTICALS INC ySUDEX TAB 20-600MG 59702019101 ATLEY PHARMACEUTICALS INC yATUSS HC SYP 59702021016 ATLEY PHARMACEUTICALS INC ySUDAL DM TAB 30-500MG 59702030501 ATLEY PHARMACEUTICALS INC yATUSS DR SYP 59702031516 ATLEY PHARMACEUTICALS INC yCEPHADYN TAB 650-50MG 59702065001 ATLEY PHARMACEUTICALS INC yATUSS HS SUS 59702079916 ATLEY PHARMACEUTICALS INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ATUSS DS SUS 59702080016 ATLEY PHARMACEUTICALS INC yATUSS-12 DX SUS 59702080116 ATLEY PHARMACEUTICALS INC yATUSS-12 DM LIQ 59702080216 ATLEY PHARMACEUTICALS INC ySUDAL 12 SUS 6-30MG/5 59702080516 ATLEY PHARMACEUTICALS INC ySUDAL 12 CHW 4-30MG 59702080901 ATLEY PHARMACEUTICALS INC yATUSS HD CAP 30-2-5MG 59702081301 ATLEY PHARMACEUTICALS INC yATUSS HX CAP 5-300MG 59702081401 ATLEY PHARMACEUTICALS INC yMIRTAZAPINE TAB 30MG 65862000330 AUROBINDO PHARMA LTD. yCITALOPRAM TAB 10MG 65862000501 AUROBINDO PHARMA LTD. yCITALOPRAM TAB 10MG 65862000505 AUROBINDO PHARMA LTD. yCITALOPRAM TAB 20MG 65862000601 AUROBINDO PHARMA LTD. yCITALOPRAM TAB 20MG 65862000605 AUROBINDO PHARMA LTD. yCITALOPRAM TAB 40MG 65862000701 AUROBINDO PHARMA LTD. yCITALOPRAM TAB 40MG 65862000705 AUROBINDO PHARMA LTD. yMETFORMIN TAB 500MG 65862000801 AUROBINDO PHARMA LTD. yMETFORMIN TAB 500MG 65862000805 AUROBINDO PHARMA LTD. yMETFORMIN TAB 850MG 65862000901 AUROBINDO PHARMA LTD. yMETFORMIN TAB 850MG 65862000905 AUROBINDO PHARMA LTD. yMETFORMIN TAB 1000MG 65862001001 AUROBINDO PHARMA LTD. yMETFORMIN TAB 1000MG 65862001005 AUROBINDO PHARMA LTD. yAMOXICILLIN TAB 500MG 65862001401 AUROBINDO PHARMA LTD. yAMOXICILLIN TAB 875MG 65862001501 AUROBINDO PHARMA LTD. yCEPHALEXIN CAP 250MG 65862001801 AUROBINDO PHARMA LTD. yCEPHALEXIN CAP 250MG 65862001805 AUROBINDO PHARMA LTD. yCEPHALEXIN CAP 500MG 65862001901 AUROBINDO PHARMA LTD. yCEPHALEXIN CAP 500MG 65862001905 AUROBINDO PHARMA LTD. yMIRTAZAPINE TAB 15MG ODT 65862002106 AUROBINDO PHARMA LTD. yMIRTAZAPINE TAB 30MG ODT 65862002206 AUROBINDO PHARMA LTD. yMIRTAZAPINE TAB 45MG ODT 65862002306 AUROBINDO PHARMA LTD. yZIDOVUDINE TAB 300MG 65862002460 AUROBINDO PHARMA LTD. yMIRTAZAPINE TAB 15MG 65862003130 AUROBINDO PHARMA LTD. yMIRTAZAPINE TAB 45MG 65862003230 AUROBINDO PHARMA LTD. yCEFUROXIME TAB 250MG 65862003420 AUROBINDO PHARMA LTD. yCEFUROXIME TAB 250MG 65862003460 AUROBINDO PHARMA LTD. yCEFUROXIME TAB 500MG 65862003520 AUROBINDO PHARMA LTD. yCEFUROXIME TAB 500MG 65862003560 AUROBINDO PHARMA LTD. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOPRIL TAB 2.5MG 65862003701 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 2.5MG 65862003705 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 5MG 65862003801 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 5MG 65862003805 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 10MG 65862003901 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 10MG 65862003905 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 20MG 65862004001 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 30MG 65862004101 AUROBINDO PHARMA LTD. yLISINOPRIL TAB 40MG 65862004201 AUROBINDO PHARMA LTD. yLISINOP/HCTZ TAB 10-12.5 65862004301 AUROBINDO PHARMA LTD. yLISINOP/HCTZ TAB 10-12.5 65862004305 AUROBINDO PHARMA LTD. yLISINOP/HCTZ TAB 20-12.5 65862004401 AUROBINDO PHARMA LTD. yLISINOP/HCTZ TAB 20-12.5 65862004405 AUROBINDO PHARMA LTD. yLISINOP/HCTZ TAB 20-25MG 65862004501 AUROBINDO PHARMA LTD. yZIDOVUDINE SYP 50MG/5ML 65862004824 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 5MG 65862005030 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 5MG 65862005090 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 10MG 65862005130 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 10MG 65862005190 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 10MG 65862005199 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 20MG 65862005230 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 20MG 65862005290 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 20MG 65862005299 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 40MG 65862005330 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 40MG 65862005390 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 40MG 65862005399 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 80MG 65862005430 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 80MG 65862005490 AUROBINDO PHARMA LTD. ySIMVASTATIN TAB 80MG 65862005499 AUROBINDO PHARMA LTD. yCITALOPRAM SOL 10MG/5ML 65862007424 AUROBINDO PHARMA LTD. yZIDOVUDINE CAP 100MG 65862010701 AUROBINDO PHARMA LTD. yAMIODARONE TAB 200MG 13107005605 AUROBINDO PHARMA USA, INC. yAMIODARONE TAB 200MG 13107005660 AUROBINDO PHARMA USA, INC. yTESTIM GEL 1%(50MG) 66887000105 AUXILIUM PHARMACEUTICALS, INC. yFAZACLO TAB 25MG 68322000102 AVANIR PHARMACEUTICALS yFAZACLO TAB 25MG 68322000103 AVANIR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FAZACLO TAB 25MG 68322000104 AVANIR PHARMACEUTICALS yFAZACLO TAB 100MG 68322000202 AVANIR PHARMACEUTICALS yFAZACLO TAB 100MG 68322000203 AVANIR PHARMACEUTICALS yFAZACLO TAB 100MG 68322000204 AVANIR PHARMACEUTICALS yTHERACYS INJ 49281088001 AVENTIS PASTEUR INC. yNORPRAMIN TAB 10MG 00068000701 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 25MG 00068001101 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 25MG 00068001110 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 50MG 00068001501 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 50MG 00068001510 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 50MG 00068001561 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 75MG 00068001901 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 100MG 00068002001 AVENTIS PHARMACEUTICALS yNORPRAMIN TAB 150MG 00068002150 AVENTIS PHARMACEUTICALS yCANTIL TAB 00068003701 AVENTIS PHARMACEUTICALS yBENTYL CAP 10MG 00068012065 AVENTIS PHARMACEUTICALS yBENTYL TAB 20MG 00068012341 AVENTIS PHARMACEUTICALS yBENTYL TAB 20MG 00068012361 AVENTIS PHARMACEUTICALS yBENTYL TAB 20MG 00068012365 AVENTIS PHARMACEUTICALS yBENTYL TAB 20MG 00068012371 AVENTIS PHARMACEUTICALS yBENTYL SYP 10MG/5ML 00068012516 AVENTIS PHARMACEUTICALS yCLOMID TAB 50MG 00068022630 AVENTIS PHARMACEUTICALS yHIPREX TAB 1GM 00068027761 AVENTIS PHARMACEUTICALS yRIFADIN CAP 300MG 00068050830 AVENTIS PHARMACEUTICALS yRIFADIN CAP 300MG 00068050860 AVENTIS PHARMACEUTICALS yRIFADIN CAP 300MG 00068050861 AVENTIS PHARMACEUTICALS yRIFAMATE CAP 00068050960 AVENTIS PHARMACEUTICALS yRIFADIN CAP 150MG 00068051030 AVENTIS PHARMACEUTICALS yRIFADIN INJ 600 MG 00068059701 AVENTIS PHARMACEUTICALS yTENUATE TAB 25MG 00068069761 AVENTIS PHARMACEUTICALS yTENUATE TAB 75MG CR 00068069861 AVENTIS PHARMACEUTICALS yTENUATE TAB 75MG CR 00068069862 AVENTIS PHARMACEUTICALS yBENTYL INJ 10MG/ML 00068080923 AVENTIS PHARMACEUTICALS yBENTYL INJ 10MG/ML 00068080925 AVENTIS PHARMACEUTICALS yRIFATER TAB 00088057641 AVENTIS PHARMACEUTICALS yALLEGRA-D TAB 12 HOUR 00088109047 AVENTIS PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALLEGRA-D TAB 12 HOUR 00088109049 AVENTIS PHARMACEUTICALS yALLEGRA-D TAB 12 HOUR 00088109055 AVENTIS PHARMACEUTICALS yALLEGRA-D TAB 24 HOUR 00088109547 AVENTIS PHARMACEUTICALS yALLEGRA TAB 30MG 00088110647 AVENTIS PHARMACEUTICALS yALLEGRA TAB 60MG 00088110747 AVENTIS PHARMACEUTICALS yALLEGRA TAB 60MG 00088110749 AVENTIS PHARMACEUTICALS yALLEGRA TAB 60MG 00088110755 AVENTIS PHARMACEUTICALS yALLEGRA TAB 180MG 00088110947 AVENTIS PHARMACEUTICALS yALLEGRA TAB 180MG 00088110955 AVENTIS PHARMACEUTICALS yNILANDRON TAB 150MG 00088111114 AVENTIS PHARMACEUTICALS yCOPAXONE KIT 20MG/ML 00088115330 AVENTIS PHARMACEUTICALS yANZEMET TAB 50MG 00088120205 AVENTIS PHARMACEUTICALS yANZEMET TAB 50MG 00088120229 AVENTIS PHARMACEUTICALS yANZEMET TAB 50MG 00088120243 AVENTIS PHARMACEUTICALS yANZEMET TAB 100MG 00088120305 AVENTIS PHARMACEUTICALS yANZEMET TAB 100MG 00088120329 AVENTIS PHARMACEUTICALS yANZEMET TAB 100MG 00088120343 AVENTIS PHARMACEUTICALS yANZEMET INJ 20MG/ML 00088120632 AVENTIS PHARMACEUTICALS yANZEMET INJ 20MG/ML 00088120806 AVENTIS PHARMACEUTICALS yANZEMET INJ 20MG/ML 00088120869 AVENTIS PHARMACEUTICALS yANZEMET INJ 20MG/ML 00088120876 AVENTIS PHARMACEUTICALS yANZEMET SOL 20MG/ML 00088120926 AVENTIS PHARMACEUTICALS yCARAFATE SUS 1GM/10ML 00088170015 AVENTIS PHARMACEUTICALS yCARAFATE TAB 1GM 00088171225 AVENTIS PHARMACEUTICALS yCARAFATE TAB 1GM 00088171247 AVENTIS PHARMACEUTICALS yCARAFATE TAB 1GM 00088171253 AVENTIS PHARMACEUTICALS yCARAFATE TAB 1GM 00088171255 AVENTIS PHARMACEUTICALS yCARAFATE TAB 1GM 00088171273 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 30MG 00088177147 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 30MG 00088177155 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 30MG 00088177190 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 60MG 00088177247 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 60MG 00088177255 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 60MG 00088177290 AVENTIS PHARMACEUTICALS yCARDIZEM INJ 5MG/ML 00088178917 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 90MG 00088179142 AVENTIS PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARDIZEM TAB 90MG 00088179147 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 90MG 00088179149 AVENTIS PHARMACEUTICALS yCARDIZEM TAB 90MG 00088179190 AVENTIS PHARMACEUTICALS yPRIFTIN TAB 150MG 00088210003 AVENTIS PHARMACEUTICALS yARAVA TAB 10MG 00088216030 AVENTIS PHARMACEUTICALS yARAVA TAB 20MG 00088216130 AVENTIS PHARMACEUTICALS yLANTUS INJ 100/ML 00088222033 AVENTIS PHARMACEUTICALS yLANTUS INJ OPTICLIK 00088222052 AVENTIS PHARMACEUTICALS yKETEK TAB 300MG 00088222320 AVENTIS PHARMACEUTICALS yKETEK PAK TAB 400MG 00088222507 AVENTIS PHARMACEUTICALS yKETEK TAB 400MG 00088222541 AVENTIS PHARMACEUTICALS yKETEK TAB 400MG 00088222549 AVENTIS PHARMACEUTICALS yAPIDRA INJ U-100 00088250033 AVENTIS PHARMACEUTICALS yAPIDRA INJ 00088250052 AVENTIS PHARMACEUTICALS ySULFACET-R LOT 00066002825 AVENTIS PHARMACEUTICALS, INC. yZETAR SHA 1% 00066006306 AVENTIS PHARMACEUTICALS, INC. yHYTONE CRE 2.5% 00066009501 AVENTIS PHARMACEUTICALS, INC. yHYTONE CRE 2.5% 00066009502 AVENTIS PHARMACEUTICALS, INC. yHYTONE LOT 2.5% 00066009802 AVENTIS PHARMACEUTICALS, INC. ySHEPARD'S LOT 00066010566 AVENTIS PHARMACEUTICALS, INC. ySHEPARD'S LOT 00066010574 AVENTIS PHARMACEUTICALS, INC. yPSORCON E CRE 0.05% 00066027231 AVENTIS PHARMACEUTICALS, INC. yPSORCON E CRE 0.05% 00066027260 AVENTIS PHARMACEUTICALS, INC. yPSORCON E OIN 0.05% 00066027531 AVENTIS PHARMACEUTICALS, INC. yPSORCON E OIN 0.05% 00066027560 AVENTIS PHARMACEUTICALS, INC. yBENZAGEL-5 GEL 5% 00066043015 AVENTIS PHARMACEUTICALS, INC. yBENZAGEL-5 GEL 5% 00066043030 AVENTIS PHARMACEUTICALS, INC. yBENZAGEL-10 GEL 10% 00066043115 AVENTIS PHARMACEUTICALS, INC. yBENZAGEL-10 GEL 10% 00066043130 AVENTIS PHARMACEUTICALS, INC. yBENZACLIN GEL 1-5% 00066049425 AVENTIS PHARMACEUTICALS, INC. yBENZACLIN GEL 1-5% 00066049450 AVENTIS PHARMACEUTICALS, INC. yBENZACLIN GEL 1-5%PUMP 00066049455 AVENTIS PHARMACEUTICALS, INC. yDERMATOP CRE 0.1% 00066050715 AVENTIS PHARMACEUTICALS, INC. yDERMATOP CRE 0.1% 00066050760 AVENTIS PHARMACEUTICALS, INC. yDERMATOP OIN 0.1% 00066050815 AVENTIS PHARMACEUTICALS, INC. yDERMATOP OIN 0.1% 00066050860 AVENTIS PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENZAMYCIN GEL 00066051046 AVENTIS PHARMACEUTICALS, INC. yBENZAMYCIN GEL PAK 00066057760 AVENTIS PHARMACEUTICALS, INC. yVANAMIDE CRE 40% 00066060303 AVENTIS PHARMACEUTICALS, INC. yVANAMIDE CRE 40% 00066060307 AVENTIS PHARMACEUTICALS, INC. yCARAC CRE 0.5% 00066715030 AVENTIS PHARMACEUTICALS, INC. yKLARON LOT 10% 00066750004 AVENTIS PHARMACEUTICALS, INC. yPENLAC SOL 8% 00066800802 AVENTIS PHARMACEUTICALS, INC. yHYTONE CRE 1% 00066804201 AVENTIS PHARMACEUTICALS, INC. ySULFACET-R LOT TINT-FRE 00066902825 AVENTIS PHARMACEUTICALS, INC. yNORITATE CRE 1% 00066985060 AVENTIS PHARMACEUTICALS, INC. yDDAVP TAB 0.1MG 00075001600 AVENTIS PHARMACEUTICALS, INC. yDDAVP TAB 0.2MG 00075002600 AVENTIS PHARMACEUTICALS, INC. yAZMACORT AER 100MCG 00075006037 AVENTIS PHARMACEUTICALS, INC. yLOZOL TAB 2.5MG 00075008223 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 40/0.4ML 00075062040 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 60/0.6ML 00075062160 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 80/0.8ML 00075062280 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 100/1ML 00075062300 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 30/0.3ML 00075062403 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 30/0.3ML 00075062430 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 300/3ML 00075062603 AVENTIS PHARMACEUTICALS, INC. yLOZOL TAB 1.25MG 00075070000 AVENTIS PHARMACEUTICALS, INC. yNASACORT AQ AER 55MCG/AC 00075150616 AVENTIS PHARMACEUTICALS, INC. yDDAVP SOL 0.01% 00075245001 AVENTIS PHARMACEUTICALS, INC. yDDAVP INJ 4MCG/ML 00075245101 AVENTIS PHARMACEUTICALS, INC. yDDAVP INJ 4MCG/ML 00075245153 AVENTIS PHARMACEUTICALS, INC. yDDAVP SPR 0.01% 00075245201 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 120/0.8 00075291201 AVENTIS PHARMACEUTICALS, INC. yLOVENOX INJ 150/1ML 00075291501 AVENTIS PHARMACEUTICALS, INC. yRILUTEK TAB 50MG 00075770060 AVENTIS PHARMACEUTICALS, INC. yTAXOTERE INJ 20/0.5ML 00075800120 AVENTIS PHARMACEUTICALS, INC. yTAXOTERE INJ 80MG/2ML 00075800180 AVENTIS PHARMACEUTICALS, INC. yULTRASE MT12 CAP 58914000210 AXCAN SCANDIPHARM, INC. yULTRASE MT20 CAP 58914000410 AXCAN SCANDIPHARM, INC. yULTRASE MT20 CAP 58914000450 AXCAN SCANDIPHARM, INC. yADEKS CHW 58914001006 AXCAN SCANDIPHARM, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENTYL CAP 10MG 58914001210 AXCAN SCANDIPHARM, INC. yBENTYL TAB 20MG 58914001310 AXCAN SCANDIPHARM, INC. yBENTYL SYP 10MG/5ML 58914001516 AXCAN SCANDIPHARM, INC. yULTRASE MT18 CAP 58914001810 AXCAN SCANDIPHARM, INC. yULTRASE CAP 58914004510 AXCAN SCANDIPHARM, INC. yVIOKASE 8 TAB 58914011110 AXCAN SCANDIPHARM, INC. yVIOKASE 8 TAB 58914011150 AXCAN SCANDIPHARM, INC. yVIOKASE POW 58914011508 AXCAN SCANDIPHARM, INC. yVIOKASE 16 TAB 58914011610 AXCAN SCANDIPHARM, INC. yVIOKASE 16 TAB 58914011650 AXCAN SCANDIPHARM, INC. yPHOTOFRIN INJ 75MG 58914015575 AXCAN SCANDIPHARM, INC. yCARAFATE SUS 1GM/10ML 58914017014 AXCAN SCANDIPHARM, INC. yCARAFATE TAB 1GM 58914017110 AXCAN SCANDIPHARM, INC. yCARAFATE TAB 1GM 58914017121 AXCAN SCANDIPHARM, INC. yCARAFATE TAB 1GM 58914017130 AXCAN SCANDIPHARM, INC. yCARAFATE TAB 1GM 58914017150 AXCAN SCANDIPHARM, INC. yADEKS PEDIAT DRO 58914021260 AXCAN SCANDIPHARM, INC. yCANASA SUP 500MG 58914050018 AXCAN SCANDIPHARM, INC. yCANASA SUP 500MG 58914050056 AXCAN SCANDIPHARM, INC. yCANASA SUP 1000MG 58914050118 AXCAN SCANDIPHARM, INC. yCANASA SUP 1000MG 58914050156 AXCAN SCANDIPHARM, INC. yURSO 250 TAB 250MG 58914078510 AXCAN SCANDIPHARM, INC. yURSO 250 TAB 250MG 58914078550 AXCAN SCANDIPHARM, INC. yURSO FORTE TAB 500MG 58914079010 AXCAN SCANDIPHARM, INC. yURSO FORTE TAB 500MG 58914079050 AXCAN SCANDIPHARM, INC. yINDERAL TAB 10MG 00046042181 AYERST LABORATORIES yINDERAL TAB 10MG 00046042195 AYERST LABORATORIES yINDERAL TAB 20MG 00046042281 AYERST LABORATORIES yINDERAL TAB 40MG 00046042481 AYERST LABORATORIES yINDERAL TAB 40MG 00046042495 AYERST LABORATORIES yINDERAL TAB 60MG 00046042681 AYERST LABORATORIES yINDERAL TAB 80MG 00046042881 AYERST LABORATORIES yINDERAL LA CAP 60MG 00046047081 AYERST LABORATORIES yINDERAL LA CAP 80MG 00046047181 AYERST LABORATORIES yINDERAL LA CAP 120MG 00046047381 AYERST LABORATORIES yINDERAL LA CAP 160MG 00046047981 AYERST LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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INDERIDE TAB 40/25 00046048481 AYERST LABORATORIES yFACTREL INJ 100MCG 00046050705 AYERST LABORATORIES yPREMARIN INJ 25MG 00046074905 AYERST LABORATORIES yPREMARIN TAB 0.9MG 00046086481 AYERST LABORATORIES yPREMARIN TAB 1.25MG 00046086699 AYERST LABORATORIES yPREMARIN TAB 0.625MG 00046086781 AYERST LABORATORIES yPREMARIN TAB 0.625MG 00046086791 AYERST LABORATORIES yPREMARIN TAB 0.3MG 00046086881 AYERST LABORATORIES yPREMARIN TAB 0.3MG 00046086891 AYERST LABORATORIES yPREMARIN VAG CRE 0.625MG 00046087293 AYERST LABORATORIES yPREMPRO TAB .625-2.5 00046087501 AYERST LABORATORIES yPREMPRO TAB .625-2.5 00046087505 AYERST LABORATORIES yPREMPRO TAB .625-2.5 00046087506 AYERST LABORATORIES yPREMPRO TAB 0.45-1.5 00046093708 AYERST LABORATORIES yPREMPRO TAB 0.45-1.5 00046093709 AYERST LABORATORIES yPREMPRO TAB 0.3-1.5 00046093808 AYERST LABORATORIES yPREMPRO TAB 0.3-1.5 00046093809 AYERST LABORATORIES yPREMPRO TAB 0.625-5 00046097505 AYERST LABORATORIES yPREMPRO TAB 0.625-5 00046097506 AYERST LABORATORIES yPHOSPHOLINE SOL 0.125%OP 00046106505 AYERST LABORATORIES yPREMARIN TAB 0.3MG 00046110081 AYERST LABORATORIES yPREMARIN TAB 0.3MG 00046110091 AYERST LABORATORIES yPREMARIN TAB 0.45MG 00046110181 AYERST LABORATORIES yPREMARIN TAB 0.625MG 00046110281 AYERST LABORATORIES yPREMARIN TAB 0.625MG 00046110291 AYERST LABORATORIES yPREMARIN TAB 0.9MG 00046110381 AYERST LABORATORIES yPREMARIN TAB 1.25MG 00046110481 AYERST LABORATORIES yPREMARIN TAB 1.25MG 00046110491 AYERST LABORATORIES yPREMPHASE TAB 00046257301 AYERST LABORATORIES yPREMPHASE TAB 00046257305 AYERST LABORATORIES yPREMPHASE TAB 00046257306 AYERST LABORATORIES yINDERAL INJ 1MG/ML 00046326510 AYERST LABORATORIES yGASTROCROM CON 100/5ML 18860067870 AZUR PHARMA, INC. yDEXTROSE INJ 5% 00264110155 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264110255 B. BRAUN MEDICAL INC. yDEXTROSE INJ 70% 00264112950 B. BRAUN MEDICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FREAMINE III INJ 8.5%/D50 00264116755 B. BRAUN MEDICAL INC. yDEXTROSE INJ 10% 00264120755 B. BRAUN MEDICAL INC. yDEXTROSE INJ 30% 00264124055 B. BRAUN MEDICAL INC. yDEXTROSE INJ 20% 00264125055 B. BRAUN MEDICAL INC. yDEXTROSE INJ 20% 00264125155 B. BRAUN MEDICAL INC. yDEXTROSE INJ 40% 00264126055 B. BRAUN MEDICAL INC. yDEXTROSE INJ 60% 00264127050 B. BRAUN MEDICAL INC. yDEXTROSE INJ 50% 00264128050 B. BRAUN MEDICAL INC. yDEXTROSE INJ 50% 00264128055 B. BRAUN MEDICAL INC. yDEXTROSE INJ 50% 00264128155 B. BRAUN MEDICAL INC. yDEXTROSE INJ 50% 00264128555 B. BRAUN MEDICAL INC. yDEXTROSE INJ 70% 00264129050 B. BRAUN MEDICAL INC. yDEXTROSE INJ 70% 00264129055 B. BRAUN MEDICAL INC. yDOPAMINE/D5W INJ 0.8MG/ML 00264144155 B. BRAUN MEDICAL INC. yDOPAMINE/D5W INJ 0.8MG/ML 00264144255 B. BRAUN MEDICAL INC. yDOPAMINE/D5W INJ 1.6MG/ML 00264148155 B. BRAUN MEDICAL INC. yDOPAMINE/D5W INJ 1.6MG/ML 00264148255 B. BRAUN MEDICAL INC. yDOPAMINE/D5W INJ 3.2MG/ML 00264149255 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264151031 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264151032 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264151036 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264180031 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264180032 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264180036 B. BRAUN MEDICAL INC. yNEPHRAMINE INJ 5.4% 00264190955 B. BRAUN MEDICAL INC. yPROCALAMINE INJ 3% 00264191500 B. BRAUN MEDICAL INC. yPROCALAMINE INJ 3% 00264191507 B. BRAUN MEDICAL INC. yPOT CHLORIDE INJ 2MEQ/ML 00264194010 B. BRAUN MEDICAL INC. yPOT CHLORIDE INJ 2MEQ/ML 00264194020 B. BRAUN MEDICAL INC. yHYPERLYTE-CR INJ 00264194320 B. BRAUN MEDICAL INC. yDEXTRAN 70 INJ NACL 0.9 00264196010 B. BRAUN MEDICAL INC. yDEXTRAN INJ 10% 00264196210 B. BRAUN MEDICAL INC. yDEXTRAN INJ 10% 00264196310 B. BRAUN MEDICAL INC. yHESPAN INJ 6% 00264196510 B. BRAUN MEDICAL INC. ySTERIL WATER SOL IRRIG 00264210100 B. BRAUN MEDICAL INC. ySTERIL WATER SOL IRRIG 00264210110 B. BRAUN MEDICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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STERIL WATER SOL IRRIG 00264210150 B. BRAUN MEDICAL INC. ySTERIL WATER SOL IRRIG 00264210170 B. BRAUN MEDICAL INC. ySODIUM CHLOR SOL 0.9% IRR 00264220100 B. BRAUN MEDICAL INC. ySODIUM CHLOR SOL 0.9% IRR 00264220110 B. BRAUN MEDICAL INC. ySODIUM CHLOR SOL 0.9% IRR 00264220150 B. BRAUN MEDICAL INC. ySODIUM CHLOR SOL 0.9% IRR 00264220170 B. BRAUN MEDICAL INC. yRINGER'S IRR SOL 00264220200 B. BRAUN MEDICAL INC. yRINGER'S IRR SOL 00264220250 B. BRAUN MEDICAL INC. yLACTATED RIN SOL IRRIGAT 00264220300 B. BRAUN MEDICAL INC. yLACTATED RIN SOL IRRIGAT 00264220350 B. BRAUN MEDICAL INC. yLACTATED RIN SOL IRRIGAT 00264220370 B. BRAUN MEDICAL INC. yPHYSIOLYTE SOL 00264220500 B. BRAUN MEDICAL INC. ySORBITOL SOL 3.3% IRR 00264230150 B. BRAUN MEDICAL INC. ySORBITOL SOL 3.3% IRR 00264230170 B. BRAUN MEDICAL INC. yAMINOAC ACID SOL 1.5% IRR 00264230250 B. BRAUN MEDICAL INC. yAMINOAC ACID SOL 1.5% IRR 00264230270 B. BRAUN MEDICAL INC. yRESECTISOL SOL 5% 00264230350 B. BRAUN MEDICAL INC. yACETIC ACID SOL 0.25%IRR 00264230400 B. BRAUN MEDICAL INC. yACETIC ACID SOL 0.25%IRR 00264230410 B. BRAUN MEDICAL INC. yBALANCED SAL SOL OP 00264240110 B. BRAUN MEDICAL INC. yMILRINONE INJ DW5 00264300032 B. BRAUN MEDICAL INC. yCEFAZOLIN SO SOL DEXTROSE 00264310311 B. BRAUN MEDICAL INC. yCEFUROX/DEXT INJ 750MG 00264311211 B. BRAUN MEDICAL INC. yCEFUROX/DEXT INJ 1.5GM 00264311411 B. BRAUN MEDICAL INC. yCEFOXITIN INJ 1GM 00264312311 B. BRAUN MEDICAL INC. yCEFOXITIN INJ 2GM 00264312511 B. BRAUN MEDICAL INC. yCEFTRIAX/DEX INJ 1GM 00264315311 B. BRAUN MEDICAL INC. yCEFTRIAX/DEX INJ 2GM 00264315511 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264400055 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264400155 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264400255 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.45% 00264402155 B. BRAUN MEDICAL INC. yMETRO IV INJ 5MG/ML 00264553532 B. BRAUN MEDICAL INC. yGENTAM/NACL INJ 60MG 00264580632 B. BRAUN MEDICAL INC. yGENTAM/NACL INJ 80MG 00264580832 B. BRAUN MEDICAL INC. yGENTAM/NACL INJ 100MG 00264581032 B. BRAUN MEDICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GENTAM/NACL INJ 60MG 00264581238 B. BRAUN MEDICAL INC. yGENTAM/NACL INJ 80MG 00264581638 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264751000 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264751010 B. BRAUN MEDICAL INC. yDEXTROSE INJ 5% 00264751020 B. BRAUN MEDICAL INC. yDEXTROSE 10% INJ FL CONT 00264752000 B. BRAUN MEDICAL INC. yDEXTROSE 10% INJ FL CONT 00264752010 B. BRAUN MEDICAL INC. yDEXTROSE 10% INJ FL CONT 00264752020 B. BRAUN MEDICAL INC. yMANNITOL INJ 20% 00264757810 B. BRAUN MEDICAL INC. yMANNITOL INJ 20% 00264757820 B. BRAUN MEDICAL INC. yD2.5W/NACL INJ 0.45% 00264760500 B. BRAUN MEDICAL INC. yD2.5W/NACL INJ 0.45% 00264760510 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.9% 00264761000 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.9% 00264761010 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.9% 00264761020 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.45% 00264761200 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.45% 00264761210 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.45% 00264761220 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.33% 00264761400 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.33% 00264761410 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.2% 00264761600 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.2% 00264761610 B. BRAUN MEDICAL INC. yD5W/NACL INJ 0.2% 00264761620 B. BRAUN MEDICAL INC. yD10W/NACL INJ 0.45% 00264762200 B. BRAUN MEDICAL INC. yD10W/NACL INJ 0.2% 00264762320 B. BRAUN MEDICAL INC. yKCL/D5W INJ 0.15% 00264762500 B. BRAUN MEDICAL INC. yKCL/D5W INJ 0.3% 00264762800 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ .075/.45 00264763400 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ .15/.45% 00264763500 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ .22/.45 00264763600 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ 0.3/0.45 00264763800 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ 0.15/0.2 00264764500 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ 0.15/0.2 00264764520 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ 0.3/0.2% 00264764800 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ 0.15/0.9 00264765200 B. BRAUN MEDICAL INC. yKCL/D5W/NACL INJ .15/.33% 00264765500 B. BRAUN MEDICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ISOLYTE-S INJ 00264770300 B. BRAUN MEDICAL INC. yISOLYTE-S INJ /D5W 00264770400 B. BRAUN MEDICAL INC. yISOLYTE-S INJ PH 7.4 00264770700 B. BRAUN MEDICAL INC. yISOLYTE-S INJ PH 7.4 00264770710 B. BRAUN MEDICAL INC. yISOLYTE-H INJ /D5W 00264771900 B. BRAUN MEDICAL INC. yISOLYTE-M INJ /D5W 00264772000 B. BRAUN MEDICAL INC. yISOLYTE-P INJ /D5W 00264773010 B. BRAUN MEDICAL INC. yLACTATED RIN INJ 00264775000 B. BRAUN MEDICAL INC. yLACTATED RIN INJ 00264775010 B. BRAUN MEDICAL INC. yLACTATED RIN INJ 00264775020 B. BRAUN MEDICAL INC. yD5W/LR INJ 00264775100 B. BRAUN MEDICAL INC. yD5W/LR INJ 00264775110 B. BRAUN MEDICAL INC. yRINGERS INJ 00264778000 B. BRAUN MEDICAL INC. yD5W/RINGER'S INJ 00264778100 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264780000 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264780010 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.9% 00264780020 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.45% 00264780200 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 0.45% 00264780210 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 3% 00264780510 B. BRAUN MEDICAL INC. ySOD CHLORIDE INJ 5% 00264780610 B. BRAUN MEDICAL INC. ySTERIL WATER INJ 00264785000 B. BRAUN MEDICAL INC. ySTERIL WATER INJ 00264785010 B. BRAUN MEDICAL INC. ySTERIL WATER INJ 00264785020 B. BRAUN MEDICAL INC. yKCL/NACL INJ 0.15-0.9 00264786500 B. BRAUN MEDICAL INC. yFREAMINE III INJ 10% 00264901055 B. BRAUN MEDICAL INC. yFREAMINE III INJ 10% 00264901155 B. BRAUN MEDICAL INC. yFREAMINE III INJ 8.5% 00264903055 B. BRAUN MEDICAL INC. yFREAMINE III INJ 8.5% 00264903155 B. BRAUN MEDICAL INC. yFREAMINE III INJ 3% 00264904055 B. BRAUN MEDICAL INC. ySTERIL WATER INJ 00264920055 B. BRAUN MEDICAL INC. ySTERIL WATER INJ 00264920155 B. BRAUN MEDICAL INC. ySTERIL WATER INJ 00264920555 B. BRAUN MEDICAL INC. yTROPHAMINE INJ 10% 00264934155 B. BRAUN MEDICAL INC. yFREAMINE HBC INJ 6.9% 00264935055 B. BRAUN MEDICAL INC. yTROPHAMINE INJ 6% 00264936155 B. BRAUN MEDICAL INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HEPATAMINE SOL 8% 00264937155 B. BRAUN MEDICAL INC. yHEP SOD/D5W INJ 20000UNT 00264956710 B. BRAUN MEDICAL INC. yHEP SOD/D5W INJ 25000UNT 00264957710 B. BRAUN MEDICAL INC. yHEP SOD/D5W INJ 25000UNT 00264958720 B. BRAUN MEDICAL INC. yLIDOCAIN/D5W INJ 4MG/ML 00264959410 B. BRAUN MEDICAL INC. yLIDOCAIN/D5W INJ 4MG/ML 00264959420 B. BRAUN MEDICAL INC. yLIDOCAIN/D5W INJ 8MG/ML 00264959810 B. BRAUN MEDICAL INC. yLIDOCAIN/D5W INJ 8MG/ML 00264959820 B. BRAUN MEDICAL INC. yHEP SOD/NACL INJ 1000UNIT 00264987210 B. BRAUN MEDICAL INC. yALACOL DM SYP 5-2-10MG 63162050716 BALLAY PHARMACEUTICALS yBALAMINE DM SYP GRAPE 63162050816 BALLAY PHARMACEUTICALS yBALAMINE DM DRO GRAPE 63162050930 BALLAY PHARMACEUTICALS yNORTEMP SUS 160/5ML 63162051012 BALLAY PHARMACEUTICALS yBALTUSSIN SYP 20-5-3 63162051316 BALLAY PHARMACEUTICALS yALACOL SYP 2-5MG 63162051516 BALLAY PHARMACEUTICALS yTETRACYCLINE CAP 500MG 00555001002 BARR LABORATORIES INC yTETRACYCLINE CAP 500MG 00555001005 BARR LABORATORIES INC yTETRACYCLINE CAP 250MG 00555001102 BARR LABORATORIES INC yTETRACYCLINE CAP 250MG 00555001105 BARR LABORATORIES INC yCHLORDIAZEP CAP 10MG 00555003302 BARR LABORATORIES INC yCHLORDIAZEP CAP 10MG 00555003305 BARR LABORATORIES INC yDIPHENHYDRAM CAP 50MG 00555005902 BARR LABORATORIES INC yDIPHENHYDRAM CAP 50MG 00555005905 BARR LABORATORIES INC yISONIAZID TAB 100MG 00555006602 BARR LABORATORIES INC yISONIAZID TAB 100MG 00555006605 BARR LABORATORIES INC yISONIAZID TAB 300MG 00555007101 BARR LABORATORIES INC yISONIAZID TAB 300MG 00555007102 BARR LABORATORIES INC yISONIAZID TAB 300MG 00555007105 BARR LABORATORIES INC yCLONAZEP ODT TAB 0.125MG 00555009496 BARR LABORATORIES INC yCLONAZEP ODT TAB 0.25MG 00555009596 BARR LABORATORIES INC yCLONAZEP ODT TAB 0.5MG 00555009696 BARR LABORATORIES INC yCLONAZEP ODT TAB 1MG 00555009796 BARR LABORATORIES INC yCLONAZEP ODT TAB 2MG 00555009896 BARR LABORATORIES INC yANAGRELIDE CAP 0.5MG 00555010102 BARR LABORATORIES INC yANAGRELIDE CAP 1MG 00555010202 BARR LABORATORIES INC yMETFORMIN TAB 750MG ER 00555010702 BARR LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHLORDIAZEP CAP 5MG 00555015802 BARR LABORATORIES INC yCHLORDIAZEP CAP 5MG 00555015804 BARR LABORATORIES INC yCHLORDIAZEP CAP 25MG 00555015902 BARR LABORATORIES INC yCHLORDIAZEP CAP 25MG 00555015904 BARR LABORATORIES INC yDIAZEPAM TAB 2MG 00555016302 BARR LABORATORIES INC yDIAZEPAM TAB 2MG 00555016305 BARR LABORATORIES INC yDIAZEPAM TAB 10MG 00555016402 BARR LABORATORIES INC yDIAZEPAM TAB 10MG 00555016405 BARR LABORATORIES INC yMEFLOQUINE TAB 250MG 00555017178 BARR LABORATORIES INC yNORETHIN ACE TAB 5MG 00555021110 BARR LABORATORIES INC yDESMOPRESSIN TAB 0.1MG 00555023202 BARR LABORATORIES INC yDESMOPRESSIN TAB 0.2MG 00555023302 BARR LABORATORIES INC yMIRTAZAPINE TAB 15MG ODT 00555024171 BARR LABORATORIES INC yMIRTAZAPINE TAB 30MG ODT 00555024271 BARR LABORATORIES INC yDIPYRIDAMOLE TAB 25MG 00555025202 BARR LABORATORIES INC yDIPYRIDAMOLE TAB 25MG 00555025205 BARR LABORATORIES INC yDIPYRIDAMOLE TAB 50MG 00555028502 BARR LABORATORIES INC yDIPYRIDAMOLE TAB 50MG 00555028505 BARR LABORATORIES INC yDIPYRIDAMOLE TAB 75MG 00555028602 BARR LABORATORIES INC yDIPYRIDAMOLE TAB 75MG 00555028605 BARR LABORATORIES INC yMETHYLPRED TAB 4MG 00555030102 BARR LABORATORIES INC yMETHYLPRED PAK 4MG 00555030138 BARR LABORATORIES INC yHYDROXYZ PAM CAP 50MG 00555030202 BARR LABORATORIES INC yHYDROXYZ PAM CAP 50MG 00555030204 BARR LABORATORIES INC yAPAP/CODEINE TAB 300-30MG 00555030302 BARR LABORATORIES INC yAPAP/CODEINE TAB 300-30MG 00555030305 BARR LABORATORIES INC yAPAP/CODEINE TAB 300-60MG 00555030402 BARR LABORATORIES INC yAPAP/CODEINE TAB 300-60MG 00555030404 BARR LABORATORIES INC yAPAP/CODEINE TAB 300-15MG 00555030502 BARR LABORATORIES INC yHYDROXYZ PAM CAP 25MG 00555032302 BARR LABORATORIES INC yHYDROXYZ PAM CAP 25MG 00555032304 BARR LABORATORIES INC yHYDROXYZ PAM CAP 100MG 00555032402 BARR LABORATORIES INC yERRIN TAB 0.35MG 00555034458 BARR LABORATORIES INC yLITHIUM CARB TAB 300MG ER 00555034502 BARR LABORATORIES INC yLEFLUNOMIDE TAB 10MG 00555035101 BARR LABORATORIES INC yLEFLUNOMIDE TAB 20MG 00555035201 BARR LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIAZEPAM TAB 5MG 00555036302 BARR LABORATORIES INC yDIAZEPAM TAB 5MG 00555036305 BARR LABORATORIES INC yDURADRIN CAP 00555036402 BARR LABORATORIES INC yCIPROFLOXACN SUS 5% 00555037987 BARR LABORATORIES INC yMEPERIDINE TAB 50MG 00555038102 BARR LABORATORIES INC yMEPERIDINE TAB 100MG 00555038202 BARR LABORATORIES INC yTRIAMT/HCTZ TAB 75-50MG 00555044402 BARR LABORATORIES INC yTRIAMT/HCTZ TAB 75-50MG 00555044404 BARR LABORATORIES INC yEES/SULFISOX SUS 200-600 00555044521 BARR LABORATORIES INC yEES/SULFISOX SUS 200-600 00555044522 BARR LABORATORIES INC yEES/SULFISOX SUS 200-600 00555044523 BARR LABORATORIES INC yTAMOXIFEN TAB 10MG 00555044605 BARR LABORATORIES INC yTAMOXIFEN TAB 10MG 00555044609 BARR LABORATORIES INC yTAMOXIFEN TAB 10MG 00555044663 BARR LABORATORIES INC yAMILOR/HCTZ TAB 5-50 00555048302 BARR LABORATORIES INC yAMILOR/HCTZ TAB 5-50 00555048305 BARR LABORATORIES INC yLEUCOVOR CA TAB 5MG 00555048401 BARR LABORATORIES INC yLEUCOVOR CA TAB 5MG 00555048402 BARR LABORATORIES INC yLEUCOVOR CA TAB 25MG 00555048527 BARR LABORATORIES INC yTRIAM/HCTZ CAP 37.5-25 00555048802 BARR LABORATORIES INC yTRIAM/HCTZ CAP 37.5-25 00555048805 BARR LABORATORIES INC yTRAZODONE TAB 50MG 00555048902 BARR LABORATORIES INC yTRAZODONE TAB 50MG 00555048904 BARR LABORATORIES INC yTRAZODONE TAB 100MG 00555049002 BARR LABORATORIES INC yTRAZODONE TAB 100MG 00555049004 BARR LABORATORIES INC yALPRAZOLAM TAB 0.5MG ER 00555049109 BARR LABORATORIES INC yALPRAZOLAM TAB 1MG ER 00555049209 BARR LABORATORIES INC yALPRAZOLAM TAB 2MG ER 00555049309 BARR LABORATORIES INC yALPRAZOLAM TAB 3MG ER 00555049409 BARR LABORATORIES INC yPROCHLORPER TAB 5MG 00555052102 BARR LABORATORIES INC yPROCHLORPER TAB 10MG 00555052202 BARR LABORATORIES INC yPROCHLORPER TAB 10MG 00555052204 BARR LABORATORIES INC yCHLORZOXAZON TAB 500MG 00555058502 BARR LABORATORIES INC yCHLORZOXAZON TAB 500MG 00555058504 BARR LABORATORIES INC yDIDANOSINE CAP 200MG 00555058801 BARR LABORATORIES INC yDIDANOSINE CAP 250MG 00555058901 BARR LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIDANOSINE CAP 400MG 00555059001 BARR LABORATORIES INC yMEGESTROL AC TAB 20MG 00555060602 BARR LABORATORIES INC yMEGESTROL AC TAB 40MG 00555060702 BARR LABORATORIES INC yMEGESTROL AC TAB 40MG 00555060704 BARR LABORATORIES INC yDANAZOL CAP 50MG 00555063302 BARR LABORATORIES INC yDANAZOL CAP 100MG 00555063402 BARR LABORATORIES INC yDANAZOL CAP 200MG 00555063502 BARR LABORATORIES INC yDANAZOL CAP 200MG 00555063509 BARR LABORATORIES INC yTRIAMT/HCTZ TAB 37.5-25 00555064302 BARR LABORATORIES INC yTRIAMT/HCTZ TAB 37.5-25 00555064304 BARR LABORATORIES INC yOXYCOD/APAP CAP 5-500MG 00555065802 BARR LABORATORIES INC yDEMECLOCYCL TAB 150MG 00555070102 BARR LABORATORIES INC yDEMECLOCYCL TAB 300MG 00555070284 BARR LABORATORIES INC yCAMILA TAB 0.35MG 00555071558 BARR LABORATORIES INC yESTROPIPATE TAB 0.75MG 00555072702 BARR LABORATORIES INC yESTROPIPATE TAB 1.5MG 00555072802 BARR LABORATORIES INC yESTROPIPATE TAB 3MG 00555072902 BARR LABORATORIES INC yTRAZODONE TAB 150MG 00555073202 BARR LABORATORIES INC yTRAZODONE TAB 150MG 00555073204 BARR LABORATORIES INC yTRAZODONE TAB 300MG 00555073302 BARR LABORATORIES INC yADDERALL TAB 5MG 00555076202 BARR LABORATORIES INC yADDERALL TAB 7.5MG 00555076302 BARR LABORATORIES INC yADDERALL TAB 10MG 00555076402 BARR LABORATORIES INC yADDERALL TAB 12.5MG 00555076502 BARR LABORATORIES INC yADDERALL TAB 15MG 00555076602 BARR LABORATORIES INC yADDERALL TAB 20MG 00555076702 BARR LABORATORIES INC yADDERALL TAB 30MG 00555076802 BARR LABORATORIES INC yAMPHETAMINE TAB 12.5MG 00555077602 BARR LABORATORIES INC yAMPHETAMINE TAB 15MG 00555077702 BARR LABORATORIES INC yMEDROXYPR AC TAB 10MG 00555077902 BARR LABORATORIES INC yMEDROXYPR AC TAB 10MG 00555077904 BARR LABORATORIES INC yCIPROFLOXACN TAB 250MG 00555081402 BARR LABORATORIES INC yCIPROFLOXACN TAB 500MG 00555081502 BARR LABORATORIES INC yCIPROFLOXACN TAB 750MG 00555081610 BARR LABORATORIES INC yZONISAMIDE CAP 25MG 00555082702 BARR LABORATORIES INC yZONISAMIDE CAP 100MG 00555082902 BARR LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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WARFARIN TAB 1MG 00555083102 BARR LABORATORIES INC yWARFARIN TAB 1MG 00555083105 BARR LABORATORIES INC yWARFARIN TAB 2.5MG 00555083202 BARR LABORATORIES INC yWARFARIN TAB 2.5MG 00555083205 BARR LABORATORIES INC yWARFARIN TAB 5MG 00555083302 BARR LABORATORIES INC yWARFARIN TAB 5MG 00555083305 BARR LABORATORIES INC yWARFARIN TAB 7.5MG 00555083402 BARR LABORATORIES INC yWARFARIN TAB 10MG 00555083502 BARR LABORATORIES INC yFLECAINIDE TAB 50MG 00555085902 BARR LABORATORIES INC yFLECAINIDE TAB 100MG 00555086002 BARR LABORATORIES INC yFLECAINIDE TAB 150MG 00555086102 BARR LABORATORIES INC yWARFARIN TAB 2MG 00555086902 BARR LABORATORIES INC yWARFARIN TAB 2MG 00555086905 BARR LABORATORIES INC yFLUTAMIDE CAP 125MG 00555087004 BARR LABORATORIES INC yFLUTAMIDE CAP 125MG 00555087063 BARR LABORATORIES INC yMEDROXYPR AC TAB 2.5MG 00555087202 BARR LABORATORIES INC yMEDROXYPR AC TAB 2.5MG 00555087204 BARR LABORATORIES INC yMEDROXYPR AC TAB 5MG 00555087302 BARR LABORATORIES INC yMEDROXYPR AC TAB 5MG 00555087304 BARR LABORATORIES INC yWARFARIN TAB 4MG 00555087402 BARR LABORATORIES INC yWARFARIN TAB 4MG 00555087405 BARR LABORATORIES INC yFLUOXETINE CAP 10MG 00555087602 BARR LABORATORIES INC yFLUOXETINE CAP 20MG 00555087702 BARR LABORATORIES INC yFLUOXETINE CAP 20MG 00555087707 BARR LABORATORIES INC yHYDROXYUREA CAP 500MG 00555088202 BARR LABORATORIES INC yESTRADIOL TAB 1MG 00555088602 BARR LABORATORIES INC yESTRADIOL TAB 1MG 00555088604 BARR LABORATORIES INC yESTRADIOL TAB 2MG 00555088702 BARR LABORATORIES INC yESTRADIOL TAB 2MG 00555088704 BARR LABORATORIES INC yESTRADIOL TAB 0.5MG 00555089902 BARR LABORATORIES INC yNALTREXONE TAB 50MG 00555090201 BARR LABORATORIES INC yNALTREXONE TAB 50MG 00555090202 BARR LABORATORIES INC yTAMOXIFEN TAB 20MG 00555090401 BARR LABORATORIES INC yTAMOXIFEN TAB 20MG 00555090414 BARR LABORATORIES INC yAMIODARONE TAB 200MG 00555091704 BARR LABORATORIES INC yAMIODARONE TAB 200MG 00555091709 BARR LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ETHAMBUTOL TAB 400MG 00555092302 BARR LABORATORIES INC yWARFARIN TAB 3MG 00555092502 BARR LABORATORIES INC yWARFARIN TAB 6MG 00555092602 BARR LABORATORIES INC yTREXALL TAB 5MG 00555092701 BARR LABORATORIES INC yTREXALL TAB 7.5MG 00555092801 BARR LABORATORIES INC yTREXALL TAB 10MG 00555092901 BARR LABORATORIES INC yCLARAVIS CAP 10MG 00555093456 BARR LABORATORIES INC yCLARAVIS CAP 10MG 00555093486 BARR LABORATORIES INC yCLARAVIS CAP 20 MG 00555093556 BARR LABORATORIES INC yCLARAVIS CAP 20 MG 00555093586 BARR LABORATORIES INC yCLARAVIS CAP 40MG 00555093656 BARR LABORATORIES INC yCLARAVIS CAP 40MG 00555093686 BARR LABORATORIES INC yDEXTROAMPHET TAB 5MG 00555095202 BARR LABORATORIES INC yDEXTROAMPHET TAB 10MG 00555095302 BARR LABORATORIES INC yDEXTROAMPHET CAP 5MG CR 00555095402 BARR LABORATORIES INC yDEXTROAMPHET CAP 10MG CR 00555095502 BARR LABORATORIES INC yDEXTROAMPHET CAP 15MG CR 00555095602 BARR LABORATORIES INC yFLUVOXAMINE TAB 25MG 00555096702 BARR LABORATORIES INC yFLUVOXAMINE TAB 50MG 00555096802 BARR LABORATORIES INC yFLUVOXAMINE TAB 100MG 00555096902 BARR LABORATORIES INC yAMPHETAMINE TAB 5MG 00555097102 BARR LABORATORIES INC yAMPHETAMINE TAB 10MG 00555097202 BARR LABORATORIES INC yAMPHETAMINE TAB 20MG 00555097302 BARR LABORATORIES INC yFLUDROCORT TAB 0.1MG 00555099702 BARR LABORATORIES INC yCLARAVIS CAP 20MG 00555105556 BARR LABORATORIES INC yCLARAVIS CAP 20MG 00555105586 BARR LABORATORIES INC yCLARAVIS CAP 30MG 00555105686 BARR LABORATORIES INC yCLARAVIS CAP 40MG 00555105756 BARR LABORATORIES INC yCLARAVIS CAP 40MG 00555105786 BARR LABORATORIES INC yNICARDIPINE CAP 20MG 00555106902 BARR LABORATORIES INC yNICARDIPINE CAP 30MG 00555107002 BARR LABORATORIES INC yFENTANYL OT LOZ 200MCG 00555108001 BARR LABORATORIES INC yFENTANYL OT LOZ 400MCG 00555108101 BARR LABORATORIES INC yFENTANYL OT LOZ 600MCG 00555108201 BARR LABORATORIES INC yFENTANYL OT LOZ 800MCG 00555108301 BARR LABORATORIES INC yFENTANYL OT LOZ 1200MCG 00555108401 BARR LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FENTANYL OT LOZ 1600MCG 00555108501 BARR LABORATORIES INC yMIRTAZAPINE TAB 45MG ODT 00555724371 BARR LABORATORIES INC yNORTREL 28 TAB 0.5/35 00555900867 BARR LABORATORIES INC yNORTREL (21) TAB 1/35 00555900942 BARR LABORATORIES INC yNORTREL (28) TAB 1/35 00555901058 BARR LABORATORIES INC yNORTREL7/7/7 TAB 28 DAYS 00555901258 BARR LABORATORIES INC yLESSINA-28 TAB 00555901458 BARR LABORATORIES INC yLESSINA-28 TAB 00555901467 BARR LABORATORIES INC ySPRINTEC 28 TAB 28 DAY 00555901658 BARR LABORATORIES INC yTRI-SPRINTEC TAB 00555901858 BARR LABORATORIES INC yPORTIA-28 TAB 00555902058 BARR LABORATORIES INC yJUNEL 1/20 TAB 00555902542 BARR LABORATORIES INC yJUNEL FE TAB 1/20 00555902658 BARR LABORATORIES INC yJUNEL 1.5/30 TAB 00555902742 BARR LABORATORIES INC yJUNEL 1.5/30 TAB 00555902757 BARR LABORATORIES INC yJUNEL FE TAB 1.5/30 00555902858 BARR LABORATORIES INC yBALZIVA TAB 00555903458 BARR LABORATORIES INC yAPRI TAB 00555904358 BARR LABORATORIES INC yAVIANE TAB 00555904558 BARR LABORATORIES INC yENPRESSE-28 TAB 28 DAY 00555904758 BARR LABORATORIES INC yCRYSELLE-28 TAB 28 TABS 00555904958 BARR LABORATORIES INC yKARIVA TAB 28 DAY 00555905058 BARR LABORATORIES INC yVELIVET PAK 00555905158 BARR LABORATORIES INC yVELIVET PAK 00555905167 BARR LABORATORIES INC yKELNOR TAB 1/35 00555906458 BARR LABORATORIES INC yKELNOR TAB 1/35 00555906467 BARR LABORATORIES INC yARANELLE TAB 00555906658 BARR LABORATORIES INC yARANELLE TAB 00555906667 BARR LABORATORIES INC yJOLESSA TAB 00555912366 BARR LABORATORIES INC yPLAN B TAB 0.75MG 51285003893 BARR LABORATORIES, INC. yZIAC TAB 10/6.25 51285004001 BARR LABORATORIES, INC. yZIAC TAB 2.5/6.25 51285004702 BARR LABORATORIES, INC. yZIAC TAB 5/6.25MG 51285005002 BARR LABORATORIES, INC. ySEASONALE TAB 51285005866 BARR LABORATORIES, INC. yZEBETA TAB 5MG 51285006001 BARR LABORATORIES, INC. yZEBETA TAB 10MG 51285006101 BARR LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PREFEST TAB 51285006390 BARR LABORATORIES, INC. yLOESTRIN TAB 1/20-21 51285007997 BARR LABORATORIES, INC. yLOESTRIN FE TAB 1/20 51285008070 BARR LABORATORIES, INC. yLOESTRIN FE TAB 1/20 51285008198 BARR LABORATORIES, INC. yLOESTRIN 21 TAB 1.5/30 51285008297 BARR LABORATORIES, INC. yLOESTRIN FE TAB 1.5/30 51285008370 BARR LABORATORIES, INC. yLOESTRIN FE TAB 1.5/30 51285008498 BARR LABORATORIES, INC. ySEASONIQUE TAB 51285008787 BARR LABORATORIES, INC. yPREFEST TAB 51285008890 BARR LABORATORIES, INC. yNORDETTE-28 TAB 51285009158 BARR LABORATORIES, INC. yMIRCETTE TAB 28 DAY 51285011458 BARR LABORATORIES, INC. yPARAGARD IUD T380A 51285020401 BARR LABORATORIES, INC. yPARAGARD IUD T380A 51285020402 BARR LABORATORIES, INC. yMETHYLPRED TAB 4MG 51285030102 BARR LABORATORIES, INC. yTREXALL TAB 5MG 51285036601 BARR LABORATORIES, INC. yTREXALL TAB 7.5MG 51285036701 BARR LABORATORIES, INC. yTREXALL TAB 10MG 51285036801 BARR LABORATORIES, INC. yTREXALL TAB 15MG 51285036901 BARR LABORATORIES, INC. yENJUVIA TAB 0.3MG 51285040602 BARR LABORATORIES, INC. yENJUVIA TAB 0.45MG 51285040702 BARR LABORATORIES, INC. yENJUVIA TAB 0.625MG 51285040802 BARR LABORATORIES, INC. yENJUVIA TAB 1.25MG 51285041002 BARR LABORATORIES, INC. yCENESTIN TAB 0.3MG 51285044102 BARR LABORATORIES, INC. yCENESTIN TAB 0.625MG 51285044202 BARR LABORATORIES, INC. yCENESTIN TAB 0.9MG 51285044302 BARR LABORATORIES, INC. yCENESTIN TAB 1.25MG 51285044402 BARR LABORATORIES, INC. yDIAMOX CAP 500MG CR 51285075402 BARR LABORATORIES, INC. yPLAN B TAB 0.75MG 51285076993 BARR LABORATORIES, INC. ySOLAGE SOL 0.01-2% 13478000101 BARRIER THERAPEUTICS yVUSION OIN 13478000201 BARRIER THERAPEUTICS yXOLEGEL GEL 2% 13478000301 BARRIER THERAPEUTICS yOPTIPRANOLOL SOL 0.3% OP 24208027507 BAUSCH & LOMB INC. yOPTIPRANOLOL SOL 0.3% OP 24208027509 BAUSCH & LOMB INC. yMURO 128 SOL 2% OP 24208027615 BAUSCH & LOMB INC. yMURO 128 SOL 5% OP 24208027715 BAUSCH & LOMB INC. yMURO 128 SOL 5% OP 24208027730 BAUSCH & LOMB INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MUROCEL SOL 1% OP 24208028015 BAUSCH & LOMB INC. yFLUOROMETHOL SUS 0.1% OP 24208028805 BAUSCH & LOMB INC. yFLUOROMETHOL SUS 0.1% OP 24208028810 BAUSCH & LOMB INC. yFLUOROMETHOL SUS 0.1% OP 24208028815 BAUSCH & LOMB INC. yTOBRAMYCIN SOL 0.3% OP 24208029005 BAUSCH & LOMB INC. yLOTEMAX SUS 0.5% 24208029905 BAUSCH & LOMB INC. yLOTEMAX SUS 0.5% 24208029910 BAUSCH & LOMB INC. yLOTEMAX SUS 0.5% 24208029915 BAUSCH & LOMB INC. yLOTEMAX SUS 0.5% 24208029925 BAUSCH & LOMB INC. yCROLOM SOL 4% OP 24208030010 BAUSCH & LOMB INC. yFLURBIPROFEN SOL 0.03% OP 24208031425 BAUSCH & LOMB INC. yTRIMETHOPRIM SOL POLYMYXN 24208031510 BAUSCH & LOMB INC. ySULF/PRED NA SOL OP 24208031705 BAUSCH & LOMB INC. ySULF/PRED NA SOL OP 24208031710 BAUSCH & LOMB INC. yTIMOLOL MAL SOL 0.25% OP 24208033005 BAUSCH & LOMB INC. yTIMOLOL MAL SOL 0.25% OP 24208033010 BAUSCH & LOMB INC. yTIMOLOL MAL SOL 0.25% OP 24208033015 BAUSCH & LOMB INC. yDESMOPRESSIN SPR 0.01% 24208034205 BAUSCH & LOMB INC. yFLUNISOLIDE SPR 0.025% 24208034425 BAUSCH & LOMB INC. yALBUTEROL NEB 0.5% 24208034720 BAUSCH & LOMB INC. yALREX SUS 0.2% 24208035305 BAUSCH & LOMB INC. yALREX SUS 0.2% 24208035310 BAUSCH & LOMB INC. yZYLET SUS 0.5-0.3% 24208035805 BAUSCH & LOMB INC. yZYLET SUS 0.5-0.3% 24208035810 BAUSCH & LOMB INC. yZYLET SUS 0.5-0.3% 24208035825 BAUSCH & LOMB INC. yCARTEOLOL SOL OPHTH 1% 24208036705 BAUSCH & LOMB INC. yCARTEOLOL SOL OPHTH 1% 24208036710 BAUSCH & LOMB INC. yCARTEOLOL SOL OPHTH 1% 24208036715 BAUSCH & LOMB INC. yMURO 128 OIN 5% OP 24208038555 BAUSCH & LOMB INC. yMURO 128 OIN 5% OP 24208038556 BAUSCH & LOMB INC. yREV-EYES SOL 0.5% OP 24208039407 BAUSCH & LOMB INC. yIPRATROPIUM SPR 0.03% 24208039830 BAUSCH & LOMB INC. yIPRATROPIUM SPR 0.06% 24208039915 BAUSCH & LOMB INC. yMETIPRANOLOL SOL 0.3% 24208040205 BAUSCH & LOMB INC. yMETIPRANOLOL SOL 0.3% 24208040210 BAUSCH & LOMB INC. yBRIMONIDINE SOL 0.2% OP 24208041105 BAUSCH & LOMB INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BRIMONIDINE SOL 0.2% OP 24208041110 BAUSCH & LOMB INC. yBRIMONIDINE SOL 0.2% OP 24208041115 BAUSCH & LOMB INC. yRETISERT IMP 0.59MG 24208041601 BAUSCH & LOMB INC. yOFLOXACIN SOL 0.3% 24208043405 BAUSCH & LOMB INC. yOFLOXACIN SOL 0.3% 24208043410 BAUSCH & LOMB INC. yCIPROFLOXACN SOL 0.3% OP 24208044405 BAUSCH & LOMB INC. yCIPROFLOXACN SOL 0.3% OP 24208044410 BAUSCH & LOMB INC. yCIPROFLOXACN SOL 0.3% OP 24208044425 BAUSCH & LOMB INC. yLEVOBUNOLOL SOL 0.5% OP 24208050505 BAUSCH & LOMB INC. yLEVOBUNOLOL SOL 0.5% OP 24208050510 BAUSCH & LOMB INC. yLEVOBUNOLOL SOL 0.5% OP 24208050515 BAUSCH & LOMB INC. yDIPIVEFRIN SOL 0.1% OP 24208054005 BAUSCH & LOMB INC. yDIPIVEFRIN SOL 0.1% OP 24208054010 BAUSCH & LOMB INC. yDIPIVEFRIN SOL 0.1% OP 24208054015 BAUSCH & LOMB INC. yLEVOBUNOLOL SOL 0.25% OP 24208054505 BAUSCH & LOMB INC. yLEVOBUNOLOL SOL 0.25% OP 24208054510 BAUSCH & LOMB INC. yBACIT/POLYMY OIN OP 24208055555 BAUSCH & LOMB INC. yANTIPY/BENZO SOL OTIC 24208056162 BAUSCH & LOMB INC. yGENTAMICIN SOL 0.3% OP 24208058060 BAUSCH & LOMB INC. yGENTAMICIN SOL 0.3% OP 24208058064 BAUSCH & LOMB INC. yTROPICAMIDE SOL 1% OP 24208058559 BAUSCH & LOMB INC. yTROPICAMIDE SOL 1% OP 24208058564 BAUSCH & LOMB INC. yTROPICAMIDE SOL 0.5% OP 24208059064 BAUSCH & LOMB INC. yACE ACD/ALUM SOL 2% OTIC 24208061577 BAUSCH & LOMB INC. yNEO/POLY/HC SOL 1% OTIC 24208063110 BAUSCH & LOMB INC. yNEO/POLY/HC SUS 1% OTIC 24208063562 BAUSCH & LOMB INC. ySOD SULFACET SOL 10% OP 24208067004 BAUSCH & LOMB INC. yPILOCARPINE SOL 1% OP 24208067615 BAUSCH & LOMB INC. yPILOCARPINE SOL 2% OP 24208068115 BAUSCH & LOMB INC. yPILOCARPINE SOL 4% OP 24208068615 BAUSCH & LOMB INC. yPRED SOD PHO SOL 1% OP 24208071502 BAUSCH & LOMB INC. yPRED SOD PHO SOL 1% OP 24208071506 BAUSCH & LOMB INC. yPRED SOD PHO SOL 1% OP 24208071510 BAUSCH & LOMB INC. yDEXAMETH PHO SOL 0.1% OP 24208072002 BAUSCH & LOMB INC. yPROPARACAINE SOL 0.5% OP 24208073006 BAUSCH & LOMB INC. yFLURATE OP SOL 0.25-0.4 24208073205 BAUSCH & LOMB INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CYCLOPENTOL SOL 1% OP 24208073501 BAUSCH & LOMB INC. yCYCLOPENTOL SOL 1% OP 24208073506 BAUSCH & LOMB INC. yPHENYLEPHRIN SOL 2.5% OP 24208074002 BAUSCH & LOMB INC. yPHENYLEPHRIN SOL 2.5% OP 24208074006 BAUSCH & LOMB INC. yPHENYLEPHRIN SOL 2.5% OP 24208074059 BAUSCH & LOMB INC. yATROPINE SUL SOL 1% OP 24208075006 BAUSCH & LOMB INC. yATROPINE SUL SOL 1% OP 24208075060 BAUSCH & LOMB INC. yNEO/BAC/POLY OIN OP 24208078055 BAUSCH & LOMB INC. yNEO/POLY/BAC OIN /HC OP1% 24208078555 BAUSCH & LOMB INC. yNEO/POLY/GRA SOL OP 24208079062 BAUSCH & LOMB INC. yNEO/POLY/DEX OIN 0.1% OP 24208079535 BAUSCH & LOMB INC. yPILOCARPINE SOL 0.5% OP 24208080615 BAUSCH & LOMB INC. yPILOCARPINE SOL 3% OP 24208081115 BAUSCH & LOMB INC. yPILOCARPINE SOL 6% OP 24208082115 BAUSCH & LOMB INC. yATROPINE SUL OIN 1% OP 24208082555 BAUSCH & LOMB INC. yNEO/POLY/DEX SUS 0.1% OP 24208083060 BAUSCH & LOMB INC. yERYTHROMYCIN OIN OP 24208091019 BAUSCH & LOMB INC. yERYTHROMYCIN OIN OP 24208091055 BAUSCH & LOMB INC. yTETRACAINE SOL 0.5% OP 24208092064 BAUSCH & LOMB INC. yCROMOLYN SOD SPR 5.2/ACT 57782039726 BAUSCH & LOMB INC. yPOLYGAM S/D SOL 5GM 00944047175 BAXTER HEALTHCARE yPOLYGAM S/D SOL 10GM 00944047180 BAXTER HEALTHCARE yBUMINATE INJ 25% 00944049001 BAXTER HEALTHCARE yBUMINATE INJ 25% 00944049002 BAXTER HEALTHCARE yBUMINATE INJ 25% 00944049003 BAXTER HEALTHCARE yBUMINATE INJ 5% 00944049101 BAXTER HEALTHCARE yBUMINATE INJ 5% 00944049102 BAXTER HEALTHCARE yFLEXBUMIN INJ 25% 00944049301 BAXTER HEALTHCARE yFLEXBUMIN INJ 25% 00944049302 BAXTER HEALTHCARE yPROPLEX T INJ FACT IX 00944058101 BAXTER HEALTHCARE yMONARC-M INJ 220-400 00944130110 BAXTER HEALTHCARE yMONARC-M INJ 401-800 00944130210 BAXTER HEALTHCARE yMONARC-M INJ 801-1700 00944130310 BAXTER HEALTHCARE yMONARC-M INJ 1701+ 00944130410 BAXTER HEALTHCARE yGAMMAGARD SD INJ 0.5GM HU 00944262001 BAXTER HEALTHCARE yGAMMAGARD SD INJ 2.5GM HU 00944262002 BAXTER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GAMMAGARD SD INJ 5GM HU 00944262003 BAXTER HEALTHCARE yGAMMAGARD SD INJ 10GM HU 00944262004 BAXTER HEALTHCARE yGAMMAGARD INJ 1G/10ML 00944270002 BAXTER HEALTHCARE yGAMMAGARD INJ 2.5GM/25 00944270003 BAXTER HEALTHCARE yGAMMAGARD INJ 5GM/50ML 00944270004 BAXTER HEALTHCARE yGAMMAGARD INJ 10GM/100 00944270005 BAXTER HEALTHCARE yGAMMAGARD INJ 20GM/200 00944270006 BAXTER HEALTHCARE yARALAST INJ 400MG 00944280101 BAXTER HEALTHCARE yARALAST INJ 800MG 00944280102 BAXTER HEALTHCARE yHEMOFIL M INJ 220-400 00944293501 BAXTER HEALTHCARE yHEMOFIL M INJ 401-800 00944293502 BAXTER HEALTHCARE yHEMOFIL M INJ 801-1700 00944293503 BAXTER HEALTHCARE yHEMOFIL M INJ 1701+ 00944293504 BAXTER HEALTHCARE yRECOMBINATE INJ 220-400 00944293801 BAXTER HEALTHCARE yRECOMBINATE INJ 401-800 00944293802 BAXTER HEALTHCARE yRECOMBINATE INJ 801-1240 00944293803 BAXTER HEALTHCARE yADVATE INJ 250UNIT 00944294001 BAXTER HEALTHCARE yADVATE INJ 500UNIT 00944294002 BAXTER HEALTHCARE yADVATE INJ 1000UNIT 00944294003 BAXTER HEALTHCARE yADVATE INJ 1500UNIT 00944294004 BAXTER HEALTHCARE yADVATE INJ 2000UNIT 00944294010 BAXTER HEALTHCARE yWINRHO SDF INJ 600UNIT 00944295002 BAXTER HEALTHCARE yWINRHO SDF INJ 1500UNIT 00944295004 BAXTER HEALTHCARE yWINRHO SDF INJ 5000UNIT 00944295006 BAXTER HEALTHCARE yWINRHO SDF INJ 600UNIT 00944296701 BAXTER HEALTHCARE yWINRHO SDF INJ 1500UNIT 00944296703 BAXTER HEALTHCARE yWINRHO SDF INJ 5000UNIT 00944296705 BAXTER HEALTHCARE yWINRHO SDF INJ 2500UNIT 00944296707 BAXTER HEALTHCARE yWINRHO SDF INJ 15000UNT 00944296709 BAXTER HEALTHCARE yTISSEEL VH KIT 1ML 00944300610 BAXTER HEALTHCARE yTISSEEL VH KIT 2ML 00944300620 BAXTER HEALTHCARE yTISSEEL VH KIT 5ML 00944300650 BAXTER HEALTHCARE yFEIBA VH INJ IMMUNO 64193022203 BAXTER HEALTHCARE yFEIBA VH INJ IMMUNO 64193022204 BAXTER HEALTHCARE yFEIBA VH INJ IMMUNO 64193022205 BAXTER HEALTHCARE yBEBULIN VH INJ 200-1200 64193024402 BAXTER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IVEEGAM EN INJ 5GM HU 64193025050 BAXTER HEALTHCARE yARISTOSPAN INJ 5MG/ML 54643105400 BAXTER HEALTHCARE CORP. yARISTOSPAN INJ 20MG/ML 54643105500 BAXTER HEALTHCARE CORP. yARISTOSPAN INJ 20MG/ML 54643105600 BAXTER HEALTHCARE CORP. yINFUVITE INJ 54643564601 BAXTER HEALTHCARE CORP. yINFUVITE INJ PEDIATRI 54643564700 BAXTER HEALTHCARE CORP. yINFUVITE INJ ADULT 54643564901 BAXTER HEALTHCARE CORP. yINFUVITE INJ ADULT 54643564902 BAXTER HEALTHCARE CORP. yREGONOL INJ 5MG/ML 54643582000 BAXTER HEALTHCARE CORP. ySTERIL WATER SOL IRRIG 00338000344 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000346 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000347 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000349 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000402 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000403 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000404 BAXTER HEALTHCARE CORPORATION ySTERIL WATER SOL IRRIG 00338000405 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 2.5% 00338001204 BAXTER HEALTHCARE CORPORATION ySTERIL WATER INJ 00338001304 BAXTER HEALTHCARE CORPORATION ySTERIL WATER INJ 00338001306 BAXTER HEALTHCARE CORPORATION ySTERIL WATER INJ 00338001308 BAXTER HEALTHCARE CORPORATION ySTERIL WATER INJ 00338001329 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001602 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001603 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001701 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001702 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001703 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001704 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001710 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001711 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001718 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001731 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001738 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001741 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% 00338001748 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 10% 00338002302 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXTROSE INJ 10% 00338002303 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 10% 00338002304 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 10% 00338002313 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 10% 00338002334 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 20% 00338003003 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 50% 00338003106 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 50% 00338003113 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 50% 00338003134 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 50% 00338003603 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 70% 00338003804 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE SOL 0.45%IRR 00338004146 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.45% 00338004303 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.45% 00338004304 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004402 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004403 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004724 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004727 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004729 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004744 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004746 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004747 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004802 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004803 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004804 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338004805 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004901 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004902 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004903 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004904 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004910 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004911 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004918 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004931 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004938 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004941 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338004948 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SODIUM CHLOR SOL 0.9% IRR 00338005047 BAXTER HEALTHCARE CORPORATION ySODIUM CHLOR SOL 0.9% IRR 00338005144 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 3% 00338005403 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 5% 00338005603 BAXTER HEALTHCARE CORPORATION yBALANCED SAL SOL OP 00338005803 BAXTER HEALTHCARE CORPORATION yD2.5W/NACL INJ 0.45% 00338007303 BAXTER HEALTHCARE CORPORATION yD2.5W/NACL INJ 0.45% 00338007304 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.2% 00338007702 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.2% 00338007703 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.2% 00338007704 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.33% 00338008102 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.33% 00338008103 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.33% 00338008104 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.45% 00338008502 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.45% 00338008503 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.45% 00338008504 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.9% 00338008902 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.9% 00338008903 BAXTER HEALTHCARE CORPORATION yD5W/NACL INJ 0.9% 00338008904 BAXTER HEALTHCARE CORPORATION yRINGER'S IRR SOL 00338010404 BAXTER HEALTHCARE CORPORATION yRINGERS INJ 00338010503 BAXTER HEALTHCARE CORPORATION yRINGERS INJ 00338010504 BAXTER HEALTHCARE CORPORATION yD5W/RINGER'S INJ 00338011103 BAXTER HEALTHCARE CORPORATION yD5W/RINGER'S INJ 00338011104 BAXTER HEALTHCARE CORPORATION yLACTATED RIN SOL IRRIGAT 00338011404 BAXTER HEALTHCARE CORPORATION yLACTATED RIN INJ 00338011702 BAXTER HEALTHCARE CORPORATION yLACTATED RIN INJ 00338011703 BAXTER HEALTHCARE CORPORATION yLACTATED RIN INJ 00338011704 BAXTER HEALTHCARE CORPORATION yLACTATED RIN SOL IRRIGAT 00338011844 BAXTER HEALTHCARE CORPORATION yD5W/LR INJ 00338012503 BAXTER HEALTHCARE CORPORATION yD5W/LR INJ 00338012504 BAXTER HEALTHCARE CORPORATION ySOD LACTATE INJ 1/6M 00338012904 BAXTER HEALTHCARE CORPORATION yLACTATED RIN SOL IRRIGAT 00338013727 BAXTER HEALTHCARE CORPORATION yLACTATED RIN SOL IRRIGAT 00338013729 BAXTER HEALTHCARE CORPORATION yD5W/LYTES INJ #75 00338014102 BAXTER HEALTHCARE CORPORATION yD5W/LYTES INJ #75 00338014103 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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D5W/LYTES INJ #48 00338014302 BAXTER HEALTHCARE CORPORATION yD5W/LYTES INJ #48 00338014303 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ 56/D5W 00338014703 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ 56/D5W 00338014704 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ /D5W 00338014904 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ 56 00338016804 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ -R 00338017704 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ -148 00338017903 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ -148 00338017904 BAXTER HEALTHCARE CORPORATION yTIS-U-SOL SOL 00338019004 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ -A 00338022103 BAXTER HEALTHCARE CORPORATION yPLASMA-LYTE INJ -A 00338022104 BAXTER HEALTHCARE CORPORATION yGENTRAN 75 INJ 6%/NACL 00338026503 BAXTER HEALTHCARE CORPORATION yGENTRAN 40 INJ 00338027003 BAXTER HEALTHCARE CORPORATION yGENTRAN 40 INJ 00338027203 BAXTER HEALTHCARE CORPORATION yGLYCINE SOL 1.5% IRR 00338028947 BAXTER HEALTHCARE CORPORATION yGLYCINE SOL 1.5% IRR 00338028949 BAXTER HEALTHCARE CORPORATION ySORBITOL SOL 3% IRR 00338029547 BAXTER HEALTHCARE CORPORATION ySORBITOL SOL 3% IRR 00338029549 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 2MEQ/ML 00338031802 BAXTER HEALTHCARE CORPORATION yCARDIOPLEGIC SOL 00338034104 BAXTER HEALTHCARE CORPORATION yOSMITROL INJ 5% 00338035104 BAXTER HEALTHCARE CORPORATION yOSMITROL INJ 10% 00338035303 BAXTER HEALTHCARE CORPORATION yOSMITROL INJ 10% 00338035304 BAXTER HEALTHCARE CORPORATION yOSMITROL INJ 15% 00338035503 BAXTER HEALTHCARE CORPORATION yOSMITROL VFX INJ 20% 00338035702 BAXTER HEALTHCARE CORPORATION yOSMITROL VFX INJ 20% 00338035703 BAXTER HEALTHCARE CORPORATION ySOD BICARB INJ 5% 00338037403 BAXTER HEALTHCARE CORPORATION yLIDOCAIN/D5W INJ 4MG/ML 00338040902 BAXTER HEALTHCARE CORPORATION yLIDOCAIN/D5W INJ 4MG/ML 00338040903 BAXTER HEALTHCARE CORPORATION yLIDOCAIN/D5W INJ 8MG/ML 00338041102 BAXTER HEALTHCARE CORPORATION yHEP SOD/NACL INJ 1000UNIT 00338043103 BAXTER HEALTHCARE CORPORATION yHEP SOD/NACL INJ 2000UNIT 00338043304 BAXTER HEALTHCARE CORPORATION yTHEOPHYL/D5W INJ 0.8MG/ML 00338043903 BAXTER HEALTHCARE CORPORATION yTHEOPHYL/D5W INJ 1.6MG/ML 00338044103 BAXTER HEALTHCARE CORPORATION yTRAVASOL 5.5 INJ /LYTES 00338045803 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRAVASOL 5.5 INJ /LYTES 00338045804 BAXTER HEALTHCARE CORPORATION yTRAVASOL 5.5 INJ /LYTES 00338045806 BAXTER HEALTHCARE CORPORATION yTRAVASOL 8.5 INJ /LYTES 00338046003 BAXTER HEALTHCARE CORPORATION yTRAVASOL 8.5 INJ /LYTES 00338046004 BAXTER HEALTHCARE CORPORATION yTRAVASOL 8.5 INJ /LYTES 00338046006 BAXTER HEALTHCARE CORPORATION yRENAMIN INJ 6.5% 00338047102 BAXTER HEALTHCARE CORPORATION yRENAMIN INJ 6.5% 00338047103 BAXTER HEALTHCARE CORPORATION yBRANCHAMIN INJ 4% 00338047703 BAXTER HEALTHCARE CORPORATION yNOVAMINE INJ 15% 00338049403 BAXTER HEALTHCARE CORPORATION yPROSOL INJ 20% 00338049906 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 60MG 00338050148 BAXTER HEALTHCARE CORPORATION yCLINISOL SF INJ 15% 00338050203 BAXTER HEALTHCARE CORPORATION yCLINISOL SF INJ 15% 00338050206 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 80MG 00338050348 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 100MG 00338050548 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 60MG 00338050741 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 120MG 00338050748 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 80MG 00338050941 BAXTER HEALTHCARE CORPORATION yGENTAM/NACL INJ 100MG PB 00338051141 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 10% 00338051802 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 10% 00338051803 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 20% 00338051902 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 20% 00338051903 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 20% 00338051904 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 20% 00338051948 BAXTER HEALTHCARE CORPORATION yINTRALIPID INJ 30% 00338052003 BAXTER HEALTHCARE CORPORATION yHEP SOD/D5W INJ 20000UNT 00338054903 BAXTER HEALTHCARE CORPORATION yHEP SOD/D5W INJ 100/ML 00338055002 BAXTER HEALTHCARE CORPORATION yHEP SOD/D5W INJ 50UNT/ML 00338055003 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% PGBK 00338055111 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 5% PGBK 00338055118 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338055311 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 0.9% 00338055318 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .15/.33% 00338060303 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .15/.33% 00338060304 BAXTER HEALTHCARE CORPORATION yTRAVASOL INJ 5.5% 00338062403 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRAVASOL INJ 8.5% 00338062603 BAXTER HEALTHCARE CORPORATION yTRAVASOL INJ 8.5% 00338062604 BAXTER HEALTHCARE CORPORATION yTRAVASOL 3.5 INJ /LYTES 00338062803 BAXTER HEALTHCARE CORPORATION yTRAVASOL 3.5 INJ /LYTES 00338062804 BAXTER HEALTHCARE CORPORATION yD10W/NACL INJ 0.2% 00338064002 BAXTER HEALTHCARE CORPORATION yTRAVASOL INJ 10% 00338064403 BAXTER HEALTHCARE CORPORATION yTRAVASOL INJ 10% 00338064404 BAXTER HEALTHCARE CORPORATION yTRAVASOL INJ 10% 00338064406 BAXTER HEALTHCARE CORPORATION yACETIC ACID SOL 0.25%IRR 00338065604 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ 0.15/0.2 00338066303 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ 0.15/0.2 00338066304 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .224/0.2 00338066504 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ 0.3/0.2% 00338066704 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .075/.45 00338066904 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .15/.45% 00338067103 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .15/.45% 00338067104 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ .224/.45 00338067304 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ 0.3/0.45 00338067504 BAXTER HEALTHCARE CORPORATION yKCL/D5W INJ 0.15% 00338068304 BAXTER HEALTHCARE CORPORATION yKCL/D5W INJ 0.224% 00338068504 BAXTER HEALTHCARE CORPORATION yKCL/D5W INJ 0.3% 00338068704 BAXTER HEALTHCARE CORPORATION yKCL/NACL INJ 0.15-0.9 00338069104 BAXTER HEALTHCARE CORPORATION yKCL/NACL INJ 0.3-0.9 00338069504 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 20MEQ 00338070341 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 40MEQ 00338070348 BAXTER HEALTHCARE CORPORATION yKCL IN NACL SOL 00338070434 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 10MEQ 00338070541 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 20MEQ 00338070548 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 30MEQ 00338070748 BAXTER HEALTHCARE CORPORATION yPOT CHLORIDE INJ 10MEQ 00338070948 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 20% 00338071113 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 20% 00338071134 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 30% 00338071313 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 30% 00338071334 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 40% 00338071513 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 40% 00338071534 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXTROSE INJ 60% 00338071713 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 70% 00338071906 BAXTER HEALTHCARE CORPORATION yDEXTROSE INJ 70% 00338071913 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ 0.15/0.9 00338080304 BAXTER HEALTHCARE CORPORATION yKCL/D5W/NACL INJ 0.3/0.9% 00338080704 BAXTER HEALTHCARE CORPORATION yKCL/D5W/LR INJ 0.15% 00338081104 BAXTER HEALTHCARE CORPORATION yKCL/D5W/LR INJ 0.3% 00338081504 BAXTER HEALTHCARE CORPORATION ySOD CHLORIDE INJ 23.4% 00338087302 BAXTER HEALTHCARE CORPORATION ySOD ACETATE INJ 2MEQ/ML 00338087502 BAXTER HEALTHCARE CORPORATION yDOPAMINE/D5W INJ 0.8MG/ML 00338100502 BAXTER HEALTHCARE CORPORATION yDOPAMINE/D5W INJ 0.8MG/ML 00338100503 BAXTER HEALTHCARE CORPORATION yDOPAMINE/D5W INJ 1.6MG/ML 00338100702 BAXTER HEALTHCARE CORPORATION yDOPAMINE/D5W INJ 1.6MG/ML 00338100703 BAXTER HEALTHCARE CORPORATION yDOPAMINE/D5W INJ 3.2MG/ML 00338100902 BAXTER HEALTHCARE CORPORATION yBACTOCILL INJ DEX 1GM 00338101341 BAXTER HEALTHCARE CORPORATION yBACTOCILL INJ DEX 2GM 00338101541 BAXTER HEALTHCARE CORPORATION yNALLPEN/DEX INJ 1GM/50ML 00338101741 BAXTER HEALTHCARE CORPORATION yNALLPEN/DEX INJ 2GM/100 00338101948 BAXTER HEALTHCARE CORPORATION yPENICILL GK/ INJ DEX 1MU 00338102141 BAXTER HEALTHCARE CORPORATION yPENICILL GK/ INJ DEX 2MU 00338102341 BAXTER HEALTHCARE CORPORATION yPENICILL GK/ INJ DEX 3MU 00338102541 BAXTER HEALTHCARE CORPORATION yNITROGLY/D5W INJ 25MG 00338104702 BAXTER HEALTHCARE CORPORATION yNITROGLY/D5W INJ 50MG 00338104902 BAXTER HEALTHCARE CORPORATION yNITROGLY/D5W INJ 100MG 00338105102 BAXTER HEALTHCARE CORPORATION yMETRON/NACL INJ 500MG PB 00338105548 BAXTER HEALTHCARE CORPORATION yDOBUTAM/D5W INJ 1MG/ML 00338107302 BAXTER HEALTHCARE CORPORATION yDOBUTAM/D5W INJ 2MG/ML 00338107502 BAXTER HEALTHCARE CORPORATION yDOBUTAM/D5W INJ 4MG/ML 00338107702 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D5W 00338108904 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D10 00338109104 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D20 00338109304 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D25 00338109504 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 5%/D15W 00338109904 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 5%/D20W 00338110104 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 5%/D25W 00338110304 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 2.75/D5W 00338110704 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLINIMIX E INJ 2.75/D10 00338110904 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 4.25/D5W 00338111304 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 4.25/D10 00338111504 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 4.25/D25 00338111904 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 5%/D15W 00338112304 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 5%/D20W 00338112504 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 5%/D25W 00338112704 BAXTER HEALTHCARE CORPORATION yPREMASOL SOL 10% 00338113003 BAXTER HEALTHCARE CORPORATION yPREMASOL SOL 10% 00338113004 BAXTER HEALTHCARE CORPORATION yPREMASOL SOL 10% 00338113006 BAXTER HEALTHCARE CORPORATION yPREMASOL SOL 6% 00338113103 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 2.75/D5W 00338113203 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D5W 00338113303 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D10 00338113403 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D20 00338113503 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 4.25/D25 00338113603 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 5%/D15W 00338113703 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 5%/D20W 00338113803 BAXTER HEALTHCARE CORPORATION yCLINIMIX INJ 5%/D25W 00338113903 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 2.75/D5W 00338114203 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 2.75/D10 00338114303 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 4.25/D5W 00338114403 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 4.25/D10 00338114503 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 4.25/D25 00338114603 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 5%/D15W 00338114703 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 5%/D20W 00338114803 BAXTER HEALTHCARE CORPORATION yCLINIMIX E INJ 5%/D25W 00338114903 BAXTER HEALTHCARE CORPORATION yONDANSETRON SOL 32/50ML 00338176241 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 1MG/ML 00338268975 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 5MG/ML 00338269075 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 10MG/ML 00338269175 BAXTER HEALTHCARE CORPORATION yCEFAZOLIN INJ 500MG 00338350241 BAXTER HEALTHCARE CORPORATION yCEFAZOLIN INJ 1GM/50ML 00338350341 BAXTER HEALTHCARE CORPORATION yVANCOCIN/DEX INJ 500MG 00338355148 BAXTER HEALTHCARE CORPORATION yVANCOCIN HCL INJ 00338355248 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE/ INJ DEX 1GM 00338500241 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CEFTRIAXONE/ INJ DEX 2GM 00338500341 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 20MG/50M 00338519741 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 20MG/50M 00338519841 BAXTER HEALTHCARE CORPORATION yMILRINONE INJ DW5 00338601048 BAXTER HEALTHCARE CORPORATION yMILRINONE INJ DW5 00338601137 BAXTER HEALTHCARE CORPORATION yFLUCONAZOLE/ INJ NACL 400 00338604537 BAXTER HEALTHCARE CORPORATION yFLUCONAZOLE/ INJ NACL 200 00338604648 BAXTER HEALTHCARE CORPORATION ySYMPT-X POW 00338917091 BAXTER HEALTHCARE CORPORATION ySYMPT-X POW 10GM 00338917791 BAXTER HEALTHCARE CORPORATION ySYMPT-X G.I. POW RAP RLS 00338917891 BAXTER HEALTHCARE CORPORATION ySYST-AMUNE POW BOOSTER 00338918091 BAXTER HEALTHCARE CORPORATION ySYST-AMUNE POW BOOSTER 00338918291 BAXTER HEALTHCARE CORPORATION yRESTORE-X PAK 00338919291 BAXTER HEALTHCARE CORPORATION yHYDROMORPHON INJ 2MG/ML 00641012125 BAXTER HEALTHCARE CORPORATION yHEP-LOCK U/P INJ 10U/ML 00641027225 BAXTER HEALTHCARE CORPORATION yHEP-LOCK U/P INJ 100/ML 00641027325 BAXTER HEALTHCARE CORPORATION yDEXAMETH PHO INJ 10MG/ML 00641036725 BAXTER HEALTHCARE CORPORATION yPROTOPAM CHL INJ 1GM 00641037406 BAXTER HEALTHCARE CORPORATION yDIPHENHYDRAM INJ 50MG/ML 00641037625 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 100/ML 00641038725 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 100/ML 00641038925 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 1000/ML 00641039125 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 10UNT/ML 00641039225 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 10UNT/ML 00641039325 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 5000/ML 00641040025 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 10000/ML 00641041025 BAXTER HEALTHCARE CORPORATION yPHENOBARB INJ 65MG/ML 00641047625 BAXTER HEALTHCARE CORPORATION yPHENOBARB INJ 130MG/ML 00641047725 BAXTER HEALTHCARE CORPORATION yPROCHLORPER INJ 5MG/ML 00641049125 BAXTER HEALTHCARE CORPORATION yPHENYTOIN INJ 50MG/ML 00641049325 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 25MG/ML 00641092825 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 50MG/ML 00641092925 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 25MG/ML 00641094835 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 50MG/ML 00641094935 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 25MG/ML 00641095525 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 50MG/ML 00641095625 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHLORPROMAZ INJ 25MG/ML 00641139735 BAXTER HEALTHCARE CORPORATION yCHLORPROMAZ INJ 25MG/ML 00641139835 BAXTER HEALTHCARE CORPORATION yDIGOXIN INJ 0.25MG/1 00641141035 BAXTER HEALTHCARE CORPORATION yDIGOXIN INJ .25MG/ML 00641141036 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 25MG/ML 00641149535 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 50MG/ML 00641149635 BAXTER HEALTHCARE CORPORATION yDIAZEPAM INJ 5MG/ML 00641228943 BAXTER HEALTHCARE CORPORATION yERYTHROM LAC INJ 1GM 00641230941 BAXTER HEALTHCARE CORPORATION yHYDROMORPHON INJ 2MG/ML 00641234141 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 100/ML 00641243641 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 100/ML 00641243645 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 10UNT/ML 00641243841 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 10UNT/ML 00641243845 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 1000/ML 00641244045 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 10UNT/ML 00641244241 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 10UNT/ML 00641244245 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 100/ML 00641244341 BAXTER HEALTHCARE CORPORATION yHEP-LOCK INJ 100/ML 00641244345 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 1000/ML 00641245045 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 5000/ML 00641246045 BAXTER HEALTHCARE CORPORATION yHEPARIN SOD INJ 10000/ML 00641247045 BAXTER HEALTHCARE CORPORATION yPHENYTOIN INJ 50MG/ML 00641255545 BAXTER HEALTHCARE CORPORATION yDIPYRIDAMOLE INJ 5MG/ML 00641256944 BAXTER HEALTHCARE CORPORATION yESMOLOL HCL INJ 10MG/ML 00641296545 BAXTER HEALTHCARE CORPORATION yATRACURIUM INJ 10MG/ML 10019000110 BAXTER HEALTHCARE CORPORATION yATRACURIUM INJ 10MG/ML 10019000205 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019001301 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019001302 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019001303 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019001306 BAXTER HEALTHCARE CORPORATION yGLYCOPYRROL INJ 0.2MG/ML 10019001602 BAXTER HEALTHCARE CORPORATION yGLYCOPYRROL INJ 0.2MG/ML 10019001617 BAXTER HEALTHCARE CORPORATION yGLYCOPYRROL INJ 0.2MG/ML 10019001654 BAXTER HEALTHCARE CORPORATION yGLYCOPYRROL INJ 0.2MG/ML 10019001663 BAXTER HEALTHCARE CORPORATION yGLYCOPYRROL INJ 0.2MG/ML 10019001681 BAXTER HEALTHCARE CORPORATION yKETOROLAC INJ 15MG/ML 10019002109 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KETOROLAC INJ 30MG/ML 10019002209 BAXTER HEALTHCARE CORPORATION yKETOROLAC INJ 30MG/ML 10019002232 BAXTER HEALTHCARE CORPORATION yBREVIBLOC INJ 250MG/ML 10019002518 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 5MG/ML 10019002701 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 5MG/ML 10019002702 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 5MG/ML 10019002703 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 5MG/ML 10019002704 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 5MG/ML 10019002705 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 5MG/ML 10019002710 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 1MG/ML 10019002802 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 1MG/ML 10019002803 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 1MG/ML 10019002805 BAXTER HEALTHCARE CORPORATION yMIDAZOLAM INJ 1MG/ML 10019002810 BAXTER HEALTHCARE CORPORATION yFENTANYL CIT INJ 0.05MG/1 10019003372 BAXTER HEALTHCARE CORPORATION yFENTANYL CIT INJ 500MCG 10019003473 BAXTER HEALTHCARE CORPORATION yFENTANYL CIT INJ 1000MCG 10019003574 BAXTER HEALTHCARE CORPORATION yFENTANYL CIT INJ 0.05MG/1 10019003682 BAXTER HEALTHCARE CORPORATION yFENTANYL CIT INJ 2500MCG 10019003783 BAXTER HEALTHCARE CORPORATION yFENTANYL CIT INJ 100MCG 10019003867 BAXTER HEALTHCARE CORPORATION yPROCHLORPER INJ 5MG/ML 10019004301 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 10MG/ML 10019004502 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 10MG/ML 10019004603 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 10MG/ML 10019004604 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 10MG/ML 10019004701 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 10MG/ML 10019004802 BAXTER HEALTHCARE CORPORATION yFAMOTIDINE INJ 10MG/ML 10019004803 BAXTER HEALTHCARE CORPORATION ySUFENTANIL INJ 50MCG/ML 10019005006 BAXTER HEALTHCARE CORPORATION ySUFENTANIL INJ 50MCG/ML 10019005021 BAXTER HEALTHCARE CORPORATION ySUFENTANIL INJ 50MCG/ML 10019005043 BAXTER HEALTHCARE CORPORATION yBREVIBLOC SOL 10MG/ML 10019005561 BAXTER HEALTHCARE CORPORATION yADENOSINE INJ 3MG/ML 10019006303 BAXTER HEALTHCARE CORPORATION yADENOSINE INJ 3MG/ML 10019006308 BAXTER HEALTHCARE CORPORATION yMILRINONE INJ 1MG/ML 10019007001 BAXTER HEALTHCARE CORPORATION yMILRINONE INJ 1MG/ML 10019007002 BAXTER HEALTHCARE CORPORATION yBREVIBLOC SOL 10019007587 BAXTER HEALTHCARE CORPORATION yBREVIBLOC SOL 20MG/ML 10019008501 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRILAT INJ 1.25/ML 10019009203 BAXTER HEALTHCARE CORPORATION yENALAPRILAT INJ 1.25/ML 10019009204 BAXTER HEALTHCARE CORPORATION yPROMETHAZINE INJ 25MG/ML 10019009701 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE INJ 1GM 10019009801 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 2MG/ML 10019010201 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 2MG/ML 10019010210 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 4MG/ML 10019010301 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 4MG/ML 10019010310 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 2MG/ML 10019010501 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 2MG/ML 10019010502 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 4MG/ML 10019010601 BAXTER HEALTHCARE CORPORATION yLORAZEPAM INJ 4MG/ML 10019010602 BAXTER HEALTHCARE CORPORATION yBREVIBLOC INJ 10MG/ML 10019011501 BAXTER HEALTHCARE CORPORATION yBREVIBLOC INJ 10MG/ML 10019012601 BAXTER HEALTHCARE CORPORATION yAMIODARONE INJ 50MG/ML 10019013301 BAXTER HEALTHCARE CORPORATION yAMIODARONE INJ 50MG/ML 10019013302 BAXTER HEALTHCARE CORPORATION yAMIODARONE INJ 50MG/ML 10019013304 BAXTER HEALTHCARE CORPORATION yFENOLDOPAM INJ 10MG/ML 10019014201 BAXTER HEALTHCARE CORPORATION yFENOLDOPAM INJ 10MG/ML 10019014202 BAXTER HEALTHCARE CORPORATION yDOPRAM INJ 20MG/ML 10019014302 BAXTER HEALTHCARE CORPORATION yPROPRANOLOL INJ 1MG/ML 10019014501 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 50MG/ML 10019015668 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 100MG/ML 10019015868 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 25MG/ML 10019015901 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 50MG/ML 10019016001 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 75MG/ML 10019016101 BAXTER HEALTHCARE CORPORATION yMEPERIDINE INJ 100MG/ML 10019016201 BAXTER HEALTHCARE CORPORATION yPHENYLEPHRIN INJ 10MG/ML 10019016301 BAXTER HEALTHCARE CORPORATION yPHENYLEPHRIN INJ 10MG/ML 10019016312 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 5MG/ML 10019017644 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 8MG/ML 10019017744 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 8MG/ML 10019017768 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 10MG/ML 10019017844 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 10MG/ML 10019017862 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 10MG/ML 10019017868 BAXTER HEALTHCARE CORPORATION yMORPHINE SUL INJ 15MG/ML 10019017944 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MORPHINE SUL INJ 15MG/ML 10019017963 BAXTER HEALTHCARE CORPORATION yENLON-PLUS INJ 10019018005 BAXTER HEALTHCARE CORPORATION yENLON-PLUS INJ 10019019515 BAXTER HEALTHCARE CORPORATION yLABETALOL INJ 5MG/ML 10019021002 BAXTER HEALTHCARE CORPORATION yLABETALOL INJ 5MG/ML 10019021004 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019021301 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019021302 BAXTER HEALTHCARE CORPORATION yPROPOFOL INJ 10MG/ML 10019021303 BAXTER HEALTHCARE CORPORATION yATROPINE SUL INJ 0.4MG/ML 10019025012 BAXTER HEALTHCARE CORPORATION yATROPINE SUL INJ 0.4MG/ML 10019025020 BAXTER HEALTHCARE CORPORATION yATROPINE SUL INJ 1MG/ML 10019025112 BAXTER HEALTHCARE CORPORATION yNEOSTIG METH INJ 1MG/ML 10019027010 BAXTER HEALTHCARE CORPORATION yNEOSTIG METH INJ 0.5MG/ML 10019027102 BAXTER HEALTHCARE CORPORATION yNEOSTIG METH INJ 0.5MG/ML 10019027110 BAXTER HEALTHCARE CORPORATION yREVEX INJ 100MCG 10019031521 BAXTER HEALTHCARE CORPORATION yFLUMAZENIL INJ 0.1MG/ML 10019032101 BAXTER HEALTHCARE CORPORATION yFLUMAZENIL INJ 0.1MG/ML 10019032102 BAXTER HEALTHCARE CORPORATION yETHRANE INH 10019035060 BAXTER HEALTHCARE CORPORATION yFORANE SOL 10019036040 BAXTER HEALTHCARE CORPORATION yFORANE SOL 10019036060 BAXTER HEALTHCARE CORPORATION yMETOCLOPRAM INJ 5MG/ML 10019045002 BAXTER HEALTHCARE CORPORATION yVECURONIUM INJ 10MG 10019048101 BAXTER HEALTHCARE CORPORATION yBUMETANIDE INJ 0.25/ML 10019050602 BAXTER HEALTHCARE CORPORATION yBUMETANIDE INJ 0.25/ML 10019050610 BAXTER HEALTHCARE CORPORATION yBUMETANIDE INJ 0.25/ML 10019050645 BAXTER HEALTHCARE CORPORATION yDILTIAZEM INJ 5MG/ML 10019051001 BAXTER HEALTHCARE CORPORATION yDILTIAZEM INJ 5MG/ML 10019051002 BAXTER HEALTHCARE CORPORATION yDILTIAZEM INJ 5MG/ML 10019051004 BAXTER HEALTHCARE CORPORATION yTRANSDERM-SC DIS 1.5MG 10019055301 BAXTER HEALTHCARE CORPORATION yTRANSDERM-SC DIS 1.5MG 10019055302 BAXTER HEALTHCARE CORPORATION yCEFAZOLIN INJ 500MG 10019061001 BAXTER HEALTHCARE CORPORATION yCEFAZOLIN INJ 1GM 10019061103 BAXTER HEALTHCARE CORPORATION yCEFUROXIME INJ 750MG 10019062001 BAXTER HEALTHCARE CORPORATION yCEFUROXIME INJ 1.5GM 10019062103 BAXTER HEALTHCARE CORPORATION yCEFUROXIME INJ 7.5GM 10019062205 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 1-0.5GM 10019063001 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMP-SULBACTA INJ 2-1GM 10019063002 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 1-0.5GM 10019063101 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 10-5GM 10019063203 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 2-1GM 10019063302 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 1-0.5GM 10019063401 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 10-5GM 10019063503 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 1-0.5GM 10019063601 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 2-1GM 10019063702 BAXTER HEALTHCARE CORPORATION yAMP-SULBACTA INJ 10-5GM 10019063803 BAXTER HEALTHCARE CORPORATION ySUPRANE INH 10019064124 BAXTER HEALTHCARE CORPORATION yAZITHROMYCIN INJ 500MG 10019064802 BAXTER HEALTHCARE CORPORATION ySEVOFLURANE SOL 10019065164 BAXTER HEALTHCARE CORPORATION yCEFOXITIN INJ 10GM 10019066203 BAXTER HEALTHCARE CORPORATION yCEFOTAXIME INJ 500MG 10019068001 BAXTER HEALTHCARE CORPORATION yCEFOTAXIME INJ 1GM 10019068102 BAXTER HEALTHCARE CORPORATION yCEFOTAXIME INJ 2GM 10019068203 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE INJ 250MG 10019068501 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE INJ 500MG 10019068602 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE INJ 1GM 10019068703 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE INJ 2GM 10019068804 BAXTER HEALTHCARE CORPORATION yCEFTRIAXONE INJ 10GM 10019068905 BAXTER HEALTHCARE CORPORATION yCEFTAZIDIME INJ 1GM 10019069102 BAXTER HEALTHCARE CORPORATION yCEFTAZIDIME INJ 2GM 10019069203 BAXTER HEALTHCARE CORPORATION yCEFTAZIDIME INJ 6GM 10019069304 BAXTER HEALTHCARE CORPORATION yONDANSETRON INJ 2MG/ML 10019090501 BAXTER HEALTHCARE CORPORATION yONDANSETRON INJ 2MG/ML 10019090603 BAXTER HEALTHCARE CORPORATION yCISPLATIN INJ 1MG/ML 10019091002 BAXTER HEALTHCARE CORPORATION yCARBOPLATIN INJ 10MG/ML 10019091203 BAXTER HEALTHCARE CORPORATION yCARBOPLATIN INJ 450MG 10019091701 BAXTER HEALTHCARE CORPORATION yDOXORUBICIN INJ 10MG 10019092001 BAXTER HEALTHCARE CORPORATION yDOXORUBICIN INJ 50MG 10019092102 BAXTER HEALTHCARE CORPORATION yCYCLOPHOSPH INJ 500MG 10019095501 BAXTER HEALTHCARE CORPORATION yCYCLOPHOSPH INJ 1GM 10019095601 BAXTER HEALTHCARE CORPORATION yCYCLOPHOSPH INJ 2GM 10019095701 BAXTER HEALTHCARE CORPORATION yHETASTARCH INJ 6%/NACL 10019099959 BAXTER HEALTHCARE CORPORATION yPHENERGAN INJ 25MG/ML 60977000101 BAXTER HEALTHCARE CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PHENERGAN INJ 25MG/ML 60977000103 BAXTER HEALTHCARE CORPORATION yPHENERGAN INJ 50MG/ML 60977000202 BAXTER HEALTHCARE CORPORATION yPHENERGAN INJ 50MG/ML 60977000204 BAXTER HEALTHCARE CORPORATION yDURAMORPH INJ 0.5MG/ML 60977001602 BAXTER HEALTHCARE CORPORATION yDURAMORPH INJ 1MG/ML 60977001701 BAXTER HEALTHCARE CORPORATION yATIVAN INJ 2MG/ML 60977011201 BAXTER HEALTHCARE CORPORATION yATIVAN INJ 2MG/ML 60977011202 BAXTER HEALTHCARE CORPORATION yATIVAN INJ 4MG/ML 60977011301 BAXTER HEALTHCARE CORPORATION yATIVAN INJ 4MG/ML 60977011302 BAXTER HEALTHCARE CORPORATION yINFUMORPH INJ 10MG/ML 60977011401 BAXTER HEALTHCARE CORPORATION yINFUMORPH INJ 25MG/ML 60977011501 BAXTER HEALTHCARE CORPORATION yDOPRAM INJ 20MG/ML 60977014402 BAXTER HEALTHCARE CORPORATION yROBAXIN INJ 100MG/ML 60977015001 BAXTER HEALTHCARE CORPORATION yROBINUL INJ 0.2MG/ML 60977015501 BAXTER HEALTHCARE CORPORATION yROBINUL INJ 0.2MG/ML 60977015502 BAXTER HEALTHCARE CORPORATION yROBINUL INJ 0.2MG/ML 60977015503 BAXTER HEALTHCARE CORPORATION yROBINUL INJ 0.2MG/ML 60977015504 BAXTER HEALTHCARE CORPORATION yROBINUL INJ 0.2MG/ML 60977015505 BAXTER HEALTHCARE CORPORATION yROBINUL INJ 0.2MG/ML 60977015506 BAXTER HEALTHCARE CORPORATION yREGLAN INJ 5MG/ML 60977045101 BAXTER HEALTHCARE CORPORATION yREGLAN INJ 5MG/ML 60977045102 BAXTER HEALTHCARE CORPORATION yREGLAN INJ 5MG/ML 60977045103 BAXTER HEALTHCARE CORPORATION yKOGENATE FS SOL 250UNIT 00026037220 BAYER CORPORATION PHARMACEUTICAL DIV. yKOGENATE FS SOL 500UNIT 00026037230 BAYER CORPORATION PHARMACEUTICAL DIV. yKOGENATE FS SOL 1000UNIT 00026037250 BAYER CORPORATION PHARMACEUTICAL DIV. yKOGENATE FS KIT 250/BS 00026037920 BAYER CORPORATION PHARMACEUTICAL DIV. yKOGENATE FS KIT 500/BS 00026037930 BAYER CORPORATION PHARMACEUTICAL DIV. yKOGENATE FS KIT 1000/BS 00026037950 BAYER CORPORATION PHARMACEUTICAL DIV. yPROLASTIN INJ 1000MG 00026060135 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASMANATE INJ 5% 00026061320 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASMANATE INJ 5% 00026061325 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYRAB INJ 150/ML 00026061802 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYRHO-D INJ 300MCG 00026063102 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYRHO-D INJ 50MCG 00026063106 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYTET INJ 250/ML 00026063402 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYGAM INJ 00026063512 BAYER CORPORATION PHARMACEUTICAL DIV. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BAYHEP B INJ 00026063601 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYHEP B INJ 00026063603 BAYER CORPORATION PHARMACEUTICAL DIV. yBAYHEP B INJ 00026063605 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMUNEX INJ 10% 00026064512 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMUNEX INJ 10% 00026064520 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMUNEX INJ 10% 00026064524 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMUNEX INJ 10% 00026064571 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMIMUNE N INJ 10% 00026064815 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMIMUNE N INJ 10% 00026064820 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMIMUNE N INJ 10% 00026064824 BAYER CORPORATION PHARMACEUTICAL DIV. yGAMIMUNE N INJ 10% 00026064871 BAYER CORPORATION PHARMACEUTICAL DIV. yKOATE-DVI INJ 500UNIT 00026066530 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-25 INJ 25% 00026068420 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-25 INJ 25% 00026068471 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-5 INJ 5% 00026068520 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-5 INJ 5% 00026069020 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-5 INJ 5% 00026069025 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-25 INJ 25% 00026069216 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-25 INJ 25% 00026069220 BAYER CORPORATION PHARMACEUTICAL DIV. yPLASBUMIN-25 INJ 25% 00026069271 BAYER CORPORATION PHARMACEUTICAL DIV. yNIMOTOP CAP 30MG 00026285548 BAYER CORPORATION PHARMACEUTICAL DIV. yNIMOTOP CAP 30MG 00026285570 BAYER CORPORATION PHARMACEUTICAL DIV. yPRECOSE TAB 50MG 00026286148 BAYER CORPORATION PHARMACEUTICAL DIV. yPRECOSE TAB 50MG 00026286151 BAYER CORPORATION PHARMACEUTICAL DIV. yPRECOSE TAB 100MG 00026286248 BAYER CORPORATION PHARMACEUTICAL DIV. yPRECOSE TAB 100MG 00026286251 BAYER CORPORATION PHARMACEUTICAL DIV. yPRECOSE TAB 25MG 00026286351 BAYER CORPORATION PHARMACEUTICAL DIV. yTRASYLOL INJ 10000/ML 00026819636 BAYER CORPORATION PHARMACEUTICAL DIV. yTRASYLOL INJ 10000/ML 00026819763 BAYER CORPORATION PHARMACEUTICAL DIV. yNEXAVAR TAB 200MG 00026848858 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO TAB 250MG 00026851248 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO TAB 250MG 00026851251 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO TAB 500MG 00026851348 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO TAB 500MG 00026851351 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO TAB 750MG 00026851448 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO TAB 750MG 00026851450 BAYER CORPORATION PHARMACEUTICAL DIV. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIPRO I.V. SOL 200MG 00026852736 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO I.V. SOL 400MG 00026852763 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO I.V. SOL 200MG 00026855236 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO I.V. SOL 400MG 00026855463 BAYER CORPORATION PHARMACEUTICAL DIV. yCIPRO I.V. INJ 400MG 00026856464 BAYER CORPORATION PHARMACEUTICAL DIV. yAVELOX INJ 00026858231 BAYER CORPORATION PHARMACEUTICAL DIV. yVIADUR KIT 00026971101 BAYER CORPORATION PHARMACEUTICAL DIV. yK-PHOS TAB 00486111101 BEACH PRODUCTS INC yK-PHOS TAB 00486111105 BEACH PRODUCTS INC yUROQID #2 TAB 00486111401 BEACH PRODUCTS INC yK-PHOS TAB NEUTRAL 00486112501 BEACH PRODUCTS INC yK-PHOS TAB NEUTRAL 00486112505 BEACH PRODUCTS INC yK-PHOS TAB NO 2 00486113401 BEACH PRODUCTS INC yK-PHOS TAB MF 00486113501 BEACH PRODUCTS INC yK-PHOS TAB MF 00486113505 BEACH PRODUCTS INC yNOREPINEPHR INJ 1MG/ML 55390000210 BEDFORD LABORATORIES yPROPRANOLOL INJ 1MG/ML 55390000310 BEDFORD LABORATORIES yGLUCAGEN DIA INJ 1MG 55390000401 BEDFORD LABORATORIES yGLUCAGEN DIA INJ 1MG 55390000410 BEDFORD LABORATORIES yBLEOMYCIN INJ 15UNIT 55390000501 BEDFORD LABORATORIES yBLEOMYCIN INJ 30UNIT 55390000601 BEDFORD LABORATORIES yVALPROATE INJ 100MG/ML 55390000710 BEDFORD LABORATORIES yLEUCOVOR CA INJ 10MG/ML 55390000901 BEDFORD LABORATORIES yENALAPRILAT INJ 1.25/ML 55390001010 BEDFORD LABORATORIES yENALAPRILAT INJ 1.25/ML 55390001110 BEDFORD LABORATORIES yFLUCONAZOLE/ INJ NACL 200 55390001201 BEDFORD LABORATORIES yDIHYDROERGOT INJ 1MG/ML 55390001310 BEDFORD LABORATORIES yDEXRAZOXANE INJ 250MG 55390001402 BEDFORD LABORATORIES yMILRINONE INJ 1MG/ML 55390001910 BEDFORD LABORATORIES yMILRINONE INJ 1MG/ML 55390002010 BEDFORD LABORATORIES yMILRINONE INJ 1MG/ML 55390002101 BEDFORD LABORATORIES yFAMOTIDINE INJ 10MG/ML 55390002601 BEDFORD LABORATORIES yFAMOTIDINE INJ 10MG/ML 55390002701 BEDFORD LABORATORIES yFAMOTIDINE INJ 10MG/ML 55390002810 BEDFORD LABORATORIES yFAMOTIDINE INJ 10MG/ML 55390002910 BEDFORD LABORATORIES yTHIOTEPA INJ 15MG 55390003010 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METHOTREXATE INJ 25MG/ML 55390003110 BEDFORD LABORATORIES yMETHOTREXATE INJ 25MG/ML 55390003210 BEDFORD LABORATORIES yMETHOTREXATE INJ 25MG/ML 55390003310 BEDFORD LABORATORIES yMETHOTREXATE INJ 25MG/ML 55390003410 BEDFORD LABORATORIES yDOXAPRAM HCL INJ 20MG/ML 55390003501 BEDFORD LABORATORIES yVECURONIUM INJ 10MG 55390003710 BEDFORD LABORATORIES yVECURONIUM INJ 20MG 55390003910 BEDFORD LABORATORIES yINAMRINONE INJ 5MG/ML 55390004210 BEDFORD LABORATORIES yMESNA INJ 1GM 55390004501 BEDFORD LABORATORIES yFLUCONAZOLE/ INJ NACL 400 55390004601 BEDFORD LABORATORIES yLEUCOVOR CA INJ 50MG 55390005110 BEDFORD LABORATORIES yLEUCOVOR CA INJ 100MG 55390005210 BEDFORD LABORATORIES yLEUCOVORIN INJ 200MG 55390005301 BEDFORD LABORATORIES yLEUCOVOR CA INJ 350MG 55390005401 BEDFORD LABORATORIES yAMIODARONE INJ 50MG/ML 55390005701 BEDFORD LABORATORIES yAMIODARONE INJ 50MG/ML 55390005710 BEDFORD LABORATORIES yORPHENADRINE INJ 30MG/ML 55390005910 BEDFORD LABORATORIES yDEXRAZOXANE INJ 500MG 55390006002 BEDFORD LABORATORIES yESMOLOL HCL INJ 10MG/ML 55390006210 BEDFORD LABORATORIES yDICYCLOMINE INJ 10MG/ML 55390006610 BEDFORD LABORATORIES yADENOSINE INJ 6MG/2ML 55390006710 BEDFORD LABORATORIES yADENOSINE INJ 12MG/4ML 55390006801 BEDFORD LABORATORIES yVINORELBINE INJ 10MG/ML 55390006901 BEDFORD LABORATORIES yVINORELBINE INJ 50MG/5ML 55390007001 BEDFORD LABORATORIES yFENOLDOPAM INJ 10MG/ML 55390007101 BEDFORD LABORATORIES yFENOLDOPAM INJ 20MG/2ML 55390007201 BEDFORD LABORATORIES yMETOPROLOL INJ 1MG/ML 55390007310 BEDFORD LABORATORIES yMILRINONE INJ 1MG/ML 55390007410 BEDFORD LABORATORIES yMILRINONE INJ 1MG/ML 55390007510 BEDFORD LABORATORIES yMILRINONE INJ 1MG/ML 55390007601 BEDFORD LABORATORIES yPROCHLORPER INJ 5MG/ML 55390007701 BEDFORD LABORATORIES yPROCHLORPER INJ 5MG/ML 55390007710 BEDFORD LABORATORIES yMITOXANTRON INJ 2MG/ML 55390008301 BEDFORD LABORATORIES yMITOXANTRON INJ 2MG/ML 55390008401 BEDFORD LABORATORIES yMITOXANTRON INJ 2MG/ML 55390008501 BEDFORD LABORATORIES yDACARBAZINE INJ 200MG 55390009010 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VINBLASTINE INJ 10MG 55390009110 BEDFORD LABORATORIES yFLUMAZENIL INJ 0.5/5ML 55390009210 BEDFORD LABORATORIES yFLUMAZENIL INJ 1MG/10ML 55390009310 BEDFORD LABORATORIES yCISPLATIN INJ 1MG/ML 55390009901 BEDFORD LABORATORIES yBUPRENORPHIN INJ 0.3MG/ML 55390010010 BEDFORD LABORATORIES yTERBUTALINE INJ 1MG/ML 55390010110 BEDFORD LABORATORIES yATRACURIUM INJ 10MG/ML 55390010205 BEDFORD LABORATORIES yATRACURIUM INJ 10MG/ML 55390010310 BEDFORD LABORATORIES yPROPOFOL INJ 10MG/ML 55390010420 BEDFORD LABORATORIES yPROPOFOL INJ 10MG/ML 55390010450 BEDFORD LABORATORIES yPROPOFOL INJ 10MG/ML 55390010499 BEDFORD LABORATORIES yAMIODARONE INJ 50MG/ML 55390010501 BEDFORD LABORATORIES yALLOPURINOL INJ 500MG 55390010601 BEDFORD LABORATORIES yPAPAVERINE SOL 30MG/ML 55390010710 BEDFORD LABORATORIES yDAUNORUBICIN INJ 5MG/ML 55390010801 BEDFORD LABORATORIES yDAUNORUBICIN INJ 5MG/ML 55390010810 BEDFORD LABORATORIES yCLINDAMYCIN INJ 150MG/ML 55390010901 BEDFORD LABORATORIES yDOXYCYCL HYC INJ 100MG 55390011010 BEDFORD LABORATORIES yCISPLATIN INJ 1MG/ML 55390011250 BEDFORD LABORATORIES yCISPLATIN INJ 1MG/ML 55390011299 BEDFORD LABORATORIES yPHENTOLAMINE INJ MESYLATE 55390011301 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390011405 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390011420 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390011450 BEDFORD LABORATORIES yCLADRIBINE INJ 1MG/ML 55390011501 BEDFORD LABORATORIES yONDANSETRON INJ 2MG/ML 55390012101 BEDFORD LABORATORIES yONDANSETRON INJ 2MG/ML 55390012110 BEDFORD LABORATORIES yCYCLOSPORINE INJ 50MG/ML 55390012210 BEDFORD LABORATORIES yRIFAMPIN INJ 600 MG 55390012301 BEDFORD LABORATORIES yCLADRIBINE INJ 1MG/ML 55390012401 BEDFORD LABORATORIES yMIDAZOLAM INJ 1MG/ML 55390012510 BEDFORD LABORATORIES yMIDAZOLAM INJ 5MG/ML 55390012605 BEDFORD LABORATORIES yMIDAZOLAM INJ 5MG/ML 55390012610 BEDFORD LABORATORIES yPAMIDRONATE INJ 30MG 55390012701 BEDFORD LABORATORIES yPAMIDRONATE INJ 90MG 55390012901 BEDFORD LABORATORIES yLABETALOL INJ 5MG/ML 55390013020 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LABETALOL INJ 5MG/ML 55390013040 BEDFORD LABORATORIES yCYTARABINE INJ 100MG 55390013110 BEDFORD LABORATORIES yCYTARABINE INJ 500MG 55390013210 BEDFORD LABORATORIES yCYTARABINE INJ 1GM 55390013301 BEDFORD LABORATORIES yCYTARABINE INJ 2GM 55390013401 BEDFORD LABORATORIES yFLOXURIDINE INJ 0.5GM 55390013501 BEDFORD LABORATORIES yLEVOCARNITIN INJ 200MG/ML 55390013605 BEDFORD LABORATORIES yMIDAZOLAM INJ 1MG/ML 55390013702 BEDFORD LABORATORIES yMIDAZOLAM INJ 1MG/ML 55390013705 BEDFORD LABORATORIES yMIDAZOLAM INJ 5MG/ML 55390013801 BEDFORD LABORATORIES yMIDAZOLAM INJ 5MG/ML 55390013802 BEDFORD LABORATORIES yPOLYMYXIN B INJ 500000 55390013910 BEDFORD LABORATORIES yDAUNORUBICIN INJ 5MG/ML 55390014210 BEDFORD LABORATORIES yMETHOTREXATE INJ 1GM 55390014301 BEDFORD LABORATORIES yHALOPER LAC INJ 5MG/ML 55390014701 BEDFORD LABORATORIES yHALOPER LAC INJ 5MG/ML 55390014710 BEDFORD LABORATORIES yCARBOPLATIN INJ 50MG 55390015001 BEDFORD LABORATORIES yCARBOPLATIN INJ 150MG 55390015101 BEDFORD LABORATORIES yCARBOPLATIN INJ 450MG 55390015201 BEDFORD LABORATORIES yCARBOPLATIN INJ 50MG/5ML 55390015301 BEDFORD LABORATORIES yCARBOPLATIN INJ 150/15ML 55390015401 BEDFORD LABORATORIES yCARBOPLATIN INJ 450/45ML 55390015501 BEDFORD LABORATORIES yPAMIDRONATE INJ 30MG 55390015701 BEDFORD LABORATORIES yPAMIDRONATE INJ 90MG 55390015901 BEDFORD LABORATORIES yOCTREOTIDE INJ 50MCG/ML 55390016010 BEDFORD LABORATORIES yOCTREOTIDE INJ 100MCG 55390016110 BEDFORD LABORATORIES yOCTREOTIDE INJ 500MCG 55390016210 BEDFORD LABORATORIES yOCTREOTIDE INJ 0.2MG/ML 55390016301 BEDFORD LABORATORIES yOCTREOTIDE INJ 1MG/ML 55390016401 BEDFORD LABORATORIES yLORAZEPAM INJ 2MG/ML 55390016810 BEDFORD LABORATORIES yLORAZEPAM INJ 4MG/ML 55390016910 BEDFORD LABORATORIES yLORAZEPAM INJ 2MG/ML 55390017010 BEDFORD LABORATORIES yLORAZEPAM INJ 4MG/ML 55390017110 BEDFORD LABORATORIES yATRACURIUM INJ 10MG/ML 55390017910 BEDFORD LABORATORIES yATRACURIUM INJ 10MG/ML 55390018005 BEDFORD LABORATORIES yBUTORPHANOL INJ 1MG/ML 55390018301 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BUTORPHANOL INJ 2MG/ML 55390018401 BEDFORD LABORATORIES yBUTORPHANOL INJ 2MG/ML 55390018402 BEDFORD LABORATORIES yBUTORPHANOL INJ 2MG/ML 55390018510 BEDFORD LABORATORIES yCISPLATIN INJ 1MG/ML 55390018701 BEDFORD LABORATORIES yTERBUTALINE INJ 1MG/ML 55390019310 BEDFORD LABORATORIES yCIPROFLOXACN INJ 200MG 55390019701 BEDFORD LABORATORIES yCIPROFLOXACN INJ 400MG 55390019801 BEDFORD LABORATORIES yCIPROFLOXACN INJ 1200MG 55390019901 BEDFORD LABORATORIES yPAMIDRONATE SOL 3MG/ML 55390020401 BEDFORD LABORATORIES yAMIKACIN INJ 100/2ML 55390022302 BEDFORD LABORATORIES yAMIKACIN INJ 500/2ML 55390022402 BEDFORD LABORATORIES yAMIKACIN INJ 500/2ML 55390022404 BEDFORD LABORATORIES yAMIKACIN INJ 100/2ML 55390022502 BEDFORD LABORATORIES yAMIKACIN INJ 500/2ML 55390022602 BEDFORD LABORATORIES yAMIKACIN INJ 500/2ML 55390022604 BEDFORD LABORATORIES yADRIAMYCIN INJ 10MG 55390023110 BEDFORD LABORATORIES yADRIAMYCIN INJ 20MG 55390023210 BEDFORD LABORATORIES yADRIAMYC INJ 50MG 55390023301 BEDFORD LABORATORIES yADRIAMYCIN INJ 2MG/ML 55390023510 BEDFORD LABORATORIES yADRIAMYCIN INJ 2MG/ML 55390023610 BEDFORD LABORATORIES yADRIAMYCIN INJ 2MG/ML 55390023701 BEDFORD LABORATORIES yADRIAMYCIN INJ 2MG/ML 55390023801 BEDFORD LABORATORIES yDOXORUBICIN INJ 10MG 55390024110 BEDFORD LABORATORIES yDOXORUBICIN INJ 50MG 55390024301 BEDFORD LABORATORIES yDOXORUBICIN INJ 2MG/ML 55390024510 BEDFORD LABORATORIES yDOXORUBICIN INJ 2MG/ML 55390024610 BEDFORD LABORATORIES yDOXORUBICIN INJ 2MG/ML 55390024701 BEDFORD LABORATORIES yDOXORUBICIN INJ 2MG/ML 55390024801 BEDFORD LABORATORIES yMITOMYCIN INJ 5MG 55390025101 BEDFORD LABORATORIES yMITOMYCIN INJ 20MG 55390025201 BEDFORD LABORATORIES yMITOMYCIN INJ 40MG 55390025301 BEDFORD LABORATORIES yMESNA INJ 1GM 55390026601 BEDFORD LABORATORIES yVINORELBINE INJ 10MG/ML 55390026701 BEDFORD LABORATORIES yVINORELBINE INJ 50MG/ML 55390026801 BEDFORD LABORATORIES yCERUBIDINE INJ 20MG 55390028110 BEDFORD LABORATORIES yETOPOSIDE INJ 20MG/ML 55390029101 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ETOPOSIDE INJ 20MG/ML 55390029201 BEDFORD LABORATORIES yETOPOSIDE INJ 20MG/ML 55390029301 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390030405 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390030420 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390030450 BEDFORD LABORATORIES yONDANSETRON INJ 2MG/ML 55390030701 BEDFORD LABORATORIES yONDANSETRON INJ 2MG/ML 55390030710 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390031405 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390031420 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390031450 BEDFORD LABORATORIES yCHLOROPROC INJ 2% 55390040320 BEDFORD LABORATORIES yCHLOROPROC INJ 3% 55390040420 BEDFORD LABORATORIES yHALOPER DEC INJ 50MG/ML 55390041201 BEDFORD LABORATORIES yHALOPER DEC INJ 50MG/ML 55390041205 BEDFORD LABORATORIES yHALOPER DEC INJ 100MG/ML 55390041301 BEDFORD LABORATORIES yHALOPER DEC INJ 100MG/ML 55390041305 BEDFORD LABORATORIES yCISPLATIN INJ 50MG 55390041450 BEDFORD LABORATORIES yCISPLATIN INJ 50MG 55390041499 BEDFORD LABORATORIES yHALOPER DEC INJ 50MG/ML 55390042201 BEDFORD LABORATORIES yHALOPER DEC INJ 100MG/ML 55390042301 BEDFORD LABORATORIES yHALOPER DEC INJ 100MG/ML 55390042305 BEDFORD LABORATORIES yFLOXURIDINE INJ 0.5GM 55390043501 BEDFORD LABORATORIES yLEVOCARNITIN INJ 200MG/ML 55390043605 BEDFORD LABORATORIES yHALOPER LAC INJ 5MG/ML 55390044701 BEDFORD LABORATORIES yHALOPER LAC INJ 5MG/ML 55390044710 BEDFORD LABORATORIES yMITOMYCIN INJ 5MG 55390045101 BEDFORD LABORATORIES yMITOMYCIN INJ 20MG 55390045201 BEDFORD LABORATORIES yMITOMYCIN INJ 40MG 55390045301 BEDFORD LABORATORIES yACETAZOLAMID INJ 500MG 55390046001 BEDFORD LABORATORIES yFLUPHENAZ DE INJ 25MG/ML 55390046505 BEDFORD LABORATORIES yKETAMINE INJ 50MG/ML 55390047510 BEDFORD LABORATORIES yKETOROLAC INJ 15MG/ML 55390048001 BEDFORD LABORATORIES yKETOROLAC INJ 30MG/ML 55390048101 BEDFORD LABORATORIES yKETOROLAC INJ 30MG/ML 55390048102 BEDFORD LABORATORIES yKETOROLAC INJ 30MG/ML 55390048110 BEDFORD LABORATORIES yETOPOSIDE INJ 20MG/ML 55390049101 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ETOPOSIDE INJ 20MG/ML 55390049201 BEDFORD LABORATORIES yETOPOSIDE INJ 20MG/ML 55390049301 BEDFORD LABORATORIES yBUMETANIDE INJ 0.25/ML 55390050002 BEDFORD LABORATORIES yBUMETANIDE INJ 0.25/ML 55390050005 BEDFORD LABORATORIES yBUMETANIDE INJ 0.25/ML 55390050010 BEDFORD LABORATORIES yBUMETANIDE INJ 0.25/ML 55390050102 BEDFORD LABORATORIES yBUMETANIDE INJ 0.25/ML 55390050105 BEDFORD LABORATORIES yBUMETANIDE INJ 0.25/ML 55390050110 BEDFORD LABORATORIES yALPROSTADIL INJ 500MCG 55390050310 BEDFORD LABORATORIES yALPROSTADIL INJ 500MCG 55390050610 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390051405 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390051420 BEDFORD LABORATORIES yPACLITAXEL INJ 6MG/ML 55390051450 BEDFORD LABORATORIES yDIPYRIDAMOLE INJ 5MG/ML 55390055510 BEDFORD LABORATORIES yDIPYRIDAMOLE INJ 5MG/ML 55390055590 BEDFORD LABORATORIES yDOBUTAMINE INJ 250MG 55390056090 BEDFORD LABORATORIES yDILTIAZEM INJ 5MG/ML 55390056505 BEDFORD LABORATORIES yDILTIAZEM INJ 5MG/ML 55390056510 BEDFORD LABORATORIES yDILTIAZEM INJ 5MG/ML 55390056530 BEDFORD LABORATORIES yDILTIAZEM INJ 5MG/ML 55390056605 BEDFORD LABORATORIES yDILTIAZEM INJ 5MG/ML 55390056610 BEDFORD LABORATORIES yDILTIAZEM INJ 5MG/ML 55390056630 BEDFORD LABORATORIES yAZATHIOPRINE INJ 100MG 55390060020 BEDFORD LABORATORIES yPAMIDRONATE SOL 3MG/ML 55390060401 BEDFORD LABORATORIES yCOLCHICINE INJ 1MG/2ML 55390060502 BEDFORD LABORATORIES yACYCLOVIR NA INJ 500MG 55390061210 BEDFORD LABORATORIES yACYCLOVIR NA INJ 1000MG 55390061320 BEDFORD LABORATORIES yRANITIDINE INJ 150/6ML 55390061601 BEDFORD LABORATORIES yRANITIDINE INJ 50MG/2ML 55390061610 BEDFORD LABORATORIES yRANITIDINE INJ 25MG/ML 55390061801 BEDFORD LABORATORIES yETOMIDATE INJ 2MG/ML 55390076210 BEDFORD LABORATORIES yETOMIDATE INJ 2MG/ML 55390076320 BEDFORD LABORATORIES yCAFFEINE/SOD INJ BENZOATE 55390078410 BEDFORD LABORATORIES yDAUNORUBICIN INJ 20MG 55390080510 BEDFORD LABORATORIES yCYTARABINE INJ 100MG 55390080610 BEDFORD LABORATORIES yCYTARABINE INJ 500MG 55390080710 BEDFORD LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CYTARABINE INJ 1GM 55390080801 BEDFORD LABORATORIES yLEUCOVOR CA INJ 100MG 55390081810 BEDFORD LABORATORIES yLEUCOVORIN INJ 200MG 55390082401 BEDFORD LABORATORIES yLEUCOVORIN INJ 350MG 55390082501 BEDFORD LABORATORIES yLEUCOVORIN INJ 500MG 55390082601 BEDFORD LABORATORIES yEPHEDRINE SU INJ 50MG/ML 55390087501 BEDFORD LABORATORIES yLEVOTHYROXIN INJ 200MCG 55390088010 BEDFORD LABORATORIES yLEVOTHYROXIN INJ 500MCG 55390088110 BEDFORD LABORATORIES yGENTIAN VIOL SOL 1% 24385000391 BERGEN BRUNSWIG DRUG COMPANY yTRAVEL SICK TAB 50MG 24385000412 BERGEN BRUNSWIG DRUG COMPANY ySORE THROAT LOZ MAX STR 24385001089 BERGEN BRUNSWIG DRUG COMPANY yPINK BISMUTH TAB 262MG 24385001758 BERGEN BRUNSWIG DRUG COMPANY yHYDROCORT CRE 1% 24385002103 BERGEN BRUNSWIG DRUG COMPANY yANTI-ITCH GEL MAX ST 24385002316 BERGEN BRUNSWIG DRUG COMPANY yPINK BISMUTH CHW 262MG 24385002465 BERGEN BRUNSWIG DRUG COMPANY yANTI-ITCH CRE 2-0.1% 24385002503 BERGEN BRUNSWIG DRUG COMPANY yCHILD ASA CHW 81MG 24385002868 BERGEN BRUNSWIG DRUG COMPANY yGLYCERIN LIQ 24385003316 BERGEN BRUNSWIG DRUG COMPANY yANTI-ITCH SPR 2% 24385003446 BERGEN BRUNSWIG DRUG COMPANY yGLYCE & ROSE LIQ WATER 24385003894 BERGEN BRUNSWIG DRUG COMPANY yGLYCE & ROSE LIQ WATER 24385003898 BERGEN BRUNSWIG DRUG COMPANY yENEMA ENE 24385003928 BERGEN BRUNSWIG DRUG COMPANY yENEMA ENE 24385003936 BERGEN BRUNSWIG DRUG COMPANY yALCOHOL SOL 70% 24385004016 BERGEN BRUNSWIG DRUG COMPANY yCOUGH DROPS LOZ CHERRY 24385004165 BERGEN BRUNSWIG DRUG COMPANY yCOUGH DROPS LOZ MENTHOL 24385004365 BERGEN BRUNSWIG DRUG COMPANY yLOZENGES LOZ CHERRY 24385004562 BERGEN BRUNSWIG DRUG COMPANY yTRIACTING LIQ NITETIME 24385004826 BERGEN BRUNSWIG DRUG COMPANY yPOVIDONE-IOD SOL 10% 24385005355 BERGEN BRUNSWIG DRUG COMPANY ySUPHEDRIN TAB 120MG CR 24385005452 BERGEN BRUNSWIG DRUG COMPANY yMENTHOL COUG LOZ 24385005763 BERGEN BRUNSWIG DRUG COMPANY yBACITRACIN OIN 500/GM 24385006003 BERGEN BRUNSWIG DRUG COMPANY yTRIPLE ANTIB OIN 24385006101 BERGEN BRUNSWIG DRUG COMPANY yTRIPLE ANTIB OIN 24385006103 BERGEN BRUNSWIG DRUG COMPANY yCENTURY TAB /LUTEIN 24385006279 BERGEN BRUNSWIG DRUG COMPANY yCENTURY TAB /LUTEIN 24385006287 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SWEET OIL 24385006392 BERGEN BRUNSWIG DRUG COMPANY yALCOHOL PREP PAD SWABS 24385006576 BERGEN BRUNSWIG DRUG COMPANY yALCOHOL PREP PAD SWABS 24385006578 BERGEN BRUNSWIG DRUG COMPANY yNASAL SPR 0.05% 24385006710 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN A&D OIN 24385007010 BERGEN BRUNSWIG DRUG COMPANY yCALDYPHEN LOT 1-8% 24385007282 BERGEN BRUNSWIG DRUG COMPANY yAMMONIA AROM INH SPIRITS 24385007492 BERGEN BRUNSWIG DRUG COMPANY yEYE DROPS SOL 0.05% OP 24385007501 BERGEN BRUNSWIG DRUG COMPANY yPRENATAL VIT TAB 27-0.8MG 24385007878 BERGEN BRUNSWIG DRUG COMPANY ySALINE SENS SOL EYES 24385007943 BERGEN BRUNSWIG DRUG COMPANY ySUNBLOCK LOT SPF30 24385008126 BERGEN BRUNSWIG DRUG COMPANY ySPORT SUN LOT SPF15 24385008226 BERGEN BRUNSWIG DRUG COMPANY yANIMAL SHAPE CHW /IRON 24385008478 BERGEN BRUNSWIG DRUG COMPANY yZINC OXIDE OIN 20% 24385008603 BERGEN BRUNSWIG DRUG COMPANY yANIMAL SHAPE CHW PLUS C 24385008978 BERGEN BRUNSWIG DRUG COMPANY yCHILD PN REL CHW 80MG 24385009165 BERGEN BRUNSWIG DRUG COMPANY yPETROLATUM GEL WHITE 24385009225 BERGEN BRUNSWIG DRUG COMPANY yPETROLATUM GEL WHITE 24385009296 BERGEN BRUNSWIG DRUG COMPANY yCHILD SUNBLK LOT SPF45 24385009326 BERGEN BRUNSWIG DRUG COMPANY yKIDS SUNSCRE LOT SPF30 24385009426 BERGEN BRUNSWIG DRUG COMPANY yPED ELCTRLYT SOL FRUIT 24385009647 BERGEN BRUNSWIG DRUG COMPANY yCHILD SUNBLK LOT SPF30 24385009726 BERGEN BRUNSWIG DRUG COMPANY yPED ELCTRLYT SOL UNFLAVRD 24385010047 BERGEN BRUNSWIG DRUG COMPANY yPED ELCTRLYT SOL BUBBLGUM 24385010147 BERGEN BRUNSWIG DRUG COMPANY yPED ELCTRLYT SOL GRAPE 24385010347 BERGEN BRUNSWIG DRUG COMPANY yNON-ASA SINU TAB MAX STR 24385010462 BERGEN BRUNSWIG DRUG COMPANY yCHILD PAIN SUS 160/5ML 24385010526 BERGEN BRUNSWIG DRUG COMPANY yBISA-LAX SUP 10MG 24385010712 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B1 TAB 100MG 24385010878 BERGEN BRUNSWIG DRUG COMPANY yKA-PEC SUS 600/15ML 24385010912 BERGEN BRUNSWIG DRUG COMPANY yCIMETIDINE TAB 200MG 24385011153 BERGEN BRUNSWIG DRUG COMPANY yCIMETIDINE TAB 200MG 24385011165 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B-6 TAB 50MG 24385011278 BERGEN BRUNSWIG DRUG COMPANY yHYDROGEN PER SOL 3% 24385011316 BERGEN BRUNSWIG DRUG COMPANY yHYDROGEN PER SOL 3% 24385011398 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B-6 TAB 100MG 24385011578 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LICE TRTMNT SHA 0.3-3% 24385011603 BERGEN BRUNSWIG DRUG COMPANY yLICE TRTMNT SHA 0.3-3% 24385011606 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B12 TAB 500MCG 24385011778 BERGEN BRUNSWIG DRUG COMPANY yGAS RELIEF CHW 80MG 24385011878 BERGEN BRUNSWIG DRUG COMPANY yFOAM ANTACID CHW MAX-STR 24385011978 BERGEN BRUNSWIG DRUG COMPANY yGAS RELIEF CHW 125MG 24385012372 BERGEN BRUNSWIG DRUG COMPANY yFIBER TAB 625MG 24385012576 BERGEN BRUNSWIG DRUG COMPANY yFOAM ANTACID CHW 80-20MG 24385012678 BERGEN BRUNSWIG DRUG COMPANY yCENTURY SR TAB W/LUTEIN 24385012778 BERGEN BRUNSWIG DRUG COMPANY yCHILD PAIN SUS RELIEVER 24385013026 BERGEN BRUNSWIG DRUG COMPANY yTHERAPEUTIC TAB M 24385013279 BERGEN BRUNSWIG DRUG COMPANY yOATMEAL BATH POW REGULAR 24385013395 BERGEN BRUNSWIG DRUG COMPANY yOATMEAL BATH CRY OILATED 24385013495 BERGEN BRUNSWIG DRUG COMPANY yESSENT ONE TAB 24385013978 BERGEN BRUNSWIG DRUG COMPANY yESSENT ONE TAB 24385013985 BERGEN BRUNSWIG DRUG COMPANY yMICONAZOLE CRE 2% 24385014203 BERGEN BRUNSWIG DRUG COMPANY yTRIPLE ANTIB OIN MAX-STR 24385014303 BERGEN BRUNSWIG DRUG COMPANY yANTIBIO/LIDO CRE MAX-STR 24385014403 BERGEN BRUNSWIG DRUG COMPANY yCHILD PAIN SUS RELIEVER 24385014626 BERGEN BRUNSWIG DRUG COMPANY yONE DAILY TAB W/IRON 24385014878 BERGEN BRUNSWIG DRUG COMPANY yONE DAILY TAB W/IRON 24385014885 BERGEN BRUNSWIG DRUG COMPANY yDAIRY-RELIEF TAB 3000UNIT 24385014976 BERGEN BRUNSWIG DRUG COMPANY yNUTR SUPPLE LIQ PLUS VAN 24385015034 BERGEN BRUNSWIG DRUG COMPANY yNUTR SUPPLE LIQ PL CHOC 24385015134 BERGEN BRUNSWIG DRUG COMPANY yNUTR SUPPLE LIQ VANILLA 24385015234 BERGEN BRUNSWIG DRUG COMPANY yNUTR SUPPLE LIQ CHOC 24385015334 BERGEN BRUNSWIG DRUG COMPANY yBANDAGES PLA MIS 3/4" 24385016472 BERGEN BRUNSWIG DRUG COMPANY yARTHRICREAM CRE 10% 24385016553 BERGEN BRUNSWIG DRUG COMPANY yBAND SHEER MIS ASSORTED 24385016672 BERGEN BRUNSWIG DRUG COMPANY yMEDICATED OIN RUB 24385017788 BERGEN BRUNSWIG DRUG COMPANY yDIAPER RELIF OIN 24385017944 BERGEN BRUNSWIG DRUG COMPANY yDAILYHIST-1 TAB 1.34MG 24385018351 BERGEN BRUNSWIG DRUG COMPANY yHYDROCORT AC CRE 0.5% 24385019003 BERGEN BRUNSWIG DRUG COMPANY yDAY TIME LIQ 24385019230 BERGEN BRUNSWIG DRUG COMPANY yLAXATIVE TAB 5MG EC 24385019365 BERGEN BRUNSWIG DRUG COMPANY ySTRESS FORMU TAB 24385019672 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BL HYGIENIC PAD CLEANSNG 24385020033 BERGEN BRUNSWIG DRUG COMPANY yIODIDE TIN 2% 24385020791 BERGEN BRUNSWIG DRUG COMPANY ySTRESS FORMU TAB W/ZINC 24385020872 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEV GEL 7% 24385020953 BERGEN BRUNSWIG DRUG COMPANY yIODIDE TIN 2% 24385021391 BERGEN BRUNSWIG DRUG COMPANY yWITCH HAZEL LIQ 24385021416 BERGEN BRUNSWIG DRUG COMPANY yCROMOLYN SOD SPR 24385022436 BERGEN BRUNSWIG DRUG COMPANY yTHERAPEUTIC GEL BLUE 24385022540 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN CAP CGH/COLD 24385022653 BERGEN BRUNSWIG DRUG COMPANY yBABY SUNSCRE LOT SPF30 24385022726 BERGEN BRUNSWIG DRUG COMPANY yOIL FREE LOT SPF15 24385022826 BERGEN BRUNSWIG DRUG COMPANY ySUNBLOCK LOT SPF15 24385023426 BERGEN BRUNSWIG DRUG COMPANY yIPECAC SYP 24385023791 BERGEN BRUNSWIG DRUG COMPANY yISOP ALCOHOL SOL 91% 24385024216 BERGEN BRUNSWIG DRUG COMPANY yISOP ALCOHOL SOL 99% 24385024316 BERGEN BRUNSWIG DRUG COMPANY yISOP ALCOHOL SOL /WG 70% 24385024928 BERGEN BRUNSWIG DRUG COMPANY yISOP ALCOHOL SOL 70% 24385025016 BERGEN BRUNSWIG DRUG COMPANY yISOP ALCOHOL SOL /WG 70% 24385025916 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM TAB 600MG 24385026972 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM 600 TAB W/D 24385027372 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM 600 TAB W/D 24385027387 BERGEN BRUNSWIG DRUG COMPANY yHYDROCORT AC CRE 1% 24385027403 BERGEN BRUNSWIG DRUG COMPANY yHYDROCORT AC CRE 1% 24385027446 BERGEN BRUNSWIG DRUG COMPANY yANIMAL SHAPE CHW REGULAR 24385027578 BERGEN BRUNSWIG DRUG COMPANY yCAL-MAG-ZINC TAB 24385027778 BERGEN BRUNSWIG DRUG COMPANY yCHILD ASA CHW 81MG 24385027868 BERGEN BRUNSWIG DRUG COMPANY yBETA CAROTEN CAP 25000UNT 24385028078 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN A CAP 8000UNIT 24385028178 BERGEN BRUNSWIG DRUG COMPANY yHYDROCORT LOT 1% 24385028306 BERGEN BRUNSWIG DRUG COMPANY yCOD LIVER OI CAP 24385028478 BERGEN BRUNSWIG DRUG COMPANY yFOLIC ACID TAB 400MCG 24385028685 BERGEN BRUNSWIG DRUG COMPANY yB-50 BALANCE TAB 24385028878 BERGEN BRUNSWIG DRUG COMPANY yB-100 BALANC TAB 24385029072 BERGEN BRUNSWIG DRUG COMPANY yANTI-NAUSEA SOL 24385029126 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 250MG 24385029278 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C CHW 500MG 24385029378 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VITAMIN C TAB 500MG 24385029578 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 500MG 24385029585 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 500MG 24385029590 BERGEN BRUNSWIG DRUG COMPANY yRANITIDINE TAB 75MG 24385029665 BERGEN BRUNSWIG DRUG COMPANY yRANITIDINE TAB 75MG 24385029672 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TR TAB 500MG 24385029778 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 1000MG 24385029878 BERGEN BRUNSWIG DRUG COMPANY yNATURAL VEG POW 33% 24385030127 BERGEN BRUNSWIG DRUG COMPANY yPINK BISMUTH SUS 527/30ML 24385030234 BERGEN BRUNSWIG DRUG COMPANY yNASAL SPR 0.05% 24385030410 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN EXP SYP 100/5ML 24385031026 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN EXP SYP 100/5ML 24385031034 BERGEN BRUNSWIG DRUG COMPANY yC/ROSE HIPS TAB 500MG 24385031178 BERGEN BRUNSWIG DRUG COMPANY yC/ROSE HIPS TAB 1000MG 24385031272 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 200UNIT 24385031478 BERGEN BRUNSWIG DRUG COMPANY yHEMORRHOIDAL SUP 24385031553 BERGEN BRUNSWIG DRUG COMPANY yGLYCERIN SUP 1.5GM 24385031763 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400UNIT 24385031878 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400UNIT 24385031887 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 1000UNIT 24385031971 BERGEN BRUNSWIG DRUG COMPANY yGLYCERIN SUP 3GM 24385032063 BERGEN BRUNSWIG DRUG COMPANY yGLYCERIN SUP 3GM 24385032071 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400UNIT 24385032178 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 1000UNIT 24385032371 BERGEN BRUNSWIG DRUG COMPANY ySALINE NASAL SPR 0.65% 24385032558 BERGEN BRUNSWIG DRUG COMPANY ySORE THROAT SPR CHERRY 24385032830 BERGEN BRUNSWIG DRUG COMPANY yMILK OF MAGN SUS MINT 24385033240 BERGEN BRUNSWIG DRUG COMPANY yCHROMIUM TAB 200MCG 24385033478 BERGEN BRUNSWIG DRUG COMPANY yCHROMIUM TAB 200MCG 24385033485 BERGEN BRUNSWIG DRUG COMPANY yFISH OIL CAP 1000MG 24385033572 BERGEN BRUNSWIG DRUG COMPANY yGARLIC OIL CAP 3MG 24385033678 BERGEN BRUNSWIG DRUG COMPANY yPINK BISMUTH SUS 524/15ML 24385033734 BERGEN BRUNSWIG DRUG COMPANY yMASANTI DS SUS 24385034040 BERGEN BRUNSWIG DRUG COMPANY yPOTASSIUM TAB 99MG 24385034578 BERGEN BRUNSWIG DRUG COMPANY yZINC TAB 50MG 24385034678 BERGEN BRUNSWIG DRUG COMPANY yNATURAL VEG POW 28.3% OR 24385034727 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HOT STEAM LI LIQ 24385034826 BERGEN BRUNSWIG DRUG COMPANY yLORATADINE-D TAB 10-240MG 24385035152 BERGEN BRUNSWIG DRUG COMPANY yNO DRIP NASL SPR 0.05% 24385035210 BERGEN BRUNSWIG DRUG COMPANY yANTACID SUS 24385035640 BERGEN BRUNSWIG DRUG COMPANY yMASANTI SUS ANTACID 24385035740 BERGEN BRUNSWIG DRUG COMPANY yORAL SALINE SOL LAXATIVE 24385035821 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN DM SYP 100-10/5 24385035926 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN DM SYP 100-10/5 24385035934 BERGEN BRUNSWIG DRUG COMPANY yMINERAL OIL ENE 24385036028 BERGEN BRUNSWIG DRUG COMPANY yCHLD IBUPROF SUS 100/5ML 24385036126 BERGEN BRUNSWIG DRUG COMPANY y12 HOUR COLD TAB 120MG CR 24385036352 BERGEN BRUNSWIG DRUG COMPANY yADULT ASA CHW 81MG 24385036468 BERGEN BRUNSWIG DRUG COMPANY yMIGRAINE TAB FORMULA 24385036578 BERGEN BRUNSWIG DRUG COMPANY yNAPROXEN SOD TAB 220MG 24385036871 BERGEN BRUNSWIG DRUG COMPANY yNAPROXEN SOD TAB 220MG 24385036878 BERGEN BRUNSWIG DRUG COMPANY yLAXATIVE PIL TAB 24385036962 BERGEN BRUNSWIG DRUG COMPANY yCHLD IBUPROF SUS 100/5ML 24385037226 BERGEN BRUNSWIG DRUG COMPANY yTIOCONAZOLE OIN -1 24385037482 BERGEN BRUNSWIG DRUG COMPANY yANTI-DIARRHE LIQ 1MG/5ML 24385037726 BERGEN BRUNSWIG DRUG COMPANY yDIPHEDRYL ELX 12.5/5ML 24385037926 BERGEN BRUNSWIG DRUG COMPANY yGLUCOS/CHOND TAB 750-600 24385038141 BERGEN BRUNSWIG DRUG COMPANY yHISTAFED SYP 1.25-30 24385038326 BERGEN BRUNSWIG DRUG COMPANY yHEMORRHOIDAL OIN 24385038716 BERGEN BRUNSWIG DRUG COMPANY yMOTION SICK TAB 25MG 24385038851 BERGEN BRUNSWIG DRUG COMPANY yNOSE DROPS SOL EX-STR 24385039010 BERGEN BRUNSWIG DRUG COMPANY yMILK OF MAGN SUS 24385039640 BERGEN BRUNSWIG DRUG COMPANY yFOAM ANTACID SUS 24385039740 BERGEN BRUNSWIG DRUG COMPANY yLAXATIVE TAB 15MG 24385040130 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 325MG 24385040371 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 325MG 24385040378 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 325MG 24385040393 BERGEN BRUNSWIG DRUG COMPANY ySENNA-LAX TAB 8.6MG 24385040478 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 500MG 24385040572 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 500MG 24385040578 BERGEN BRUNSWIG DRUG COMPANY yCALAMINE LOT PHENOLAT 24385040796 BERGEN BRUNSWIG DRUG COMPANY yRI-MAG SUS 540/5ML 24385040840 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RI MAG PLUS SUS 24385040940 BERGEN BRUNSWIG DRUG COMPANY yASPIRIN TAB 325MG 24385041678 BERGEN BRUNSWIG DRUG COMPANY yASPIRIN TAB 325MG 24385041685 BERGEN BRUNSWIG DRUG COMPANY yASPIRIN TAB 325MG 24385041687 BERGEN BRUNSWIG DRUG COMPANY yACNE 10 GEL 10% 24385042349 BERGEN BRUNSWIG DRUG COMPANY yNON-ASA SINU TAB ALLERGY 24385042762 BERGEN BRUNSWIG DRUG COMPANY yGAS RELIEF CAP 125MG XS 24385042865 BERGEN BRUNSWIG DRUG COMPANY yASPIRIN TAB 325MG EC 24385042978 BERGEN BRUNSWIG DRUG COMPANY yASPIRIN TAB 325MG EC 24385042990 BERGEN BRUNSWIG DRUG COMPANY yASPIRIN TAB 325MG EC 24385042993 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 24385043078 BERGEN BRUNSWIG DRUG COMPANY ySUPHEDRIN TAB 30MG 24385043262 BERGEN BRUNSWIG DRUG COMPANY ySUPHEDRIN TAB 30MG 24385043280 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 500MG 24385043371 BERGEN BRUNSWIG DRUG COMPANY yHISTAFED TAB 2.5/60MG 24385043462 BERGEN BRUNSWIG DRUG COMPANY yHISTAFED TAB 2.5/60MG 24385043467 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVR TAB SLEEP PM 24385043771 BERGEN BRUNSWIG DRUG COMPANY yNON-ASA SINU TAB MAX STR 24385043862 BERGEN BRUNSWIG DRUG COMPANY ySLEEP AID TAB 25MG 24385044164 BERGEN BRUNSWIG DRUG COMPANY ySLEEP AID TAB 25MG 24385044173 BERGEN BRUNSWIG DRUG COMPANY yNON-ASPIRIN CHW 160MG JR 24385044962 BERGEN BRUNSWIG DRUG COMPANY ySUPHEDRIN TAB PLUS 24385045062 BERGEN BRUNSWIG DRUG COMPANY yGLUCOSAMINE TAB 750MG 24385045776 BERGEN BRUNSWIG DRUG COMPANY yDIPHEDRYL CAP 25MG 24385046262 BERGEN BRUNSWIG DRUG COMPANY yDIPHEDRYL CAP 25MG 24385046278 BERGEN BRUNSWIG DRUG COMPANY yALLERGY TAB 4MG 24385046362 BERGEN BRUNSWIG DRUG COMPANY yALLERGY TAB 4MG 24385046378 BERGEN BRUNSWIG DRUG COMPANY yIBU-PRO COLD TAB /SINUS 24385046560 BERGEN BRUNSWIG DRUG COMPANY ySTOOL SOFTEN LIQ 50MG/5ML 24385046843 BERGEN BRUNSWIG DRUG COMPANY ySTOOL SOFTEN SYP 60/15ML 24385046943 BERGEN BRUNSWIG DRUG COMPANY yLORATADINE TAB 10MG 24385047165 BERGEN BRUNSWIG DRUG COMPANY yANTACID CHW 500MG 24385047847 BERGEN BRUNSWIG DRUG COMPANY yDIPHEDRYL TAB 25MG 24385047962 BERGEN BRUNSWIG DRUG COMPANY yDIPHEDRYL TAB 25MG 24385047978 BERGEN BRUNSWIG DRUG COMPANY yCHLD PN REL CHW 80MG GRP 24385048165 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 500MG 24385048471 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAIN RELIEVE TAB 500MG 24385048478 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 500MG 24385048490 BERGEN BRUNSWIG DRUG COMPANY yPAIN RELIEVE TAB 500MG 24385048493 BERGEN BRUNSWIG DRUG COMPANY yANTACID CHW 500MG 24385048547 BERGEN BRUNSWIG DRUG COMPANY yNAPROXEN SOD TAB 220MG 24385049071 BERGEN BRUNSWIG DRUG COMPANY yNAPROXEN SOD TAB 220MG 24385049078 BERGEN BRUNSWIG DRUG COMPANY yCHLD PN REL CHW 80MG FRT 24385049265 BERGEN BRUNSWIG DRUG COMPANY ySTOOL SOFTEN TAB 8.6-50MG 24385049572 BERGEN BRUNSWIG DRUG COMPANY ySTOOL SOFTEN TAB 8.6-50MG 24385049578 BERGEN BRUNSWIG DRUG COMPANY yANUSERT SUP 24385050612 BERGEN BRUNSWIG DRUG COMPANY yCORAL CALCIU TAB 500MG 24385051072 BERGEN BRUNSWIG DRUG COMPANY yFISH OIL CAP 24385051372 BERGEN BRUNSWIG DRUG COMPANY yINFANTS PAIN DRO RLVR CLD 24385051405 BERGEN BRUNSWIG DRUG COMPANY yCASTOR OIL 95% 24385051516 BERGEN BRUNSWIG DRUG COMPANY yCASTOR OIL 95% 24385051592 BERGEN BRUNSWIG DRUG COMPANY yONE DAILY TAB DIET SPT 24385051671 BERGEN BRUNSWIG DRUG COMPANY yDI BROM C/A ELX CLD/ALLE 24385052126 BERGEN BRUNSWIG DRUG COMPANY yDI BROMM C/C ELX CLD/COUG 24385052226 BERGEN BRUNSWIG DRUG COMPANY ySORE THROAT SPR MENTHOL 24385053230 BERGEN BRUNSWIG DRUG COMPANY yASA LOW STR TAB 81MG EC 24385053548 BERGEN BRUNSWIG DRUG COMPANY yASA LOW STR TAB 81MG EC 24385053576 BERGEN BRUNSWIG DRUG COMPANY yASA LOW STR TAB 81MG EC 24385053587 BERGEN BRUNSWIG DRUG COMPANY yANTI-DIARRHE TAB 2MG 24385055453 BERGEN BRUNSWIG DRUG COMPANY yANTI-DIARRHE TAB 2MG 24385055462 BERGEN BRUNSWIG DRUG COMPANY yANTI-DIARRHE TAB 2MG 24385055489 BERGEN BRUNSWIG DRUG COMPANY yDAY TIME CAP COLD/FLU 24385056253 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN CF SYP 24385057226 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN CG&CD LIQ PEDIATRI 24385057526 BERGEN BRUNSWIG DRUG COMPANY yTUSSIN DM SYP CLEAR 24385057826 BERGEN BRUNSWIG DRUG COMPANY yMICONAZOLE 7 CRE 2% 24385059029 BERGEN BRUNSWIG DRUG COMPANY yULTRA ANTACD CHW 1000MG 24385059523 BERGEN BRUNSWIG DRUG COMPANY yMAGN CITRATE SOL 24385060010 BERGEN BRUNSWIG DRUG COMPANY ySTAT AWAKE TAB 200MG 24385060173 BERGEN BRUNSWIG DRUG COMPANY yIBUPROFEN TAB 200MG 24385060471 BERGEN BRUNSWIG DRUG COMPANY yIBUPROFEN TAB 200MG 24385060478 BERGEN BRUNSWIG DRUG COMPANY yIBUPROFEN TAB 200MG 24385060490 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MICONAZOLE 3 KIT COMBO PK 24385060602 BERGEN BRUNSWIG DRUG COMPANY yCOCOA BUTTER CRE 24385062491 BERGEN BRUNSWIG DRUG COMPANY yPOLY-VITAMIN DRO 24385062550 BERGEN BRUNSWIG DRUG COMPANY yGINKGO BILOB TAB 120MG 24385064171 BERGEN BRUNSWIG DRUG COMPANY yOYSTER SHELL TAB 500MG 24385064478 BERGEN BRUNSWIG DRUG COMPANY yIBUPROFEN TAB 200MG 24385064771 BERGEN BRUNSWIG DRUG COMPANY yIBUPROFEN TAB 200MG 24385064778 BERGEN BRUNSWIG DRUG COMPANY yECHINACEA TAB 167MG 24385066275 BERGEN BRUNSWIG DRUG COMPANY yCRANBERRY TAB 400-160M 24385066375 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400UNIT 24385066678 BERGEN BRUNSWIG DRUG COMPANY yWINTERGREEN OIL 24385066792 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 200UNIT 24385066878 BERGEN BRUNSWIG DRUG COMPANY yMILK OF MAGN SUS 400/5ML 24385067016 BERGEN BRUNSWIG DRUG COMPANY yMSM GLUCOSAM TAB 24385067272 BERGEN BRUNSWIG DRUG COMPANY yMINERAL OIL LIGHT 24385067316 BERGEN BRUNSWIG DRUG COMPANY yMAGN CITRATE SOL 24385067510 BERGEN BRUNSWIG DRUG COMPANY yMAX ONE DAIL TAB 24385067978 BERGEN BRUNSWIG DRUG COMPANY yWOMEN'S ONE TAB DAILY 24385068078 BERGEN BRUNSWIG DRUG COMPANY yMINERAL OIL HEAVY 24385068516 BERGEN BRUNSWIG DRUG COMPANY yTHERAPEUTIC SHA MAX ST 24385069830 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400UNIT 24385076178 BERGEN BRUNSWIG DRUG COMPANY yGAS RELIEF DRO 40/0.6ML 24385078530 BERGEN BRUNSWIG DRUG COMPANY yEPSOM SALT GRA 24385080701 BERGEN BRUNSWIG DRUG COMPANY yEPSOM SALT GRA 24385080704 BERGEN BRUNSWIG DRUG COMPANY yEPSOM SALT GRA 24385080794 BERGEN BRUNSWIG DRUG COMPANY yOPTI-VITAMIN TAB 24385080972 BERGEN BRUNSWIG DRUG COMPANY yPRENATAL VIT TAB 24385081678 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B-6 TAB 100MG 24385084378 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B-12 TAB 500MCG 24385084678 BERGEN BRUNSWIG DRUG COMPANY yB-100 COMPLX TAB TR 24385084972 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 500MG 24385085678 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 500MG 24385085685 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 500MG TR 24385085778 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN C TAB 1000MG 24385085978 BERGEN BRUNSWIG DRUG COMPANY yC/ROSE HIPS TAB 500MG 24385086078 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 200IU 24385086278 BERGEN BRUNSWIG DRUG COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VITAMIN E CAP 400IU 24385086378 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 1000IU 24385086571 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400IU 24385086778 BERGEN BRUNSWIG DRUG COMPANY yOYSTER SHELL TAB 500MG 24385087206 BERGEN BRUNSWIG DRUG COMPANY yOYSTER SHELL TAB 500MG 24385087298 BERGEN BRUNSWIG DRUG COMPANY yOYSTER SHELL TAB /D 500MG 24385087306 BERGEN BRUNSWIG DRUG COMPANY yOYSTER SHELL TAB /D 500MG 24385087398 BERGEN BRUNSWIG DRUG COMPANY yCA/MG/ZN TAB 24385087478 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM TAB 600MG 24385087772 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM 600 TAB 600MG 24385087972 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM 600 TAB 600MG 24385087987 BERGEN BRUNSWIG DRUG COMPANY yPOT GLUCONAT TAB 2.5 MEQ 24385089078 BERGEN BRUNSWIG DRUG COMPANY yZINC GLUCON TAB 50MG 24385089178 BERGEN BRUNSWIG DRUG COMPANY yNON-ASA COLD SYP CHILD 24385089926 BERGEN BRUNSWIG DRUG COMPANY yCALCIUM 600 TAB + SOY 24385090072 BERGEN BRUNSWIG DRUG COMPANY yBISA-LAX TAB 5MG EC 24385090325 BERGEN BRUNSWIG DRUG COMPANY yBISA-LAX TAB 5MG EC 24385090378 BERGEN BRUNSWIG DRUG COMPANY yCHLD IBUPROF SUS 100/5ML 24385090526 BERGEN BRUNSWIG DRUG COMPANY yFLAX SEED OI CAP 1000MG 24385093378 BERGEN BRUNSWIG DRUG COMPANY yGARLIC-PARSL CAP 24385094278 BERGEN BRUNSWIG DRUG COMPANY yGINSENG CAP 100MG 24385094865 BERGEN BRUNSWIG DRUG COMPANY yCLOVE OIL 24385094991 BERGEN BRUNSWIG DRUG COMPANY yEAR DROPS SOL 6.5% OT 24385095501 BERGEN BRUNSWIG DRUG COMPANY yGLUCOS/CHOND TAB 500/400 24385095625 BERGEN BRUNSWIG DRUG COMPANY yGLUCOS/CHOND TAB 500/400 24385095647 BERGEN BRUNSWIG DRUG COMPANY yGLUCOS/CHOND TAB 500/400 24385095671 BERGEN BRUNSWIG DRUG COMPANY yGARLIC TAB 400MG 24385095765 BERGEN BRUNSWIG DRUG COMPANY yMAGNESIUM TAB 250MG 24385096778 BERGEN BRUNSWIG DRUG COMPANY yNIACIN TAB 250MG TR 24385096978 BERGEN BRUNSWIG DRUG COMPANY ySAW PALMETTO CAP 160MG 24385097171 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN E CAP 400UNIT 24385099678 BERGEN BRUNSWIG DRUG COMPANY yVITAMIN B12 TAB 1000 CR 24385099972 BERGEN BRUNSWIG DRUG COMPANY yLEUKINE INJ 250MCG 50419000201 BERLEX, INC. yLEUKINE INJ 250MCG 50419000233 BERLEX, INC. yLEUKINE SOL 500MCG 50419005014 BERLEX, INC. yLEUKINE SOL 500MCG 50419005030 BERLEX, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETAPACE TAB 80MG 50419010510 BERLEX, INC. yBETAPACE TAB 80MG 50419010511 BERLEX, INC. yBETAPACE TAB 160MG 50419010610 BERLEX, INC. yBETAPACE TAB 160MG 50419010611 BERLEX, INC. yBETAPACE TAB 240MG 50419010710 BERLEX, INC. yBETAPACE TAB 240MG 50419010711 BERLEX, INC. yBETAPACE TAB 120MG 50419010910 BERLEX, INC. yBETAPACE TAB 120MG 50419010911 BERLEX, INC. yBETAPACE AF TAB 80MG 50419011506 BERLEX, INC. yBETAPACE AF TAB 80MG 50419011511 BERLEX, INC. yBETAPACE AF TAB 160MG 50419011606 BERLEX, INC. yBETAPACE AF TAB 160MG 50419011611 BERLEX, INC. yBETAPACE AF TAB 120MG 50419011906 BERLEX, INC. yBETAPACE AF TAB 120MG 50419011911 BERLEX, INC. yREFLUDAN INJ 50MG 50419015057 BERLEX, INC. yCAMPATH INJ 30MG/ML 50419035703 BERLEX, INC. yYASMIN 28 TAB 3-0.03MG 50419040203 BERLEX, INC. yYAZ TAB 3-0.02MG 50419040503 BERLEX, INC. yLEVLITE TAB -28 50419040803 BERLEX, INC. yLEVLEN TAB CONTR PK 50419041112 BERLEX, INC. yLEVLEN-28 TAB 50419041128 BERLEX, INC. yMIRENA IUD SYSTEM 50419042101 BERLEX, INC. yTRI-LEVLEN TAB 28 50419043303 BERLEX, INC. yTRI-LEVLEN TAB 28 50419043306 BERLEX, INC. yTRI-LEVLEN TAB CONTR PK 50419043312 BERLEX, INC. yCLIMARA DIS 0.05MG 50419045104 BERLEX, INC. yCLIMARA DIS 0.1MG 50419045204 BERLEX, INC. yCLIMARA DIS 0.075MG 50419045304 BERLEX, INC. yCLIMARA DIS 0.025MG 50419045404 BERLEX, INC. yMENOSTAR DIS 14MCG 50419045504 BERLEX, INC. yCLIMARA DIS 0.0375MG 50419045604 BERLEX, INC. yCLIMARA DIS 0.06MG 50419045904 BERLEX, INC. yCLIMARA PRO DIS WEEKLY 50419049104 BERLEX, INC. yFLUDARA INJ 50MG 50419051106 BERLEX, INC. yBETASERON INJ 0.3MG 50419052325 BERLEX, INC. yLEUKINE INJ 500 MCG 50419059505 BERLEX, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FINACEA GEL 15% 50419082501 BERLEX, INC. yFINACEA GEL 15% 50419082502 BERLEX, INC. yDR. SMITHS OIN DIAPER 53062001002 BETA DERMACEUTICALS INC. yDR. SMITHS OIN DIAPER 53062001003 BETA DERMACEUTICALS INC. yBETA HC LOT 1% 53062001202 BETA DERMACEUTICALS INC. yAVONEX INJ 30MCG 59627000103 BIOGEN IDEC yAVONEX KIT 59627000205 BIOGEN IDEC yAMEVIVE INJ 15MG 59627002103 BIOGEN IDEC yAMEVIVE INJ 15MG 59627002104 BIOGEN IDEC yRONDEC TAB 4-60MG 64455002201 BIOVAIL PHARMACEUTICALS INC. yATIVAN TAB 0.5MG 64455006301 BIOVAIL PHARMACEUTICALS INC. yATIVAN TAB 1MG 64455006401 BIOVAIL PHARMACEUTICALS INC. yATIVAN TAB 1MG 64455006410 BIOVAIL PHARMACEUTICALS INC. yATIVAN TAB 2MG 64455006501 BIOVAIL PHARMACEUTICALS INC. yRONDEC DM SYP 64455007112 BIOVAIL PHARMACEUTICALS INC. yRONDEC DM SYP 64455007148 BIOVAIL PHARMACEUTICALS INC. yRONDEC SYP 4-45MG/5 64455008112 BIOVAIL PHARMACEUTICALS INC. yRONDEC SYP 4-45MG/5 64455008148 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 120MG 64455010010 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 120MG 64455010030 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 120MG 64455010090 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 180MG 64455010110 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 180MG 64455010130 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 180MG 64455010190 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 240MG 64455010210 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 240MG 64455010230 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 240MG 64455010290 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 300MG 64455010330 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 300MG 64455010390 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 360MG 64455010410 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 360MG 64455010430 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 360MG 64455010490 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 420MG 64455010510 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 420MG 64455010530 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM LA TAB 420MG 64455010590 BIOVAIL PHARMACEUTICALS INC. yTEVETEN TAB 400MG 64455013001 BIOVAIL PHARMACEUTICALS INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TEVETEN TAB 600MG 64455013101 BIOVAIL PHARMACEUTICALS INC. yTEVETEN HCT TAB 600-12.5 64455013201 BIOVAIL PHARMACEUTICALS INC. yTEVETEN HCT TAB 600-25MG 64455013301 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 2.5MG 64455014090 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 5MG 64455014110 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 5MG 64455014190 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 10MG 64455014210 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 10MG 64455014290 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 20MG 64455014310 BIOVAIL PHARMACEUTICALS INC. yVASOTEC TAB 20MG 64455014390 BIOVAIL PHARMACEUTICALS INC. yVASERETIC TAB 5-12.5MG 64455014501 BIOVAIL PHARMACEUTICALS INC. yVASERETIC TAB 10-25MG 64455014601 BIOVAIL PHARMACEUTICALS INC. yISORDIL TAB 40MG 64455019201 BIOVAIL PHARMACEUTICALS INC. yCEDAX CAP 400MG 64455069101 BIOVAIL PHARMACEUTICALS INC. yCEDAX CAP 400MG 64455069102 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM TAB 30MG 64455077147 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM TAB 30MG 64455077155 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM TAB 60MG 64455077247 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM TAB 60MG 64455077255 BIOVAIL PHARMACEUTICALS INC. yCEDAX SUS 90MG/5ML 64455077701 BIOVAIL PHARMACEUTICALS INC. yCEDAX SUS 90MG/5ML 64455077702 BIOVAIL PHARMACEUTICALS INC. yCEDAX SUS 90MG/5ML 64455077703 BIOVAIL PHARMACEUTICALS INC. yCEDAX SUS 90MG/5ML 64455077704 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM TAB 90MG 64455079147 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM TAB 120MG 64455079247 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 120MG/24 64455079530 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 120MG/24 64455079542 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 120MG/24 64455079549 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 180MG/24 64455079630 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 180MG/24 64455079642 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 180MG/24 64455079649 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 180MG/24 64455079650 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 240MG/24 64455079730 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 240MG/24 64455079742 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 240MG/24 64455079749 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 300MG/24 64455079830 BIOVAIL PHARMACEUTICALS INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARDIZEM CD CAP 300MG/24 64455079842 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 300MG/24 64455079849 BIOVAIL PHARMACEUTICALS INC. yCARDIZEM CD CAP 360MG/24 64455079942 BIOVAIL PHARMACEUTICALS INC. yZOVIRAX OIN 5% 64455099394 BIOVAIL PHARMACEUTICALS INC. yZOVIRAX CRE 5% 64455099442 BIOVAIL PHARMACEUTICALS INC. yZOVIRAX CRE 5% 64455099445 BIOVAIL PHARMACEUTICALS INC. yMAG-OX 400 TAB 400MG 00165002210 BLAINE COMPANY yMAG-OX 400 TAB 400MG 00165002212 BLAINE COMPANY yMAG-OX 400 TAB 400MG 00165002241 BLAINE COMPANY yMAG-OX 400 TAB 400MG 00165002260 BLAINE COMPANY yURO-MAG CAP 140MG 00165005401 BLAINE COMPANY yURO-MAG CAP 140MG 00165005410 BLAINE COMPANY yURO-MAG CAP 140MG 00165005441 BLAINE COMPANY yNASAL MOIST SPR 0.65% 50486002701 BLAIREX LABORATORIES, INC. yNASAL MOIST GEL 50486002735 BLAIREX LABORATORIES, INC. yBRONCHO SAL AER 0.9% 50486007822 BLAIREX LABORATORIES, INC. yBRONCHO SAL AER 0.9% 50486007823 BLAIREX LABORATORIES, INC. yWOUND WASH SOL 0.9% 50486008552 BLAIREX LABORATORIES, INC. yNALEX SOL EXPECT 51674000207 BLANSETT PHARMACAL CO., INC. yNALEX DH LIQ 51674000507 BLANSETT PHARMACAL CO., INC. yNALEX-A LIQ 51674000707 BLANSETT PHARMACAL CO., INC. yNALEX-A TAB 51674000801 BLANSETT PHARMACAL CO., INC. yANOLOR 300 CAP 51674000901 BLANSETT PHARMACAL CO., INC. yPROLEX DH SOL EXPECT 51674001207 BLANSETT PHARMACAL CO., INC. yPROLEX DM LIQ 15-300/5 51674001307 BLANSETT PHARMACAL CO., INC. yPROLEX DM LIQ 15-300/5 51674001907 BLANSETT PHARMACAL CO., INC. yNALEX DH LIQ 5-2.5/5M 51674002507 BLANSETT PHARMACAL CO., INC. yNALEX-A 12 SUS 51674002704 BLANSETT PHARMACAL CO., INC. yBLANEX-A TAB 4-40-20 51674005801 BLANSETT PHARMACAL CO., INC. yCORTANE-B DRO OTIC 51674011601 BLANSETT PHARMACAL CO., INC. yCORTANE-B LOT 51674011702 BLANSETT PHARMACAL CO., INC. yCORTANE-B DRO AQ OTIC 51674011801 BLANSETT PHARMACAL CO., INC. yPROLEX D TAB 20-600MG 51674012401 BLANSETT PHARMACAL CO., INC. yPROLEX PD TAB 10-600MG 51674012601 BLANSETT PHARMACAL CO., INC. yPROSET D TAB 20-600MG 51674012701 BLANSETT PHARMACAL CO., INC. yRELAGARD GEL 51674013005 BLANSETT PHARMACAL CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROLEX DH SYP 51674021204 BLANSETT PHARMACAL CO., INC. yPROLEX DH SYP 51674021207 BLANSETT PHARMACAL CO., INC. yTUSSINAL 12 SUS 51674033004 BLANSETT PHARMACAL CO., INC. yNAPRELAN TAB 375MG CR 51674037501 BLANSETT PHARMACAL CO., INC. yB-TUSS LIQ 51674064507 BLANSETT PHARMACAL CO., INC. yPSEUDO CM TAB 64376003201 BOCA PHARMACAL, INC. yPSEUDO GG TR TAB 48-595MG 64376003301 BOCA PHARMACAL, INC. yPSE BPM HD LIQ 64376003416 BOCA PHARMACAL, INC. yPHENYLEPHRIN LIQ HD 64376003516 BOCA PHARMACAL, INC. yPCM ALLERGY TAB 64376003601 BOCA PHARMACAL, INC. yCPM/PTOLOX/ LIQ PE 64376043116 BOCA PHARMACAL, INC. yBPM PE LIQ 64376043216 BOCA PHARMACAL, INC. yBPM PE LIQ 64376043240 BOCA PHARMACAL, INC. yBPM PE HC LIQ 64376043316 BOCA PHARMACAL, INC. yBPM PE HC LIQ 64376043340 BOCA PHARMACAL, INC. yPE/GG TAB 20-300MG 64376052001 BOCA PHARMACAL, INC. yPCM CHW 64376053001 BOCA PHARMACAL, INC. yPSE CPM CHW 15-2MG 64376053201 BOCA PHARMACAL, INC. yPSEUDO MAX TAB DMX 64376053301 BOCA PHARMACAL, INC. yPHENCARB GG SYP 64376053716 BOCA PHARMACAL, INC. yPSEUDO MAX TAB 64376053801 BOCA PHARMACAL, INC. yGUAIPHEN-PD TAB 64376053901 BOCA PHARMACAL, INC. yGUAIPHEN-PD TAB 64376053931 BOCA PHARMACAL, INC. yGUAIPHEN-D TAB 64376054001 BOCA PHARMACAL, INC. yGUAIPHEN-D TAB 1200 64376054101 BOCA PHARMACAL, INC. yG-BID DM TAB 64376054201 BOCA PHARMACAL, INC. yBPM TAB 6MG 64376054301 BOCA PHARMACAL, INC. yBPM TAB 6MG 64376054331 BOCA PHARMACAL, INC. yBPM PSEUDO TAB 6-45MG 64376054401 BOCA PHARMACAL, INC. yBPM PSEUDO TAB 6-45MG 64376054431 BOCA PHARMACAL, INC. yG PHEN DM TAB 64376054501 BOCA PHARMACAL, INC. yG PHEN DM TAB 64376054531 BOCA PHARMACAL, INC. yPHENYLEPH CM TAB 64376054601 BOCA PHARMACAL, INC. yPHENYLEPH CM TAB 64376054631 BOCA PHARMACAL, INC. yMETHSCOPOLAM TAB 5MG 64376060406 BOCA PHARMACAL, INC. yCARBINOXAMIN LIQ 4MG/5ML 64376070416 BOCA PHARMACAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PSE BROM DM SYP 64376070616 BOCA PHARMACAL, INC. yP CHLOR GG SOL DROPS 64376070730 BOCA PHARMACAL, INC. yPSEUDOX M SYP 64376070916 BOCA PHARMACAL, INC. yPDM GG SYP 10-30-20 64376071016 BOCA PHARMACAL, INC. yDEX PC SYP 64376071116 BOCA PHARMACAL, INC. yPSE/DM/GG SYP 40-15-10 64376071216 BOCA PHARMACAL, INC. yCARBINO-PSE SYP 2-25MG 64376071316 BOCA PHARMACAL, INC. yCPM/PSE SYP 64376071416 BOCA PHARMACAL, INC. yPSE/GG SYP 40-200MG 64376071616 BOCA PHARMACAL, INC. yPSE CARBINOX SYP DM 64376071816 BOCA PHARMACAL, INC. yCARBIHIST LIQ 4MG/5ML 64376071940 BOCA PHARMACAL, INC. yPDM GG DRO 64376072030 BOCA PHARMACAL, INC. yPSE BPM LIQ 64376072116 BOCA PHARMACAL, INC. yPEDIAHIST DM DRO 15-1-4MG 64376072230 BOCA PHARMACAL, INC. yPEDIAHIST DM SYP 64376072316 BOCA PHARMACAL, INC. yPSEUDO CARB LIQ 64376072416 BOCA PHARMACAL, INC. yPSEUDO CARB LIQ 64376072440 BOCA PHARMACAL, INC. yPSEUDO CARB LIQ DM 64376072516 BOCA PHARMACAL, INC. yPSEUDO CARB LIQ DM 64376072540 BOCA PHARMACAL, INC. yC-PHEN DM DRO 64376072630 BOCA PHARMACAL, INC. yC-PHEN DM SYP 64376072716 BOCA PHARMACAL, INC. yC-PHEN DM SYP 64376072740 BOCA PHARMACAL, INC. yC-PHEN DRO 64376072830 BOCA PHARMACAL, INC. yC-PHEN SYP 64376072916 BOCA PHARMACAL, INC. yC-PHEN SYP 64376072940 BOCA PHARMACAL, INC. yPSE CARB DM DRO 64376073030 BOCA PHARMACAL, INC. yPSE ALLERGY LIQ 64376073116 BOCA PHARMACAL, INC. yPSE ALLERGY LIQ 64376073140 BOCA PHARMACAL, INC. yPSE ALLERGY LIQ DM 64376073216 BOCA PHARMACAL, INC. yPSE ALLERGY LIQ DM 64376073240 BOCA PHARMACAL, INC. yPSEUDO COUGH LIQ 64376073316 BOCA PHARMACAL, INC. yPSEUDO COUGH LIQ 64376073340 BOCA PHARMACAL, INC. yPRENATAL TAB VITAMIN 64376080101 BOCA PHARMACAL, INC. yFE C PLUS TAB 64376080201 BOCA PHARMACAL, INC. yFE C TAB 64376080301 BOCA PHARMACAL, INC. yAGGRENOX CAP 25-200MG 00597000160 BOEHRINGER INGELHEIM PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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APTIVUS CAP 250MG 00597000302 BOEHRINGER INGELHEIM PHARMACEUTICALS yCATAPRES TAB 0.1MG 00597000601 BOEHRINGER INGELHEIM PHARMACEUTICALS yCATAPRES TAB 0.2MG 00597000701 BOEHRINGER INGELHEIM PHARMACEUTICALS yCATAPRES TAB 0.3MG 00597001101 BOEHRINGER INGELHEIM PHARMACEUTICALS yCOMBIVENT AER 00597001314 BOEHRINGER INGELHEIM PHARMACEUTICALS yPERSANTINE TAB 25MG 00597001701 BOEHRINGER INGELHEIM PHARMACEUTICALS yPERSANTINE TAB 50MG 00597001801 BOEHRINGER INGELHEIM PHARMACEUTICALS yPERSANTINE TAB 75MG 00597001901 BOEHRINGER INGELHEIM PHARMACEUTICALS yMOBIC TAB 7.5MG 00597002901 BOEHRINGER INGELHEIM PHARMACEUTICALS yMOBIC TAB 15MG 00597003001 BOEHRINGER INGELHEIM PHARMACEUTICALS yCATAPRES-TTS DIS 0.1/24HR 00597003112 BOEHRINGER INGELHEIM PHARMACEUTICALS yCATAPRES-TTS DIS 0.2/24HR 00597003212 BOEHRINGER INGELHEIM PHARMACEUTICALS yCATAPRES-TTS DIS 0.3/24HR 00597003334 BOEHRINGER INGELHEIM PHARMACEUTICALS yMOBIC SUS 7.5/5ML 00597003401 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS TAB 20MG 00597003928 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS TAB 20MG 00597003937 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS TAB 40MG 00597004028 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS TAB 40MG 00597004037 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS TAB 80MG 00597004128 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS TAB 80MG 00597004137 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS HCT TAB 80/25MG 00597004228 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS HCT TAB 80/25MG 00597004237 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS HCT TAB 40/12.5 00597004337 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS HCT TAB 80/12.5 00597004428 BOEHRINGER INGELHEIM PHARMACEUTICALS yMICARDIS HCT TAB 80/12.5 00597004437 BOEHRINGER INGELHEIM PHARMACEUTICALS yVIRAMUNE TAB 200MG 00597004660 BOEHRINGER INGELHEIM PHARMACEUTICALS yVIRAMUNE SUS 50MG/5ML 00597004724 BOEHRINGER INGELHEIM PHARMACEUTICALS yFLOMAX CAP 0.4MG 00597005801 BOEHRINGER INGELHEIM PHARMACEUTICALS yALUPENT INH AER 0.65/ACT 00597007017 BOEHRINGER INGELHEIM PHARMACEUTICALS ySPIRIVA CAP HANDIHLR 00597007506 BOEHRINGER INGELHEIM PHARMACEUTICALS ySPIRIVA CAP HANDIHLR 00597007537 BOEHRINGER INGELHEIM PHARMACEUTICALS yATROVENT NAS SOL 0.03% 00597008130 BOEHRINGER INGELHEIM PHARMACEUTICALS yATROVENT INH AER 18MCG/AC 00597008214 BOEHRINGER INGELHEIM PHARMACEUTICALS yMIRAPEX TAB 0.5MG 00597008561 BOEHRINGER INGELHEIM PHARMACEUTICALS yMIRAPEX TAB 0.5MG 00597008590 BOEHRINGER INGELHEIM PHARMACEUTICALS yATROVENT NAS SOL 0.06% 00597008676 BOEHRINGER INGELHEIM PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ATROVENT HFA AER 17MCG 00597008717 BOEHRINGER INGELHEIM PHARMACEUTICALS yBOUDREAUXS PST BUTT 62103033304 BOUDREAUX'S BUTT PASTE yBOUDREAUXS PST BUTT 62103033306 BOUDREAUX'S BUTT PASTE yGOLYTELY SOL 52268010001 BRAINTREE LABORATORIES INC., yGOLYTELY SOL PINEAPPL 52268010101 BRAINTREE LABORATORIES INC., yAXID SOL 15MG/ML 52268014762 BRAINTREE LABORATORIES INC., yNULYTELY SOL 52268030001 BRAINTREE LABORATORIES INC., yNULYTELY SOL CHERRY 52268030101 BRAINTREE LABORATORIES INC., yNULYTELY SOL LMN/LIME 52268030201 BRAINTREE LABORATORIES INC., yNULYTELY SOL ORANGE 52268030301 BRAINTREE LABORATORIES INC., yNULYTELY SOL 52268040001 BRAINTREE LABORATORIES INC., yHALFLYTELY KIT BWL-PREP 52268050201 BRAINTREE LABORATORIES INC., yHALFLYTELY KIT BWL-PREP 52268052001 BRAINTREE LABORATORIES INC., yGOLYTELY SOL 52268070001 BRAINTREE LABORATORIES INC., yMIRALAX POW 3350 NF 52268080002 BRAINTREE LABORATORIES INC., yMIRALAX POW 3350 NF 52268080003 BRAINTREE LABORATORIES INC., yMIRALAX POW 3350 NF 52268080005 BRAINTREE LABORATORIES INC., yGG/PE TAB 900-25MG 10914010001 BRIGHTON PHARMACEUTICALS, INC. yGUAI/DM TAB 800-30MG 10914015001 BRIGHTON PHARMACEUTICALS, INC. yPE/GUAI TAB 30-1200 10914017001 BRIGHTON PHARMACEUTICALS, INC. yPE/GUAI TAB 30-900MG 10914017501 BRIGHTON PHARMACEUTICALS, INC. yGUAI 800/PSE TAB 60/DM 30 10914019001 BRIGHTON PHARMACEUTICALS, INC. yGG/PE TAB 1200-25 10914020001 BRIGHTON PHARMACEUTICALS, INC. yPE/GG TAB 15-600MG 10914030001 BRIGHTON PHARMACEUTICALS, INC. yPE/BPM CAP 7.5-6MG 10914050001 BRIGHTON PHARMACEUTICALS, INC. yPE/BPM CAP 15-12MG 10914060001 BRIGHTON PHARMACEUTICALS, INC. yBROM T/DM T/ SUS PSE T 10914091016 BRIGHTON PHARMACEUTICALS, INC. yCARBINOXAMIN CAP 10MG SR 10914092006 BRIGHTON PHARMACEUTICALS, INC. yCARBINOXAMIN SUS 2-6MG 10914092504 BRIGHTON PHARMACEUTICALS, INC. yCARBINOXAMIN SUS 2-6MG 10914092516 BRIGHTON PHARMACEUTICALS, INC. yDIPHEN/PE/CT CHW 25-10-30 10914093106 BRIGHTON PHARMACEUTICALS, INC. yBROMPHENIRAM CHW 12MG 10914094006 BRIGHTON PHARMACEUTICALS, INC. yPSE/CPM CAP 100-12MG 10914095001 BRIGHTON PHARMACEUTICALS, INC. yGG/CARBETA TAB 10914096001 BRIGHTON PHARMACEUTICALS, INC. yGG/DM TAB 1200-20 10914097001 BRIGHTON PHARMACEUTICALS, INC. yPE/GUAI/DM TAB 10914097501 BRIGHTON PHARMACEUTICALS, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCOD/GG SYP 3.5-100 10914098004 BRIGHTON PHARMACEUTICALS, INC. yHYDROCOD/GG SYP 3.5-100 10914098016 BRIGHTON PHARMACEUTICALS, INC. yATRIPLA TAB 15584010101 BRISTOL-MYERS SQUIBB AND GILEAD SCIENCE yMONOPRIL TAB 10MG 00087015846 BRISTOL-MYERS SQUIBB COMPANY yMONOPRIL TAB 10MG 00087015885 BRISTOL-MYERS SQUIBB COMPANY yPOLY-VI-FLOR DRO 0.25MG 00087045141 BRISTOL-MYERS SQUIBB COMPANY yTRI-VI-FLOR DRO 0.25MG 00087045241 BRISTOL-MYERS SQUIBB COMPANY yPOLY-VI-FLOR DRO 0.5MG/ML 00087047202 BRISTOL-MYERS SQUIBB COMPANY yTRI-VI-FLOR DRO /FE 0.25 00087047841 BRISTOL-MYERS SQUIBB COMPANY yPOLY-VI-FLOR DRO /FE 0.25 00087048341 BRISTOL-MYERS SQUIBB COMPANY yQUESTRAN POW 4GM 00087058005 BRISTOL-MYERS SQUIBB COMPANY yQUESTRAN POW 4GM 00087058011 BRISTOL-MYERS SQUIBB COMPANY yMONOPRIL TAB 20MG 00087060942 BRISTOL-MYERS SQUIBB COMPANY yMONOPRIL TAB 20MG 00087060985 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE-ORANG TAB 25MEQ EF 00087076101 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE-ORANG TAB 25MEQ EF 00087076143 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE/CL TAB CITRUS 00087076641 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE/CL TAB CITRUS 00087076643 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE/CL TAB FRUIT 00087076741 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE/CL TAB FRUIT 00087076743 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE DS TAB 50MEQ OR 00087077141 BRISTOL-MYERS SQUIBB COMPANY yK-LYTE DS TAB 50MEQ OR 00087077142 BRISTOL-MYERS SQUIBB COMPANY yDESYREL TAB 150MG 00087077843 BRISTOL-MYERS SQUIBB COMPANY yDESYREL TAB 150MG 00087077844 BRISTOL-MYERS SQUIBB COMPANY yDESYREL TAB 300MG 00087079641 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 5MG 00087081841 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 5MG 00087081844 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 10MG 00087081941 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 10MG 00087081944 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 15MG 00087082232 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 15MG 00087082233 BRISTOL-MYERS SQUIBB COMPANY yBUSPAR TAB 30MG 00087082481 BRISTOL-MYERS SQUIBB COMPANY yMONOPRIL TAB 40MG 00087120213 BRISTOL-MYERS SQUIBB COMPANY yMONOPRIL HCT TAB 10/12.5 00087149201 BRISTOL-MYERS SQUIBB COMPANY yMONOPRIL HCT TAB 20/12.5 00087149301 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 75MG 00087277131 BRISTOL-MYERS SQUIBB COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AVAPRO TAB 75MG 00087277132 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 150MG 00087277215 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 150MG 00087277231 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 150MG 00087277232 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 150MG 00087277235 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 300MG 00087277315 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 300MG 00087277331 BRISTOL-MYERS SQUIBB COMPANY yAVAPRO TAB 300MG 00087277332 BRISTOL-MYERS SQUIBB COMPANY yAVALIDE TAB 150-12.5 00087277531 BRISTOL-MYERS SQUIBB COMPANY yAVALIDE TAB 150-12.5 00087277532 BRISTOL-MYERS SQUIBB COMPANY yAVALIDE TAB 300-12.5 00087277631 BRISTOL-MYERS SQUIBB COMPANY yAVALIDE TAB 300-12.5 00087277632 BRISTOL-MYERS SQUIBB COMPANY yAVALIDE TAB 300-25MG 00087278831 BRISTOL-MYERS SQUIBB COMPANY yAVALIDE TAB 300-25MG 00087278832 BRISTOL-MYERS SQUIBB COMPANY yCAFCIT INJ 20MG/ML 00087601142 BRISTOL-MYERS SQUIBB COMPANY yGLUCOPHAGE TAB 500MG 00087606005 BRISTOL-MYERS SQUIBB COMPANY yGLUCOPHAGE TAB 500MG 00087606010 BRISTOL-MYERS SQUIBB COMPANY yGLUCOPHAGE TAB XR 500MG 00087606313 BRISTOL-MYERS SQUIBB COMPANY yGLUCOPHAGE TAB XR 750MG 00087606413 BRISTOL-MYERS SQUIBB COMPANY yGLUCOPHAGE TAB 850MG 00087607005 BRISTOL-MYERS SQUIBB COMPANY yGLUCOPHAGE TAB 1000MG 00087607111 BRISTOL-MYERS SQUIBB COMPANY yGLUCOVANCE TAB 1.25/250 00087607211 BRISTOL-MYERS SQUIBB COMPANY yGLUCOVANCE TAB 2.5/500 00087607311 BRISTOL-MYERS SQUIBB COMPANY yGLUCOVANCE TAB 5/500MG 00087607411 BRISTOL-MYERS SQUIBB COMPANY yMETAGLIP TAB 2.5-500M 00087607731 BRISTOL-MYERS SQUIBB COMPANY yMETAGLIP TAB 5-500MG 00087607831 BRISTOL-MYERS SQUIBB COMPANY yMETAGLIP TAB 2.5-250M 00087608131 BRISTOL-MYERS SQUIBB COMPANY yCAFCIT SOL 20MG/ML 00087611142 BRISTOL-MYERS SQUIBB COMPANY yVIDEX SOL 2GM 00087663241 BRISTOL-MYERS SQUIBB COMPANY yVIDEX SOL 4GM 00087663341 BRISTOL-MYERS SQUIBB COMPANY yVIDEX BUFFER CHW 25MG 00087665001 BRISTOL-MYERS SQUIBB COMPANY yVIDEX BUFFER CHW 50MG 00087665101 BRISTOL-MYERS SQUIBB COMPANY yVIDEX BUFFER CHW 100MG 00087665201 BRISTOL-MYERS SQUIBB COMPANY yVIDEX BUFFER CHW 150MG 00087665301 BRISTOL-MYERS SQUIBB COMPANY yVIDEX BUFFER CHW 200MG 00087666515 BRISTOL-MYERS SQUIBB COMPANY yVIDEX EC CAP 125MG 00087667117 BRISTOL-MYERS SQUIBB COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VIDEX EC CAP 200MG 00087667217 BRISTOL-MYERS SQUIBB COMPANY yVIDEX EC CAP 250MG 00087667317 BRISTOL-MYERS SQUIBB COMPANY yVIDEX EC CAP 400MG 00087667417 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL SUS 125/5ML 00087771840 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL SUS 125/5ML 00087771862 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL SUS 125/5ML 00087771864 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL SUS 250/5ML 00087771940 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL SUS 250/5ML 00087771962 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL SUS 250/5ML 00087771964 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL TAB 250MG FC 00087772060 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL TAB 500MG FC 00087772150 BRISTOL-MYERS SQUIBB COMPANY yCEFZIL TAB 500MG FC 00087772160 BRISTOL-MYERS SQUIBB COMPANY yQUESTRAN POW 4GM LITE 00087944211 BRISTOL-MYERS SQUIBB COMPANY yPLAVIX TAB 75MG 63653117101 BRISTOL-MYERS SQUIBB/SANOFI PARTNERSHIP yPLAVIX TAB 75MG 63653117103 BRISTOL-MYERS SQUIBB/SANOFI PARTNERSHIP yPLAVIX TAB 75MG 63653117105 BRISTOL-MYERS SQUIBB/SANOFI PARTNERSHIP yPLAVIX TAB 75MG 63653117106 BRISTOL-MYERS SQUIBB/SANOFI PARTNERSHIP yGLYCERIN SUP 2GM 00132007912 C B FLEET COMPANY INC yGLYCERIN SUP 2GM 00132007924 C B FLEET COMPANY INC yGLYCERIN SUP 2GM 00132007950 C B FLEET COMPANY INC yGLYCERIN SUP 3GM 00132008012 C B FLEET COMPANY INC yGLYCERIN SUP 1.5GM 00132008112 C B FLEET COMPANY INC yFL PHOSPHO SOL UNFLAVOR 00132010701 C B FLEET COMPANY INC yFL PHOSPHO SOL GNGR-LEM 00132010702 C B FLEET COMPANY INC yFL PHOSPHO SOL SODA-REG 00132010815 C B FLEET COMPANY INC yFL PHOSPHO SOL SODA-FLV 00132010915 C B FLEET COMPANY INC yFLEET ACCU KIT PREP 00132011500 C B FLEET COMPANY INC yFLEET ENE BABYLAX 00132018001 C B FLEET COMPANY INC yFLEET LIQUID ENE GLYCERIN 00132018582 C B FLEET COMPANY INC yFLEET ENE 00132020140 C B FLEET COMPANY INC yFLEET ENE 00132020142 C B FLEET COMPANY INC yFLEET ENE 00132020199 C B FLEET COMPANY INC yFLEET ENE PED 00132020220 C B FLEET COMPANY INC yFLEET PREP KIT #2 00132021001 C B FLEET COMPANY INC yFLEET OIL ENE 00132030140 C B FLEET COMPANY INC yFLEET BISACO ENE 10/30ML 00132070336 C B FLEET COMPANY INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLEET LAXATI TAB 5MG EC 00132070402 C B FLEET COMPANY INC yFLEET LAXATI SUP 10MG 00132070504 C B FLEET COMPANY INC ySOF-LAX CAP 100MG 00132075160 C B FLEET COMPANY INC yFLEET ENE 00132080199 C B FLEET COMPANY INC yFLEET MIS BAGENEMA 00132090110 C B FLEET COMPANY INC yWINRHO SDF INJ 600UNIT 60492002101 CANGENE CORPORATION yWINRHO SDF INJ 1500UNIT 60492002301 CANGENE CORPORATION yWINRHO SDF INJ 5000UNIT 60492002401 CANGENE CORPORATION yRESCON-GG LIQ 64543004404 CAPELLON PHARMACEUTICALS, LTD. yRESCON-GG LIQ 64543004416 CAPELLON PHARMACEUTICALS, LTD. yRESCON-JR TAB 64543008501 CAPELLON PHARMACEUTICALS, LTD. yRESCON-MX TAB 64543009001 CAPELLON PHARMACEUTICALS, LTD. yRESCON TAB 64543009590 CAPELLON PHARMACEUTICALS, LTD. yRESCON-DM SYP 64543010504 CAPELLON PHARMACEUTICALS, LTD. yRESCON-DM SYP 64543010516 CAPELLON PHARMACEUTICALS, LTD. ySYMAX-SL SUB 0.125MG 64543011101 CAPELLON PHARMACEUTICALS, LTD. ySYMAX-SR TAB 0.375MG 64543011201 CAPELLON PHARMACEUTICALS, LTD. ySYMAX FASTAB TAB 0.125MG 64543011401 CAPELLON PHARMACEUTICALS, LTD. ySYMAX DUOTAB TAB 64543011890 CAPELLON PHARMACEUTICALS, LTD. yLIQUIBID TAB 400MG 64543013001 CAPELLON PHARMACEUTICALS, LTD. yLIQUIBID-D TAB 40-1200 64543014001 CAPELLON PHARMACEUTICALS, LTD. yDUOMAX TAB 40-1200 64543014201 CAPELLON PHARMACEUTICALS, LTD. yLIQUIBID-PD TAB 25-275MG 64543014601 CAPELLON PHARMACEUTICALS, LTD. yLIQUIBID-D TAB 40-650MG 64543015090 CAPELLON PHARMACEUTICALS, LTD. yTUSSI-BID TAB 64543017101 CAPELLON PHARMACEUTICALS, LTD. yCERTUSS-D TAB 64543017501 CAPELLON PHARMACEUTICALS, LTD. yCERTUSS TAB 64543018090 CAPELLON PHARMACEUTICALS, LTD. yLIQUIBID-PD TAB 64543024690 CAPELLON PHARMACEUTICALS, LTD. ySALSALATE TAB 500MG 57664010308 CARACO PHARMACEUTICAL LABORATORIES LTD ySALSALATE TAB 500MG 57664010313 CARACO PHARMACEUTICAL LABORATORIES LTD ySALSALATE TAB 500MG 57664010318 CARACO PHARMACEUTICAL LABORATORIES LTD ySALSALATE TAB 750MG 57664010508 CARACO PHARMACEUTICAL LABORATORIES LTD ySALSALATE TAB 750MG 57664010513 CARACO PHARMACEUTICAL LABORATORIES LTD ySALSALATE TAB 750MG 57664010518 CARACO PHARMACEUTICAL LABORATORIES LTD yFLURBIPROFEN TAB 50MG 57664016408 CARACO PHARMACEUTICAL LABORATORIES LTD yFLURBIPROFEN TAB 100MG 57664016508 CARACO PHARMACEUTICAL LABORATORIES LTD y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLURBIPROFEN TAB 100MG 57664016513 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 50MG 57664016608 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 50MG 57664016618 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 100MG 57664016708 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 100MG 57664016718 CARACO PHARMACEUTICAL LABORATORIES LTD yPAROMOMYCIN CAP 250MG 57664017508 CARACO PHARMACEUTICAL LABORATORIES LTD yCHO MAG TRIS TAB 500MG 57664021908 CARACO PHARMACEUTICAL LABORATORIES LTD yCHO MAG TRIS TAB 750MG 57664022008 CARACO PHARMACEUTICAL LABORATORIES LTD yCHO MAG TRIS TAB 1000MG 57664022108 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRAPHEN PSE TAB 120-600 57664022208 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRAPHEN PSE TAB 120-600 57664022213 CARACO PHARMACEUTICAL LABORATORIES LTD yCLOZAPINE TAB 50MG 57664024188 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 0.5MG 57664027308 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 0.5MG 57664027313 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 0.5MG 57664027318 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 1MG 57664027408 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 1MG 57664027413 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 1MG 57664027418 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 2MG 57664027508 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 2MG 57664027513 CARACO PHARMACEUTICAL LABORATORIES LTD yCLONAZEPAM TAB 2MG 57664027518 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRAPHEN PE TAB 20-300MG 57664031708 CARACO PHARMACEUTICAL LABORATORIES LTD yTICLOPIDINE TAB 250MG 57664032706 CARACO PHARMACEUTICAL LABORATORIES LTD yTICLOPIDINE TAB 250MG 57664032713 CARACO PHARMACEUTICAL LABORATORIES LTD yTICLOPIDINE TAB 250MG 57664032783 CARACO PHARMACEUTICAL LABORATORIES LTD yCARBAMAZEPIN CHW 100MG 57664034213 CARACO PHARMACEUTICAL LABORATORIES LTD yCARBAMAZEPIN CHW 100MG 57664034288 CARACO PHARMACEUTICAL LABORATORIES LTD yCLOZAPINE TAB 25MG 57664034513 CARACO PHARMACEUTICAL LABORATORIES LTD yCLOZAPINE TAB 25MG 57664034588 CARACO PHARMACEUTICAL LABORATORIES LTD yCLOZAPINE TAB 100MG 57664034713 CARACO PHARMACEUTICAL LABORATORIES LTD yCLOZAPINE TAB 100MG 57664034788 CARACO PHARMACEUTICAL LABORATORIES LTD yGG/DM CR TAB 600-30MG 57664035508 CARACO PHARMACEUTICAL LABORATORIES LTD yFLUVOXAMINE TAB 25MG 57664035788 CARACO PHARMACEUTICAL LABORATORIES LTD yFLUVOXAMINE TAB 50MG 57664036113 CARACO PHARMACEUTICAL LABORATORIES LTD yFLUVOXAMINE TAB 50MG 57664036188 CARACO PHARMACEUTICAL LABORATORIES LTD yFLUVOXAMINE TAB 100MG 57664036213 CARACO PHARMACEUTICAL LABORATORIES LTD y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUVOXAMINE TAB 100MG 57664036288 CARACO PHARMACEUTICAL LABORATORIES LTD yTRAMADOL HCL TAB 50MG 57664037708 CARACO PHARMACEUTICAL LABORATORIES LTD yTRAMADOL HCL TAB 50MG 57664037713 CARACO PHARMACEUTICAL LABORATORIES LTD yTRAMADOL HCL TAB 50MG 57664037718 CARACO PHARMACEUTICAL LABORATORIES LTD yOXAPROZIN TAB 600MG 57664039108 CARACO PHARMACEUTICAL LABORATORIES LTD yOXAPROZIN TAB 600MG 57664039113 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 500MG 57664039713 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 500MG 57664039718 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 500MG 57664039751 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 500MG 57664039753 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 500MG 57664039758 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 500MG 57664039788 CARACO PHARMACEUTICAL LABORATORIES LTD yGLIPIZIDE TAB 5MG 57664039813 CARACO PHARMACEUTICAL LABORATORIES LTD yGLIPIZIDE TAB 5MG 57664039818 CARACO PHARMACEUTICAL LABORATORIES LTD yGLIPIZIDE TAB 5MG 57664039888 CARACO PHARMACEUTICAL LABORATORIES LTD yGLIPIZIDE TAB 10MG 57664039913 CARACO PHARMACEUTICAL LABORATORIES LTD yGLIPIZIDE TAB 10MG 57664039918 CARACO PHARMACEUTICAL LABORATORIES LTD yGLIPIZIDE TAB 10MG 57664039988 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 850MG 57664043513 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 850MG 57664043518 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 850MG 57664043551 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 850MG 57664043553 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 850MG 57664043558 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 850MG 57664043588 CARACO PHARMACEUTICAL LABORATORIES LTD yDIGOXIN TAB 0.125MG 57664043718 CARACO PHARMACEUTICAL LABORATORIES LTD yDIGOXIN TAB 0.125MG 57664043788 CARACO PHARMACEUTICAL LABORATORIES LTD yDIGOXIN TAB 0.25MG 57664044118 CARACO PHARMACEUTICAL LABORATORIES LTD yDIGOXIN TAB 0.25MG 57664044188 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 1000MG 57664047413 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 1000MG 57664047418 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 1000MG 57664047451 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 1000MG 57664047453 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 1000MG 57664047458 CARACO PHARMACEUTICAL LABORATORIES LTD yMETFORMIN TAB 1000MG 57664047488 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 50MG 57664047708 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 50MG 57664047718 CARACO PHARMACEUTICAL LABORATORIES LTD y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MIRTAZAPINE TAB 15MG 57664049918 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRTAZAPINE TAB 15MG 57664049983 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRTAZAPINE TAB 30MG 57664050018 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRTAZAPINE TAB 30MG 57664050083 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRTAZAPINE TAB 45MG 57664050118 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRTAZAPINE TAB 45MG 57664050183 CARACO PHARMACEUTICAL LABORATORIES LTD yTIZANIDINE TAB 2MG 57664050213 CARACO PHARMACEUTICAL LABORATORIES LTD yTIZANIDINE TAB 2MG 57664050218 CARACO PHARMACEUTICAL LABORATORIES LTD yTIZANIDINE TAB 2MG 57664050289 CARACO PHARMACEUTICAL LABORATORIES LTD yTIZANIDINE TAB 4MG 57664050313 CARACO PHARMACEUTICAL LABORATORIES LTD yTIZANIDINE TAB 4MG 57664050318 CARACO PHARMACEUTICAL LABORATORIES LTD yTIZANIDINE TAB 4MG 57664050389 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 25MG 57664050608 CARACO PHARMACEUTICAL LABORATORIES LTD yMETOPROLOL TAB 25MG 57664050618 CARACO PHARMACEUTICAL LABORATORIES LTD yCITALOPRAM TAB 10MG 57664050713 CARACO PHARMACEUTICAL LABORATORIES LTD yCITALOPRAM TAB 10MG 57664050788 CARACO PHARMACEUTICAL LABORATORIES LTD yCITALOPRAM TAB 20MG 57664050813 CARACO PHARMACEUTICAL LABORATORIES LTD yCITALOPRAM TAB 20MG 57664050888 CARACO PHARMACEUTICAL LABORATORIES LTD yCITALOPRAM TAB 40MG 57664050913 CARACO PHARMACEUTICAL LABORATORIES LTD yCITALOPRAM TAB 40MG 57664050988 CARACO PHARMACEUTICAL LABORATORIES LTD yMIRTAZAPINE TAB 7.5MG 57664051083 CARACO PHARMACEUTICAL LABORATORIES LTD yMELOXICAM TAB 7.5MG 57664051213 CARACO PHARMACEUTICAL LABORATORIES LTD yMELOXICAM TAB 7.5MG 57664051218 CARACO PHARMACEUTICAL LABORATORIES LTD yMELOXICAM TAB 7.5MG 57664051288 CARACO PHARMACEUTICAL LABORATORIES LTD yMELOXICAM TAB 15MG 57664051313 CARACO PHARMACEUTICAL LABORATORIES LTD yMELOXICAM TAB 15MG 57664051318 CARACO PHARMACEUTICAL LABORATORIES LTD yMELOXICAM TAB 15MG 57664051388 CARACO PHARMACEUTICAL LABORATORIES LTD yCARBAMAZEPIN TAB 200MG 57664053313 CARACO PHARMACEUTICAL LABORATORIES LTD yCARBAMAZEPIN TAB 200MG 57664053318 CARACO PHARMACEUTICAL LABORATORIES LTD yCARBAMAZEPIN TAB 200MG 57664053388 CARACO PHARMACEUTICAL LABORATORIES LTD yTRAMADL/APAP TAB 57664053713 CARACO PHARMACEUTICAL LABORATORIES LTD yTRAMADL/APAP TAB 57664053718 CARACO PHARMACEUTICAL LABORATORIES LTD yTRAMADL/APAP TAB 57664053788 CARACO PHARMACEUTICAL LABORATORIES LTD yHUMIBID LA TAB 600-300 68249020010 CAROLINA PHARMACEUTICALS, INC. yHUMIBID LA TAB 600-300 68249020015 CAROLINA PHARMACEUTICALS, INC. yHUMIBID DM CAP CR 68249020103 CAROLINA PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HUMIBID DM CAP CR 68249020110 CAROLINA PHARMACEUTICALS, INC. yDECONSAL II CAP 20-375MG 68249020210 CAROLINA PHARMACEUTICALS, INC. yMICROKLENZ LIQ 53303000708 CARRINGTON LABORATORIES, INC. yCARA-KLENZ SOL 53303002060 CARRINGTON LABORATORIES, INC. yCARA-KLENZ SOL 53303002062 CARRINGTON LABORATORIES, INC. yRADIAGEL GEL 53303002130 CARRINGTON LABORATORIES, INC. yCARA-KLENZ SOL 53303002160 CARRINGTON LABORATORIES, INC. yCARRINGTON CRE MOISTURE 53303004040 CARRINGTON LABORATORIES, INC. yCARRINGTON CRE /ZINC 53303004135 CARRINGTON LABORATORIES, INC. yANTIFUNGAL CRE 2% 53303005050 CARRINGTON LABORATORIES, INC. yCARRAFOAM KIT SKN CARE 53303010204 CARRINGTON LABORATORIES, INC. yCARRAFOAM KIT SKN CARE 53303010205 CARRINGTON LABORATORIES, INC. yDISKETS TAB 40MG 64019053825 CEBERT PHARMACEUTICALS, INC. yMETHADONE CON 10MG/ML 64019055367 CEBERT PHARMACEUTICALS, INC. yMETHADONE CON 10MG/ML 64019055467 CEBERT PHARMACEUTICALS, INC. yTHALOMID CAP 50MG 59572020514 CELGENE CORPORATION yTHALOMID CAP 50MG 59572020594 CELGENE CORPORATION yTHALOMID CAP 100MG 59572021015 CELGENE CORPORATION yTHALOMID CAP 100MG 59572021095 CELGENE CORPORATION yTHALOMID CAP 200MG 59572022016 CELGENE CORPORATION yTHALOMID CAP 200MG 59572022096 CELGENE CORPORATION yALKERAN TAB 2MG 59572030250 CELGENE CORPORATION yREVLIMID CAP 5MG 59572040500 CELGENE CORPORATION yREVLIMID CAP 5MG 59572040530 CELGENE CORPORATION yREVLIMID CAP 10MG 59572041000 CELGENE CORPORATION yREVLIMID CAP 10MG 59572041030 CELGENE CORPORATION yREVLIMID CAP 15MG 59572041500 CELGENE CORPORATION yREVLIMID CAP 15MG 59572041521 CELGENE CORPORATION yREVLIMID CAP 25MG 59572042500 CELGENE CORPORATION yREVLIMID CAP 25MG 59572042525 CELGENE CORPORATION yTRISENOX SOL 10MG/10M 60553011110 CELL THERAPEUTICS, INC. yPEDIAPRED LIQ 6.7/5ML 53014025001 CELLTECH PHARMACEUTICALS yAMERICAINE GEL 20% 53014037616 CELLTECH PHARMACEUTICALS yAMERICAINE GEL 20% 53014037662 CELLTECH PHARMACEUTICALS ySEMPREX-D CAP 8-60MG 53014040410 CELLTECH PHARMACEUTICALS yDELSYM LIQ 30MG/5ML 53014046343 CELLTECH PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DELSYM LIQ 30MG/5ML 53014046348 CELLTECH PHARMACEUTICALS yDELSYM LIQ 30MG/5ML 53014046356 CELLTECH PHARMACEUTICALS yDELSYM LIQ 30MG/5ML 53014046361 CELLTECH PHARMACEUTICALS yMETHYLPHENID TAB 10MG 53014053007 CELLTECH PHARMACEUTICALS yMETHYLPHENID TAB 10MG 53014053012 CELLTECH PHARMACEUTICALS yMETHYLPHENID TAB 5MG 53014053107 CELLTECH PHARMACEUTICALS yMETHYLPHENID TAB 5MG 53014053112 CELLTECH PHARMACEUTICALS yMETHYLPHENID TAB 20MG 53014053207 CELLTECH PHARMACEUTICALS yMETHYLPHENID TAB 20MG 53014053212 CELLTECH PHARMACEUTICALS yTUSSIONEX SUS EXT-REL 53014054867 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 10MG 53014057407 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 20MG 53014057507 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 30MG 53014057607 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 10MG 53014057907 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 20MG 53014058007 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 30MG 53014058107 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 40MG 53014058207 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 50MG 53014058307 CELLTECH PHARMACEUTICALS yMETADATE CD CAP 60MG 53014058407 CELLTECH PHARMACEUTICALS yMETADATE TAB 10MG ER 53014059307 CELLTECH PHARMACEUTICALS yMETADATE TAB 20MG ER 53014059407 CELLTECH PHARMACEUTICALS yGASTROCROM CON 100/5ML 53014067870 CELLTECH PHARMACEUTICALS yDIPENTUM CAP 250MG 53014072671 CELLTECH PHARMACEUTICALS yDIPENTUM CAP 250MG 53014072682 CELLTECH PHARMACEUTICALS yZAROXOLYN TAB 10MG 53014083571 CELLTECH PHARMACEUTICALS yDELSYM LIQ 30MG/5ML 53014084243 CELLTECH PHARMACEUTICALS yDELSYM LIQ 30MG/5ML 53014084261 CELLTECH PHARMACEUTICALS yZAROXOLYN TAB 5MG 53014085071 CELLTECH PHARMACEUTICALS yIONAMIN-30 CAP 30MG 53014090471 CELLTECH PHARMACEUTICALS yIONAMIN-30 CAP 30MG 53014090484 CELLTECH PHARMACEUTICALS yZAROXOLYN TAB 2.5MG 53014097571 CELLTECH PHARMACEUTICALS yREMICADE INJ 100MG 57894003001 CENTOCOR, INC. yDICEL SUS 11528010016 CENTRIX PHARMACEUTICAL, INC. yDICEL DM SUS 11528010516 CENTRIX PHARMACEUTICAL, INC. yERGOCAFF PB SUP 11528020098 CENTRIX PHARMACEUTICAL, INC. yPROVIGIL TAB 100MG 63459010001 CEPHALON, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROVIGIL TAB 100MG 63459010101 CEPHALON, INC. yPROVIGIL TAB 200MG 63459020001 CEPHALON, INC. yPROVIGIL TAB 200MG 63459020101 CEPHALON, INC. yVIVITROL INJ 380MG 63459030042 CEPHALON, INC. yACTIQ LOZ 200MCG 63459030224 CEPHALON, INC. yACTIQ LOZ 400MCG 63459030424 CEPHALON, INC. yACTIQ LOZ 600MCG 63459030624 CEPHALON, INC. yACTIQ LOZ 800MCG 63459030824 CEPHALON, INC. yACTIQ LOZ 1200MCG 63459031224 CEPHALON, INC. yACTIQ LOZ 1600MCG 63459031624 CEPHALON, INC. yGABITRIL TAB 2MG 63459040201 CEPHALON, INC. yGABITRIL TAB 4MG 63459040401 CEPHALON, INC. yGABITRIL TAB 12MG 63459041201 CEPHALON, INC. yGABITRIL TAB 16MG 63459041601 CEPHALON, INC. yACTIQ LOZ 200MCG 63459050230 CEPHALON, INC. yACTIQ LOZ 400MCG 63459050430 CEPHALON, INC. yACTIQ LOZ 600MCG 63459050630 CEPHALON, INC. yACTIQ LOZ 800MCG 63459050830 CEPHALON, INC. yACTIQ LOZ 1200MCG 63459051230 CEPHALON, INC. yACTIQ LOZ 1600MCG 63459051630 CEPHALON, INC. yFENTORA TAB 100MCG 63459054128 CEPHALON, INC. yFENTORA TAB 200MCG 63459054228 CEPHALON, INC. yFENTORA TAB 400MCG 63459054428 CEPHALON, INC. yFENTORA TAB 600MCG 63459054628 CEPHALON, INC. yFENTORA TAB 800MCG 63459054828 CEPHALON, INC. yTRISENOX SOL 10MG/10M 63459060010 CEPHALON, INC. yQC PRENATAL TAB 27-0.8MG 63868000101 CHAIN DRUG MARKETING ASSOCIATION, INC. yDOCUSATE CAL CAP 240MG 63868001701 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC EAR WAX SOL REMOVAL 63868005115 CHAIN DRUG MARKETING ASSOCIATION, INC. yGAS RELIEF DRO 40/0.6ML 63868005230 CHAIN DRUG MARKETING ASSOCIATION, INC. yCALC ANTACID CHW 500MG 63868005315 CHAIN DRUG MARKETING ASSOCIATION, INC. yCALC ANTACID CHW 500MG 63868005415 CHAIN DRUG MARKETING ASSOCIATION, INC. yCAL ANTACID CHW ULTRA 63868005572 CHAIN DRUG MARKETING ASSOCIATION, INC. yLONG ACTING SPR 0.05% 63868005630 CHAIN DRUG MARKETING ASSOCIATION, INC. ySALINE NASAL SPR 0.65% 63868005730 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NO DRIP SPR 0.05% 63868005830 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ANTISEPTIC LIQ PAIN REL 63868006045 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC COUGH LIQ SORE THR 63868006508 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC COUGH LIQ SORE THR 63868006608 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOMP ALLERGY CAP 25MG 63868008701 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOMP ALLERGY CAP 25MG 63868008724 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868008801 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868008803 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868008824 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868008850 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ARTHRITIS TAB 650MG CR 63868008901 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB PM 63868009050 CHAIN DRUG MARKETING ASSOCIATION, INC. ySTAY AWAKE TAB MAX ST 63868010216 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID CHW 750MG 63868010219 CHAIN DRUG MARKETING ASSOCIATION, INC. yGAS RELIEF CHW 80MG 63868010316 CHAIN DRUG MARKETING ASSOCIATION, INC. yTOLNAFTATE CRE 1% 63868010446 CHAIN DRUG MARKETING ASSOCIATION, INC. yDAIRY RELIEF TAB 4500UNIT 63868010514 CHAIN DRUG MARKETING ASSOCIATION, INC. ySTOOL SOFTEN CAP 100MG 63868011001 CHAIN DRUG MARKETING ASSOCIATION, INC. ySTOOL SOFTEN CAP 100MG 63868011025 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID SUS SUPREME 63868011502 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID CHW EX STR 63868012722 CHAIN DRUG MARKETING ASSOCIATION, INC. ySTOOL SOFTEN TAB LAXATIVE 63868013101 CHAIN DRUG MARKETING ASSOCIATION, INC. ySTOOL SOFTEN CAP LAXATIVE 63868013125 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SUPHEDRIN TAB 10MG 63868014436 CHAIN DRUG MARKETING ASSOCIATION, INC. ySUPHEDRINE TAB 30MG 63868014624 CHAIN DRUG MARKETING ASSOCIATION, INC. ySUPHEDRINE TAB 30MG 63868014648 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SUPHEDRIN TAB CLD/ALRG 63868014724 CHAIN DRUG MARKETING ASSOCIATION, INC. yLORATADINE TAB 10MG 63868015101 CHAIN DRUG MARKETING ASSOCIATION, INC. yLORATADINE TAB 10MG 63868015110 CHAIN DRUG MARKETING ASSOCIATION, INC. yLORATADINE TAB 10MG 63868015130 CHAIN DRUG MARKETING ASSOCIATION, INC. yLORATADINE TAB 10MG 63868015160 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SUPHEDRIN TAB SINUS 63868015212 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID CHW 750MG 63868015396 CHAIN DRUG MARKETING ASSOCIATION, INC. yLORATADINE-D TAB 10-240MG 63868015405 CHAIN DRUG MARKETING ASSOCIATION, INC. yLORATADINE-D TAB 10-240MG 63868015410 CHAIN DRUG MARKETING ASSOCIATION, INC. yALLERGY RELF SYP 5MG/5ML 63868015604 CHAIN DRUG MARKETING ASSOCIATION, INC. yTRAVEL SICK TAB 50MG 63868016012 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PINK BISMUTH TAB 262MG 63868017228 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC CHILDRENS CHW ANTACID 63868017324 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASA CHLD SUS 160/5ML 63868017526 CHAIN DRUG MARKETING ASSOCIATION, INC. yDAIRY RELIEF CHW 9000UNIT 63868017581 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NON-ASA SUS CHILDREN 63868017626 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTI-GAS CAP 180MG 63868018023 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID CHW 600MG 63868018370 CHAIN DRUG MARKETING ASSOCIATION, INC. yMICONAZOLE 7 SUP 100MG 63868019907 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC HYDROCORT CRE 1% 63868020001 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC HYDROCORT CRE 1% 63868020012 CHAIN DRUG MARKETING ASSOCIATION, INC. yMICONAZOLE 7 CRE 2% 63868020046 CHAIN DRUG MARKETING ASSOCIATION, INC. yHEMORRHOIDAL OIN 63868020102 CHAIN DRUG MARKETING ASSOCIATION, INC. yPHOSPHA-LAX SOL 63868020303 CHAIN DRUG MARKETING ASSOCIATION, INC. yPHOSPHA-LAX SOL 63868020315 CHAIN DRUG MARKETING ASSOCIATION, INC. yBORIC ACID POW 63868020504 CHAIN DRUG MARKETING ASSOCIATION, INC. yBORIC ACID POW 63868020512 CHAIN DRUG MARKETING ASSOCIATION, INC. yHEMORRHOIDAL GEL COOLING 63868020618 CHAIN DRUG MARKETING ASSOCIATION, INC. yCLEAR ANTI- LOT ITCH 63868021830 CHAIN DRUG MARKETING ASSOCIATION, INC. yARTIFICIAL SOL TEARS 63868022305 CHAIN DRUG MARKETING ASSOCIATION, INC. yANTACID PAIN TAB RELIEF 63868022936 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC HOT STEAM LIQ 63868023004 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC HOSP ANTI SOL 10% 63868023008 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC CHILD'S CHW ASPIRIN 63868024136 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC PMS MULTI TAB SYMPTOM 63868024332 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ACID RELI CHW ORIGINAL 63868025817 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ACID RELI CHW ORIGINAL 63868025853 CHAIN DRUG MARKETING ASSOCIATION, INC. yPEDI ELECTRO SOL 63868026133 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SENNA TAB 8.6MG 63868026301 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SENNA CAP 8.6MG 63868026380 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SENNA-S TAB 8.6-50MG 63868026401 CHAIN DRUG MARKETING ASSOCIATION, INC. yPINK BISMUTH SUS 262/15ML 63868030234 CHAIN DRUG MARKETING ASSOCIATION, INC. yPINK BISMUTH SUS 262/15ML 63868030235 CHAIN DRUG MARKETING ASSOCIATION, INC. yMILK OF MAGN SUS 400/5ML 63868031012 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868031310 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868031350 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 325MG 63868031410 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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NON-ASPIRIN TAB 500MG 63868031510 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868031560 CHAIN DRUG MARKETING ASSOCIATION, INC. yCALAMINE LOT 63868031706 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC CASTOR OIL 63868032204 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOD LIVER OIL OIL 63868032504 CHAIN DRUG MARKETING ASSOCIATION, INC. yPAIN RELIEVE TAB PM X-STR 63868032550 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC LAXATIVE SUP 10MG 63868032808 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC LAXATIVE TAB 5MG EC 63868032825 CHAIN DRUG MARKETING ASSOCIATION, INC. yPINK BISMUTH SUS MAX STR 63868033734 CHAIN DRUG MARKETING ASSOCIATION, INC. yANTI-DIARRHE TAB 2MG 63868033812 CHAIN DRUG MARKETING ASSOCIATION, INC. yANTI-DIARRHE TAB 2MG 63868033824 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTI-DIAR LIQ 750/5ML 63868033912 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868034110 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868034124 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868034150 CHAIN DRUG MARKETING ASSOCIATION, INC. ySOL FIBER POW THERAPY 63868034716 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NATURAL POW VEGETABL 63868034717 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NATURAL POW VEGETABL 63868034718 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NATURAL POW VEGETABL 63868034719 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NATURAL POW VEGETABL 63868034720 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NATURAL POW VEGETABL 63868034721 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAT FIBER POW LAXATIVE 63868034727 CHAIN DRUG MARKETING ASSOCIATION, INC. yFIBER LAXTIV CAP 0.52GM 63868034801 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ASPIRIN TAB 325MG 63868035203 CHAIN DRUG MARKETING ASSOCIATION, INC. yASPIRIN TAB 325MG EC 63868035210 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ASPIRIN TAB 325MG 63868035250 CHAIN DRUG MARKETING ASSOCIATION, INC. yLO-DOSE ASA TAB 81MG EC 63868036020 CHAIN DRUG MARKETING ASSOCIATION, INC. yLO-DOSE ASA TAB 81MG EC 63868036103 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC TRIPLE OIN ANTIOBIO 63868036230 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC EYE DROPS SOL 0.05% OP 63868037605 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC EYE DROPS SOL 0.05% OP 63868037705 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ENEMA ENE 63868038045 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ENEMA ENE 63868038090 CHAIN DRUG MARKETING ASSOCIATION, INC. yDAYTIME CAP COLD/FLU 63868038112 CHAIN DRUG MARKETING ASSOCIATION, INC. yDAYTIME CAP COLD/FLU 63868038120 CHAIN DRUG MARKETING ASSOCIATION, INC. yNITETIME CAP COLD/FLU 63868038212 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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NITETIME CAP COLD/FLU 63868038220 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOLD/ALLERGY TAB 2.5-60MG 63868038324 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOLD/ALLERGY TAB 2.5-60MG 63868038348 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME CAP COLD/FLU 63868038412 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME CAP COLD/FLU 63868038420 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC DAYTIME CAP COLD/FLU 63868038612 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC DAYTIME CAP COLD/FLU 63868038620 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC DAYTIME CAP SINUS 63868038712 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME CAP SINUS 63868038812 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME CAP SINUS 63868038820 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASA FLU TAB MAX ST 63868041910 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASA FLU TAB MAX ST 63868041912 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB COLD/SIN 63868045320 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC STERILE PAD 4"X4" 63868045325 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAPROXEN SOD TAB 220MG 63868046501 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAPROXEN SOD TAB 220MG 63868046524 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAPROXEN SOD TAB 220MG 63868046550 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAPROXEN SOD TAB 220MG 63868046601 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAPROXEN SOD TAB 220MG 63868046624 CHAIN DRUG MARKETING ASSOCIATION, INC. yNAPROXEN SOD TAB 220MG 63868046650 CHAIN DRUG MARKETING ASSOCIATION, INC. yPAIN RELIEVR TAB PLUS 63868048501 CHAIN DRUG MARKETING ASSOCIATION, INC. ySTOOL SOFTEN CAP 100MG 63868049830 CHAIN DRUG MARKETING ASSOCIATION, INC. yWOMANS LAXAT TAB 5MG EC 63868049930 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOMP ALLERGY TAB 25MG 63868050001 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOMP ALLERGY TAB 25MG 63868050024 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC EYE DROPS SOL SEASONAL 63868050505 CHAIN DRUG MARKETING ASSOCIATION, INC. ySEVERE COLD TAB CONGESTI 63868051512 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC HEARTBURN TAB 200MG 63868051912 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC HEARTBURN TAB 200MG 63868051930 CHAIN DRUG MARKETING ASSOCIATION, INC. yFIBER LAX TAB 625MG 63868053090 CHAIN DRUG MARKETING ASSOCIATION, INC. yLAXATIVE TAB MAX-STR 63868054924 CHAIN DRUG MARKETING ASSOCIATION, INC. yPEDIA ELECTR SOL 63868060633 CHAIN DRUG MARKETING ASSOCIATION, INC. yNIGHT TIME TAB 25MG 63868061132 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SLEEP AID CAP 50MG 63868061232 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID SUS 63868069457 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID SUS PLUS 63868069557 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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RANITIDINE TAB 75MG 63868071110 CHAIN DRUG MARKETING ASSOCIATION, INC. yRANITIDINE TAB 75MG 63868071130 CHAIN DRUG MARKETING ASSOCIATION, INC. yRANITIDINE TAB 75MG 63868071160 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID SUS ANTI-GAS 63868071257 CHAIN DRUG MARKETING ASSOCIATION, INC. yACID CONTROL TAB 10MG 63868071430 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID SUS ANTI-GAS 63868071557 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ANTACID CHW 750MG 63868071890 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC DAYTIME LIQ COLD MED 63868074055 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOUGH/SORE LOZ THROAT 63868074910 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ALLERGY TAB 50MG 63868075124 CHAIN DRUG MARKETING ASSOCIATION, INC. yMEDIFIN PE TAB 10-400MG 63868075250 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC MEDIFIN TAB DM 63868075350 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC MEDIFIN TAB 200MG 63868075460 CHAIN DRUG MARKETING ASSOCIATION, INC. ySINUS RELIEF TAB 63868075516 CHAIN DRUG MARKETING ASSOCIATION, INC. ySEVERE CONGE TAB COUGH AI 63868075716 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC IBUPROFEN CAP 200MG 63868075940 CHAIN DRUG MARKETING ASSOCIATION, INC. yMILK OF MAGN SUS 400/5ML 63868078757 CHAIN DRUG MARKETING ASSOCIATION, INC. yMILK OF MAGN SUS 400/5ML 63868078857 CHAIN DRUG MARKETING ASSOCIATION, INC. yREST SIMPLY TAB 25MG 63868078924 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME LIQ COLD/FLU 63868080306 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME LIQ COLD/FLU 63868080310 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME LIQ COLD/FLU 63868080406 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC NIGHTTIME LIQ COLD/FLU 63868080410 CHAIN DRUG MARKETING ASSOCIATION, INC. yNIGHTTIME LIQ COLD 63868080555 CHAIN DRUG MARKETING ASSOCIATION, INC. yNIGHTTIME LIQ COLD 63868080563 CHAIN DRUG MARKETING ASSOCIATION, INC. yNIGHTTIME LIQ COLD 63868080655 CHAIN DRUG MARKETING ASSOCIATION, INC. yNIGHTTIME LIQ COLD 63868080663 CHAIN DRUG MARKETING ASSOCIATION, INC. ySORE THROAT SPR CHERRY 63868081155 CHAIN DRUG MARKETING ASSOCIATION, INC. ySORE THROAT SPR MENTHOL 63868081255 CHAIN DRUG MARKETING ASSOCIATION, INC. ySORE THROAT SPR 63868081355 CHAIN DRUG MARKETING ASSOCIATION, INC. yCHLD ALLERGY LIQ 12.5/5ML 63868082354 CHAIN DRUG MARKETING ASSOCIATION, INC. yCHLOR-PHENIR TAB 4MG 63868082601 CHAIN DRUG MARKETING ASSOCIATION, INC. yCHLOR-PHENIR TAB 4MG 63868082624 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC INFANTS DRO 80/0.8ML 63868083801 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASA CHLD ELX 160/5ML 63868083954 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASA CHLD ELX 160/5ML 63868084054 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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TUSSIN COLD/ CAP COUGH 63868085012 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOLD/ALLERGY ELX 1-15/5ML 63868085154 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOLD/ALLERGY ELX 1-15/5ML 63868085156 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOLD/ALLERGY ELX DM 63868085254 CHAIN DRUG MARKETING ASSOCIATION, INC. yTUSSIN DM SYP 100-10/5 63868085554 CHAIN DRUG MARKETING ASSOCIATION, INC. yTUSSIN DM SYP 100-10/5 63868085556 CHAIN DRUG MARKETING ASSOCIATION, INC. yTUSSIN PE SYP 30-100/5 63868085654 CHAIN DRUG MARKETING ASSOCIATION, INC. yTUSSIN SYP 100/5ML 63868085754 CHAIN DRUG MARKETING ASSOCIATION, INC. yTUSSIN SYP 100/5ML 63868085756 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC TUSSIN CF SYP 63868086154 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC TUSSIN CF SYP 63868086156 CHAIN DRUG MARKETING ASSOCIATION, INC. yASPIRIN EC TAB MAX ST 63868091360 CHAIN DRUG MARKETING ASSOCIATION, INC. yTRIACTIN CLD SYP /ALLERGY 63868091454 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC TRIACTIN SYP CHST CON 63868091554 CHAIN DRUG MARKETING ASSOCIATION, INC. yOVULATION PR KIT ONE STEP 63868092907 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC PREGNANCY TES ONE STEP 63868093001 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC PREGNANCY TES ONE STEP 63868093002 CHAIN DRUG MARKETING ASSOCIATION, INC. yTHERAPEUTIC SHA GEL 63868095116 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SCAR GEL RELIEF 63868095202 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868098303 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868098309 CHAIN DRUG MARKETING ASSOCIATION, INC. ySORE THROAT LOZ 63868098318 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868098324 CHAIN DRUG MARKETING ASSOCIATION, INC. yIBUPROFEN TAB 200MG 63868098350 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC SINUS PAI TAB RELIEF 63868098424 CHAIN DRUG MARKETING ASSOCIATION, INC. yQC ALLERGY/ TAB SINUS 63868098524 CHAIN DRUG MARKETING ASSOCIATION, INC. yPAIN RELIEVE CAP 500MG 63868098701 CHAIN DRUG MARKETING ASSOCIATION, INC. yPAIN RELIEVE CAP 500MG 63868098750 CHAIN DRUG MARKETING ASSOCIATION, INC. yPINK BISMUTH CHW 262MG 63868098930 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN CHW 80MG 63868099030 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN CHW 80MG 63868099130 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN CHW 80MG 63868099230 CHAIN DRUG MARKETING ASSOCIATION, INC. yNON-ASPIRIN TAB 500MG 63868099301 CHAIN DRUG MARKETING ASSOCIATION, INC. yTRI-BUFF ASA TAB 325MG 63868099401 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOMP ALLERGY CAP 25MG 63868099501 CHAIN DRUG MARKETING ASSOCIATION, INC. yCOMP ALLERGY CAP 25MG 63868099524 CHAIN DRUG MARKETING ASSOCIATION, INC. y

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FOAM ANTACID CHW EX ST 63868099601 CHAIN DRUG MARKETING ASSOCIATION, INC. yCLOTRIMAZOLE CRE 1% 63868200202 CHAIN DRUG MARKETING ASSOCIATION, INC. yPOT CHLORIDE LIQ 10% 10235100106 CHEMRICH LABORATORIES INC. yPOT CHLORIDE LIQ 10% 10235100108 CHEMRICH LABORATORIES INC. yTOBI NEB 300/5ML 53905006501 CHIRON CORPORATION yPROLEUKIN INJ 22MU 53905099101 CHIRON CORPORATION yCOATS ALOE LIQ VERA 58826070108 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE LIQ VERA 58826070128 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE LOT VERA 58826070202 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE LOT VERA 58826070208 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE LOT VERA 58826070233 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE CRE VERA 58826070304 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE CRE VERA 58826070316 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE LIQ LINIMENT 58826070408 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE LIQ LINIMENT 58826070433 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE GEL VERA 58826070508 COATS ALOE INTERNATIONAL, INC. yCOATS ALOE GEL VERA 58826070533 COATS ALOE INTERNATIONAL, INC. yALBUTEROL NEB 0.083% 16252009722 COBALT LABORATORIES, INC. yALBUTEROL NEB 0.083% 16252009733 COBALT LABORATORIES, INC. yALBUTEROL NEB 0.083% 16252009766 COBALT LABORATORIES, INC. yIPRATROPIUM SOL INHAL 16252009822 COBALT LABORATORIES, INC. yIPRATROPIUM SOL INHAL 16252009833 COBALT LABORATORIES, INC. yIPRATROPIUM SOL INHAL 16252009866 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 5MG 16252050530 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 5MG 16252050550 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 5MG 16252050590 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 10MG 16252050630 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 10MG 16252050650 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 10MG 16252050690 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 20MG 16252050730 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 20MG 16252050750 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 20MG 16252050790 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 40MG 16252050830 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 40MG 16252050850 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 40MG 16252050890 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 80MG 16252050930 COBALT LABORATORIES, INC. y

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SIMVASTATIN TAB 80MG 16252050950 COBALT LABORATORIES, INC. ySIMVASTATIN TAB 80MG 16252050990 COBALT LABORATORIES, INC. yPRAVASTATIN TAB 10MG 16252052690 COBALT LABORATORIES, INC. yPRAVASTATIN TAB 20MG 16252052790 COBALT LABORATORIES, INC. yPRAVASTATIN TAB 40MG 16252052890 COBALT LABORATORIES, INC. yLURIDE DRO 0.5MG/ML 00126000262 COLGATE ORAL PHARMACEUTICALS, INC. yLURIDE CHW 1MG 00126000621 COLGATE ORAL PHARMACEUTICALS, INC. yLURIDE CHW 0.5MG 00126001421 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT PST 5000 BST 00126007534 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT PST 5000 BST 00126007634 COLGATE ORAL PHARMACEUTICALS, INC. yPEROXYL SOL 00126008008 COLGATE ORAL PHARMACEUTICALS, INC. yPEROXYL SOL 00126008016 COLGATE ORAL PHARMACEUTICALS, INC. yPEROXYL SOL 00126008050 COLGATE ORAL PHARMACEUTICALS, INC. yPEROXYL SPOT GEL TRTMNT 00126008188 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT GEL 1.1% MIN 00126008802 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT GEL 1.1% MIN 00126008882 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126013516 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126013546 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126013816 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126013846 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126013916 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126013946 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126014416 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126014446 COLGATE ORAL PHARMACEUTICALS, INC. yPHOS FLUR SOL 0.044% 00126015146 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126016593 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126016598 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126016698 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT SOL RINSE 00126017916 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT SOL RINSE 00126017999 COLGATE ORAL PHARMACEUTICALS, INC. yLURIDE CHW 0.25MG 00126018621 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126019293 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126019298 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126019393 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM GEL 0.4% 00126019398 COLGATE ORAL PHARMACEUTICALS, INC. yTHERA-FLUR-N DRO 1.1% 00126019654 COLGATE ORAL PHARMACEUTICALS, INC. y

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PERIOGARD SOL 0.12% 00126027116 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT CRE 5000 PLS 00126028666 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT CRE 5000 PLS 00126028733 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT CRE 5000 PLS 00126028766 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT GEL 1.1% BER 00126028802 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT GEL 1.1% BER 00126028882 COLGATE ORAL PHARMACEUTICALS, INC. yPREVIDENT GEL 1.1% CHR 00126029002 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM CON 0.63% 00126231002 COLGATE ORAL PHARMACEUTICALS, INC. yGEL-KAM CON 0.63% 00126231202 COLGATE ORAL PHARMACEUTICALS, INC. yPERIOSTAT TAB 64682000802 COLLAGENEX PHARMACEUTICALS yORACEA CAP 40MG 64682000901 COLLAGENEX PHARMACEUTICALS yPANDEL CRE 0.1% 64682020015 COLLAGENEX PHARMACEUTICALS yPANDEL CRE 0.1% 64682020045 COLLAGENEX PHARMACEUTICALS yPANDEL CRE 0.1% 64682020080 COLLAGENEX PHARMACEUTICALS yCARISOPRODOL TAB 350MG 64720010310 COREPHARMA, LLC yCARISOPRODOL TAB 350MG 64720010311 COREPHARMA, LLC yCARISOPRODOL TAB 350MG 64720010350 COREPHARMA, LLC yCILOSTAZOL TAB 50MG 64720015806 COREPHARMA, LLC yCILOSTAZOL TAB 100MG 64720015906 COREPHARMA, LLC yCITALOPRAM TAB 10MG 64720017003 COREPHARMA, LLC yCITALOPRAM TAB 10MG 64720017010 COREPHARMA, LLC yCITALOPRAM TAB 20MG 64720017103 COREPHARMA, LLC yCITALOPRAM TAB 20MG 64720017110 COREPHARMA, LLC yCITALOPRAM TAB 20MG 64720017111 COREPHARMA, LLC yCITALOPRAM TAB 40MG 64720017203 COREPHARMA, LLC yCITALOPRAM TAB 40MG 64720017210 COREPHARMA, LLC yCITALOPRAM TAB 40MG 64720017211 COREPHARMA, LLC ySALEX CRE 6% 13548001013 CORIA LABORATORIES, LTD. ySALEX LOT 6% 13548001114 CORIA LABORATORIES, LTD. yAKNE-MYCIN OIN 2% 13548003025 CORIA LABORATORIES, LTD. yCLODERM CRE 0.1% 13548003115 CORIA LABORATORIES, LTD. yCLODERM CRE 0.1% 13548003145 CORIA LABORATORIES, LTD. yCLODERM CRE 0.1% 13548003190 CORIA LABORATORIES, LTD. yOVACE WASH LIQ 10% 13548004006 CORIA LABORATORIES, LTD. yOVACE WASH LIQ 10% 13548004012 CORIA LABORATORIES, LTD. yOVACE AER 10% 13548004110 CORIA LABORATORIES, LTD. y

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OVACE AER 10% 13548004150 CORIA LABORATORIES, LTD. yOVACE GEL 10% 13548004230 CORIA LABORATORIES, LTD. yOVACE GEL 10% 13548004260 CORIA LABORATORIES, LTD. yOVACE CRE 10% 13548004330 CORIA LABORATORIES, LTD. yOVACE CRE 10% 13548004360 CORIA LABORATORIES, LTD. yDECONSAL II CAP 20-375MG 10122020110 CORNERSTONE BIOPHARMA, INC. yDECONSAL CT CHW 16-10MG 10122020210 CORNERSTONE BIOPHARMA, INC. yDECONSAL DM CHW 10122020310 CORNERSTONE BIOPHARMA, INC. yBALACET 325 TAB 10122030110 CORNERSTONE BIOPHARMA, INC. yEXTENDRYL CHW 10122040310 CORNERSTONE BIOPHARMA, INC. yEXTENDRYL SYP 10122040416 CORNERSTONE BIOPHARMA, INC. yALLERX TAB DOSE PAC 10122070120 CORNERSTONE BIOPHARMA, INC. yALLERX TAB DOSE PAC 10122070160 CORNERSTONE BIOPHARMA, INC. yALLERX-D TAB 120/2.5 10122070260 CORNERSTONE BIOPHARMA, INC. yALLERX SUS 10122070316 CORNERSTONE BIOPHARMA, INC. yALLERX DF MIS 10122070420 CORNERSTONE BIOPHARMA, INC. yALLERX PE MIS 10122070520 CORNERSTONE BIOPHARMA, INC. yVENTAVIS SOL 10MCG/ML 10148010100 COTHERIX, INC. yVENTAVIS SOL 10MCG/ML 10148010101 COTHERIX, INC. yVENTAVIS SOL 10MCG/ML 10148010130 COTHERIX, INC. yVENTAVIS SOL 10MCG/ML 10148010200 COTHERIX, INC. yVENTAVIS SOL 10MCG/ML 10148010230 COTHERIX, INC. yZYFLO TAB 600MG 68734070010 CRITICAL THERAPEUTICS (CRTX) yCUBICIN SOL 500MG 67919001101 CUBIST PHARMACEUTICALS, INC. yCEFAZOLIN INJ 1GM 66860000203 CURA PHARMACEUTICAL CO., INC. yCEFAZOLIN INJ 10GM 66860000302 CURA PHARMACEUTICAL CO., INC. yEPINEPHRINE INJ 1MG/ML 66860002102 CURA PHARMACEUTICAL CO., INC. yCEFUROXIME INJ 750MG 66860003003 CURA PHARMACEUTICAL CO., INC. yCEFUROXIME INJ 1.5GM 66860003103 CURA PHARMACEUTICAL CO., INC. yCEFUROXIME INJ 7.5GM 66860003202 CURA PHARMACEUTICAL CO., INC. yRANEXA TAB 500MG 67159011203 CV THERAPEUTICS, INC. (CVT) yFLOXIN OTIC SOL 0.3% 63395010105 DAIICHI SANKYO, INC. yFLOXIN OTIC SOL 0.3% 63395010110 DAIICHI SANKYO, INC. yFLOXIN OTIC SOL SINGLES 63395010111 DAIICHI SANKYO, INC. yEVOXAC CAP 30MG 63395020113 DAIICHI SANKYO, INC. yBENICAR TAB 5MG 65597010130 DAIICHI SANKYO, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENICAR TAB 20MG 65597010310 DAIICHI SANKYO, INC. yBENICAR TAB 20MG 65597010330 DAIICHI SANKYO, INC. yBENICAR TAB 20MG 65597010390 DAIICHI SANKYO, INC. yBENICAR TAB 40MG 65597010410 DAIICHI SANKYO, INC. yBENICAR TAB 40MG 65597010430 DAIICHI SANKYO, INC. yBENICAR TAB 40MG 65597010490 DAIICHI SANKYO, INC. yBENICAR HCT TAB 20-12.5 65597010530 DAIICHI SANKYO, INC. yBENICAR HCT TAB 20-12.5 65597010590 DAIICHI SANKYO, INC. yBENICAR HCT TAB 40-12.5 65597010630 DAIICHI SANKYO, INC. yBENICAR HCT TAB 40-12.5 65597010690 DAIICHI SANKYO, INC. yBENICAR HCT TAB 40-25MG 65597010730 DAIICHI SANKYO, INC. yBENICAR HCT TAB 40-25MG 65597010790 DAIICHI SANKYO, INC. yWELCHOL TAB 625MG 65597070118 DAIICHI SANKYO, INC. yMIFEPREX TAB 200MG 64875000103 DANCO LABORATORIES, LLC yTOURO ALLERG CAP CR 58869040101 DARTMOUTH PHARMACEUTICALS, INC. yTOURO DM TAB 30-575MG 58869041101 DARTMOUTH PHARMACEUTICALS, INC. yTOURO CC TAB 58869044101 DARTMOUTH PHARMACEUTICALS, INC. yTOURO CC-LD TAB 58869044501 DARTMOUTH PHARMACEUTICALS, INC. yTOURO HC TAB 58869058101 DARTMOUTH PHARMACEUTICALS, INC. yTOURO LA-LD TAB 58869063501 DARTMOUTH PHARMACEUTICALS, INC. yTOURO LA TAB 58869063601 DARTMOUTH PHARMACEUTICALS, INC. yCLARITHROMYC TAB 250MG 68774012060 DAVA PHARMACEUTICALS, INC. yCLARITHROMYC TAB 500MG 68774012260 DAVA PHARMACEUTICALS, INC. yOXYCODONE TAB 10MG ER 68774016101 DAVA PHARMACEUTICALS, INC. yOXYCODONE TAB 20MG ER 68774016201 DAVA PHARMACEUTICALS, INC. yOXYCODONE TAB 40MG ER 68774016301 DAVA PHARMACEUTICALS, INC. yOXYCODONE TAB 80MG ER 68774016401 DAVA PHARMACEUTICALS, INC. yCLARITHROMYC SUS 125/5ML 68774030229 DAVA PHARMACEUTICALS, INC. yCLARITHROMYC SUS 125/5ML 68774030235 DAVA PHARMACEUTICALS, INC. yCLARITHROMYC SUS 250/5ML 68774030329 DAVA PHARMACEUTICALS, INC. yCLARITHROMYC SUS 250/5ML 68774030335 DAVA PHARMACEUTICALS, INC. yVOSPIRE ER TAB 4MG 68774060001 DAVA PHARMACEUTICALS, INC. yVOSPIRE ER TAB 8MG 68774060101 DAVA PHARMACEUTICALS, INC. yPROQUIN XR TAB 500MG 13913000150 DEPOMED. INC. yGLUMETZA TAB 500MG 13913000213 DEPOMED. INC. yDERMAGEL LIQ SANITIZE 61924010027 DERMARITE INDUSTRIES, LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DERMAPHOR OIN 61924018404 DERMARITE INDUSTRIES, LLC yDERMAPHOR OIN 61924018416 DERMARITE INDUSTRIES, LLC yDERMASARRA LOT 61924018808 DERMARITE INDUSTRIES, LLC yPERIGIENE LIQ 61924019801 DERMARITE INDUSTRIES, LLC yPERIGIENE LIQ 61924019808 DERMARITE INDUSTRIES, LLC yPERIGUARD OIN 61924020404 DERMARITE INDUSTRIES, LLC yPERIGUARD OIN 61924020416 DERMARITE INDUSTRIES, LLC yDERMAMED OIN 61924021404 DERMARITE INDUSTRIES, LLC yDERMAMED OIN 61924021444 DERMARITE INDUSTRIES, LLC yDERMAMED SPR 61924022404 DERMARITE INDUSTRIES, LLC yDERMAFUNGAL OIN 2% 61924023404 DERMARITE INDUSTRIES, LLC yAQUATAB DM TAB 16881010010 DESTON THERAPEUTICS, LLC yAQUATAB D TAB 16881011010 DESTON THERAPEUTICS, LLC yEPIPEN INJ 0.3MG 49502050001 DEY L.P. yEPIPEN 2-PAK INJ 0.3MG 49502050002 DEY L.P. yEPIPEN-JR INJ 0.15MG 49502050101 DEY L.P. yEPIPEN-JR INJ 2-PAK 49502050102 DEY L.P. yDUONEB SOL 49502067230 DEY L.P. yDUONEB SOL 49502067231 DEY L.P. yDUONEB SOL 49502067260 DEY L.P. yMETAPROTEREN NEB 0.6% 49502067624 DEY L.P. yMETAPROTEREN NEB 0.4% 49502067824 DEY L.P. yIPRATROPIUM SOL INHAL 49502068524 DEY L.P. yIPRATROPIUM SOL INHAL 49502068526 DEY L.P. yIPRATROPIUM SOL INHAL 49502068529 DEY L.P. yIPRATROPIUM SOL INHAL 49502068530 DEY L.P. yIPRATROPIUM SOL INHAL 49502068531 DEY L.P. yIPRATROPIUM SOL INHAL 49502068562 DEY L.P. yCROMOLYN SOD NEB 20MG/2ML 49502068961 DEY L.P. yACCUNEB NEB 0.63MG/3 49502069203 DEY L.P. yACCUNEB NEB 1.25MG/3 49502069303 DEY L.P. yALBUTEROL NEB 0.083% 49502069724 DEY L.P. yALBUTEROL NEB 0.083% 49502069729 DEY L.P. yALBUTEROL NEB 0.083% 49502069730 DEY L.P. yALBUTEROL NEB 0.083% 49502069761 DEY L.P. yPANCRECARB CAP MS-8 59767000101 DIGESTIVE CARE, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PANCRECARB CAP MS-8 59767000102 DIGESTIVE CARE, INC. yPANCRECARB CAP MS-4 59767000201 DIGESTIVE CARE, INC. yPANCRECARB CAP MS-16 59767000301 DIGESTIVE CARE, INC. yPANCRECARB CAP MS-16 59767000302 DIGESTIVE CARE, INC. yKEFLEX CAP 250MG 00777086902 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yKEFLEX CAP 250MG 00777086920 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yKEFLEX CAP 500MG 00777087102 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yKEFLEX CAP 500MG 00777087120 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yPROZAC CAP 10MG 00777310402 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yPROZAC CAP 20MG 00777310502 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yPROZAC CAP 20MG 00777310507 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yPROZAC CAP 20MG 00777310530 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yPROZAC CAP 40MG 00777310730 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yPROZAC SOL 20MG/5ML 00777512058 DISTA PRODUCTS CO DIV OF ELI LILLY & CO yIBUPROFEN TAB 400MG 55111010101 DR. REDDY'S LABORATORIES, INC. yIBUPROFEN TAB 400MG 55111010105 DR. REDDY'S LABORATORIES, INC. yIBUPROFEN TAB 600MG 55111010201 DR. REDDY'S LABORATORIES, INC. yIBUPROFEN TAB 600MG 55111010205 DR. REDDY'S LABORATORIES, INC. yIBUPROFEN TAB 800MG 55111010301 DR. REDDY'S LABORATORIES, INC. yIBUPROFEN TAB 800MG 55111010305 DR. REDDY'S LABORATORIES, INC. yFAMOTIDINE TAB 20MG 55111011901 DR. REDDY'S LABORATORIES, INC. yFAMOTIDINE TAB 20MG 55111011910 DR. REDDY'S LABORATORIES, INC. yFAMOTIDINE TAB 40MG 55111012001 DR. REDDY'S LABORATORIES, INC. yCIPROFLOXACN TAB 100MG 55111012506 DR. REDDY'S LABORATORIES, INC. yCIPROFLOXACN TAB 250MG 55111012601 DR. REDDY'S LABORATORIES, INC. yCIPROFLOXACN TAB 250MG 55111012605 DR. REDDY'S LABORATORIES, INC. yCIPROFLOXACN TAB 500MG 55111012701 DR. REDDY'S LABORATORIES, INC. yCIPROFLOXACN TAB 500MG 55111012705 DR. REDDY'S LABORATORIES, INC. yCIPROFLOXACN TAB 750MG 55111012850 DR. REDDY'S LABORATORIES, INC. yRANITIDINE CAP 150MG 55111012960 DR. REDDY'S LABORATORIES, INC. yRANITIDINE CAP 300MG 55111013030 DR. REDDY'S LABORATORIES, INC. yENALAPR/HCTZ TAB 5-12.5MG 55111013301 DR. REDDY'S LABORATORIES, INC. yENALAPR/HCTZ TAB 10-25MG 55111013401 DR. REDDY'S LABORATORIES, INC. yFLUCONAZOLE TAB 50MG 55111014330 DR. REDDY'S LABORATORIES, INC. yFLUCONAZOLE TAB 100MG 55111014405 DR. REDDY'S LABORATORIES, INC. yFLUCONAZOLE TAB 100MG 55111014430 DR. REDDY'S LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUCONAZOLE TAB 150MG 55111014571 DR. REDDY'S LABORATORIES, INC. yFLUCONAZOLE TAB 200MG 55111014605 DR. REDDY'S LABORATORIES, INC. yFLUCONAZOLE TAB 200MG 55111014630 DR. REDDY'S LABORATORIES, INC. yFLUOXETINE CAP 10MG 55111014701 DR. REDDY'S LABORATORIES, INC. yFLUOXETINE CAP 20MG 55111014801 DR. REDDY'S LABORATORIES, INC. yFLUOXETINE CAP 20MG 55111014810 DR. REDDY'S LABORATORIES, INC. yFLUOXETINE CAP 40MG 55111014901 DR. REDDY'S LABORATORIES, INC. yFLUOXETINE CAP 40MG 55111014930 DR. REDDY'S LABORATORIES, INC. yONDANSETRON TAB 4MG 55111015313 DR. REDDY'S LABORATORIES, INC. yONDANSETRON TAB 4MG 55111015330 DR. REDDY'S LABORATORIES, INC. yONDANSETRON TAB 8MG 55111015413 DR. REDDY'S LABORATORIES, INC. yONDANSETRON TAB 8MG 55111015430 DR. REDDY'S LABORATORIES, INC. yONDANSETRON TAB 24MG 55111015611 DR. REDDY'S LABORATORIES, INC. yOXAPROZIN TAB 600MG 55111017001 DR. REDDY'S LABORATORIES, INC. yOXAPROZIN TAB 600MG 55111017005 DR. REDDY'S LABORATORIES, INC. yTIZANIDINE TAB 2MG 55111017910 DR. REDDY'S LABORATORIES, INC. yTIZANIDINE TAB 2MG 55111017915 DR. REDDY'S LABORATORIES, INC. yTIZANIDINE TAB 4MG 55111018010 DR. REDDY'S LABORATORIES, INC. yTIZANIDINE TAB 4MG 55111018015 DR. REDDY'S LABORATORIES, INC. yFEXOFENADINE TAB 30MG 55111019201 DR. REDDY'S LABORATORIES, INC. yFEXOFENADINE TAB 30MG 55111019205 DR. REDDY'S LABORATORIES, INC. yFEXOFENADINE TAB 60MG 55111019301 DR. REDDY'S LABORATORIES, INC. yFEXOFENADINE TAB 60MG 55111019305 DR. REDDY'S LABORATORIES, INC. yFEXOFENADINE TAB 180MG 55111019401 DR. REDDY'S LABORATORIES, INC. yFEXOFENADINE TAB 180MG 55111019405 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 10MG 55111019805 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 10MG 55111019830 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 10MG 55111019890 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 20MG 55111019905 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 20MG 55111019930 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 20MG 55111019990 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 40MG 55111020005 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 40MG 55111020030 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 40MG 55111020090 DR. REDDY'S LABORATORIES, INC. yPRAVASTATIN TAB 10MG 55111022905 DR. REDDY'S LABORATORIES, INC. yPRAVASTATIN TAB 10MG 55111022990 DR. REDDY'S LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PRAVASTATIN TAB 20MG 55111023005 DR. REDDY'S LABORATORIES, INC. yPRAVASTATIN TAB 20MG 55111023090 DR. REDDY'S LABORATORIES, INC. yPRAVASTATIN TAB 40MG 55111023105 DR. REDDY'S LABORATORIES, INC. yPRAVASTATIN TAB 40MG 55111023190 DR. REDDY'S LABORATORIES, INC. yMELOXICAM TAB 7.5MG 55111023301 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 80MG 55111026805 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 80MG 55111026830 DR. REDDY'S LABORATORIES, INC. ySIMVASTATIN TAB 80MG 55111026890 DR. REDDY'S LABORATORIES, INC. yZONISAMIDE CAP 100MG 55111028801 DR. REDDY'S LABORATORIES, INC. yGLIMEPIRIDE TAB 1MG 55111032001 DR. REDDY'S LABORATORIES, INC. yGLIMEPIRIDE TAB 1MG 55111032005 DR. REDDY'S LABORATORIES, INC. yGLIMEPIRIDE TAB 2MG 55111032101 DR. REDDY'S LABORATORIES, INC. yGLIMEPIRIDE TAB 2MG 55111032105 DR. REDDY'S LABORATORIES, INC. yGLIMEPIRIDE TAB 4MG 55111032201 DR. REDDY'S LABORATORIES, INC. yGLIMEPIRIDE TAB 4MG 55111032205 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 10MG 55111034201 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 10MG 55111034205 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 10MG 55111034230 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 20MG 55111034301 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 20MG 55111034305 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 20MG 55111034330 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 40MG 55111034401 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 40MG 55111034405 DR. REDDY'S LABORATORIES, INC. yCITALOPRAM TAB 40MG 55111034430 DR. REDDY'S LABORATORIES, INC. yNAPROXEN TAB 250MG 55111036601 DR. REDDY'S LABORATORIES, INC. yNAPROXEN TAB 250MG 55111036605 DR. REDDY'S LABORATORIES, INC. yNAPROXEN TAB 375MG 55111036701 DR. REDDY'S LABORATORIES, INC. yNAPROXEN TAB 375MG 55111036705 DR. REDDY'S LABORATORIES, INC. yNAPROXEN TAB 500MG 55111036801 DR. REDDY'S LABORATORIES, INC. yNAPROXEN TAB 500MG 55111036805 DR. REDDY'S LABORATORIES, INC. yREVIA TAB 50MG 00056001130 DUPONT PHARMACEUTICALS yCOUMADIN TAB 4MG 00056016870 DUPONT PHARMACEUTICALS yCOUMADIN TAB 4MG 00056016890 DUPONT PHARMACEUTICALS yCOUMADIN TAB 1MG 00056016970 DUPONT PHARMACEUTICALS yCOUMADIN TAB 1MG 00056016975 DUPONT PHARMACEUTICALS yCOUMADIN TAB 1MG 00056016990 DUPONT PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COUMADIN TAB 2MG 00056017070 DUPONT PHARMACEUTICALS yCOUMADIN TAB 2MG 00056017075 DUPONT PHARMACEUTICALS yCOUMADIN TAB 2MG 00056017090 DUPONT PHARMACEUTICALS yCOUMADIN TAB 5MG 00056017270 DUPONT PHARMACEUTICALS yCOUMADIN TAB 5MG 00056017275 DUPONT PHARMACEUTICALS yCOUMADIN TAB 5MG 00056017290 DUPONT PHARMACEUTICALS yCOUMADIN TAB 7.5MG 00056017370 DUPONT PHARMACEUTICALS yCOUMADIN TAB 10MG 00056017470 DUPONT PHARMACEUTICALS yCOUMADIN TAB 2.5MG 00056017670 DUPONT PHARMACEUTICALS yCOUMADIN TAB 2.5MG 00056017675 DUPONT PHARMACEUTICALS yCOUMADIN TAB 2.5MG 00056017690 DUPONT PHARMACEUTICALS yCOUMADIN TAB 3MG 00056018870 DUPONT PHARMACEUTICALS yCOUMADIN TAB 3MG 00056018875 DUPONT PHARMACEUTICALS yCOUMADIN TAB 3MG 00056018890 DUPONT PHARMACEUTICALS yCOUMADIN TAB 6MG 00056018970 DUPONT PHARMACEUTICALS yCOUMADIN TAB 6MG 00056018975 DUPONT PHARMACEUTICALS yCOUMADIN TAB 6MG 00056018990 DUPONT PHARMACEUTICALS ySUSTIVA CAP 50MG 00056047030 DUPONT PHARMACEUTICALS ySUSTIVA CAP 100MG 00056047330 DUPONT PHARMACEUTICALS ySUSTIVA CAP 200MG 00056047492 DUPONT PHARMACEUTICALS ySUSTIVA TAB 600MG 00056051030 DUPONT PHARMACEUTICALS yLODOSYN TAB 25MG 00056051168 DUPONT PHARMACEUTICALS ySINEMET CR TAB 50/200 00056052168 DUPONT PHARMACEUTICALS ySINEMET CR TAB 50/200 00056052185 DUPONT PHARMACEUTICALS ySINEMET CR TAB 25/100 00056060128 DUPONT PHARMACEUTICALS ySINEMET CR TAB 25/100 00056060168 DUPONT PHARMACEUTICALS ySINEMET TAB 10/100 00056064768 DUPONT PHARMACEUTICALS ySINEMET TAB 25/100 00056065068 DUPONT PHARMACEUTICALS ySINEMET TAB 25/250 00056065468 DUPONT PHARMACEUTICALS yCOUMADIN INJ 5 MG 00590032435 DUPONT PHARMACEUTICALS yAZACTAM INJ 500MG 51479004005 DURA PHARMACEUTICALS INC yAZACTAM INJ 1GM 51479004110 DURA PHARMACEUTICALS INC yAZACTAM INJ 1GM 51479004115 DURA PHARMACEUTICALS INC yAZACTAM INJ 2GM 51479004215 DURA PHARMACEUTICALS INC yAZACTAM/DEX INJ 1GM 51479004801 DURA PHARMACEUTICALS INC yAZACTAM/DEX INJ 2GM 51479004901 DURA PHARMACEUTICALS INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MAXIPIME INJ 500MG 51479005310 DURA PHARMACEUTICALS INC yMAXIPIME INJ 1GM 51479005410 DURA PHARMACEUTICALS INC yMAXIPIME INJ 1GM 51479005420 DURA PHARMACEUTICALS INC yMAXIPIME INJ 1GM 51479005430 DURA PHARMACEUTICALS INC yMAXIPIME INJ 2GM 51479005510 DURA PHARMACEUTICALS INC yMAXIPIME INJ 2GM 51479005530 DURA PHARMACEUTICALS INC yTRIAMCINOLON CRE 0.5% 00168000215 E FOUGERA AND CO. yTRIAMCINOLON CRE 0.025% 00168000315 E FOUGERA AND CO. yTRIAMCINOLON CRE 0.025% 00168000380 E FOUGERA AND CO. yTRIAMCINOLON CRE 0.1% 00168000415 E FOUGERA AND CO. yTRIAMCINOLON CRE 0.1% 00168000416 E FOUGERA AND CO. yTRIAMCINOLON CRE 0.1% 00168000480 E FOUGERA AND CO. yTRIAMCINOLON OIN 0.025% 00168000580 E FOUGERA AND CO. yTRIAMCINOLON OIN 0.1% 00168000615 E FOUGERA AND CO. yTRIAMCINOLON OIN 0.1% 00168000616 E FOUGERA AND CO. yTRIAMCINOLON OIN 0.1% 00168000680 E FOUGERA AND CO. yNYSTATIN OIN 100000 00168000715 E FOUGERA AND CO. yNYSTATIN OIN 100000 00168000730 E FOUGERA AND CO. yTOLNAFTATE CRE 1% 00168000815 E FOUGERA AND CO. yTOLNAFTATE SOL 1% 00168000910 E FOUGERA AND CO. yBACITR ZINC OIN 500/GM 00168001104 E FOUGERA AND CO. yBACITR ZINC OIN 500/GM 00168001116 E FOUGERA AND CO. yBACITR ZINC OIN 500/GM 00168001131 E FOUGERA AND CO. yBACITR ZINC OIN 500/GM 00168001135 E FOUGERA AND CO. yBAC/NEO/POLY OIN 00168001209 E FOUGERA AND CO. yBAC/NEO/POLY OIN 00168001231 E FOUGERA AND CO. yBAC/NEO/POLY OIN 00168001235 E FOUGERA AND CO. yHYDROCORT CRE 0.5% 00168001431 E FOUGERA AND CO. yHYDROCORT CRE 1% 00168001516 E FOUGERA AND CO. yHYDROCORT CRE 1% 00168001531 E FOUGERA AND CO. yHYDROCORT OIN 0.5% 00168001631 E FOUGERA AND CO. yHYDROCORT OIN 1% 00168002016 E FOUGERA AND CO. yHYDROCORT OIN 1% 00168002031 E FOUGERA AND CO. yBACIT/POLYMY OIN 00168002109 E FOUGERA AND CO. yBACIT/POLYMY OIN 00168002131 E FOUGERA AND CO. yBACIT/POLYMY OIN 00168002135 E FOUGERA AND CO. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BACITRACIN OIN OP 00168002638 E FOUGERA AND CO. yBAC/NEO/POLY OIN OP 00168002738 E FOUGERA AND CO. yBAC/POLY/NEO OIN /HC OP1% 00168002938 E FOUGERA AND CO. yBETAMETH VAL OIN 0.1% 00168003315 E FOUGERA AND CO. yBETAMETH VAL OIN 0.1% 00168003346 E FOUGERA AND CO. yVITAMIN A&D OIN 00168003501 E FOUGERA AND CO. yVITAMIN A&D OIN 00168003502 E FOUGERA AND CO. yVITAMIN A&D OIN 00168003504 E FOUGERA AND CO. yVITAMIN A&D OIN 00168003516 E FOUGERA AND CO. yVITAMIN A&D OIN 00168003545 E FOUGERA AND CO. yANALGESIC OIN BALM 00168003631 E FOUGERA AND CO. yNYSTATIN SUS 100000 00168003760 E FOUGERA AND CO. yNYSTATIN SUS 100000 00168003761 E FOUGERA AND CO. yBETAMETH VAL CRE 0.1% 00168004015 E FOUGERA AND CO. yBETAMETH VAL CRE 0.1% 00168004046 E FOUGERA AND CO. yBETAMETH VAL LOT 0.1% 00168004160 E FOUGERA AND CO. yDIBUCAINE OIN 1% 00168004631 E FOUGERA AND CO. yHYDROPHILIC OIN 00168004716 E FOUGERA AND CO. yLANOLIN OIN 00168005116 E FOUGERA AND CO. yLANOLIN OIN 00168005131 E FOUGERA AND CO. yPETROLATUM GEL 00168005316 E FOUGERA AND CO. yPETROLATUM GEL 00168005321 E FOUGERA AND CO. yPETROLATUM GEL 00168005331 E FOUGERA AND CO. yPETROLATUM GEL 00168005345 E FOUGERA AND CO. yNYSTATIN CRE 100000 00168005415 E FOUGERA AND CO. yNYSTATIN CRE 100000 00168005430 E FOUGERA AND CO. yBETAMETH DIP CRE 0.05% 00168005515 E FOUGERA AND CO. yBETAMETH DIP CRE 0.05% 00168005546 E FOUGERA AND CO. yBETAMETH DIP OIN 0.05% 00168005615 E FOUGERA AND CO. yBETAMETH DIP OIN 0.05% 00168005646 E FOUGERA AND CO. yBETAMETH DIP LOT 0.05% 00168005760 E FOUGERA AND CO. yFLUOCIN ACET CRE 0.01% 00168005815 E FOUGERA AND CO. yFLUOCIN ACET CRE 0.01% 00168005860 E FOUGERA AND CO. yFLUOCIN ACET SOL 0.01% 00168005960 E FOUGERA AND CO. yFLUOCIN ACET CRE 0.025% 00168006015 E FOUGERA AND CO. yFLUOCIN ACET CRE 0.025% 00168006060 E FOUGERA AND CO. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZINC OXIDE OIN 20% 00168006202 E FOUGERA AND CO. yZINC OXIDE OIN 20% 00168006216 E FOUGERA AND CO. yZINC OXIDE OIN 20% 00168006231 E FOUGERA AND CO. yFLUOCIN ACET OIN 0.025% 00168006415 E FOUGERA AND CO. yFLUOCIN ACET OIN 0.025% 00168006460 E FOUGERA AND CO. yATROPINE SUL OIN 1% OP 00168006538 E FOUGERA AND CO. yERYTHROMYCIN OIN OP 00168007011 E FOUGERA AND CO. yERYTHROMYCIN OIN OP 00168007038 E FOUGERA AND CO. yERYTHROMYCIN OIN OP 00168007039 E FOUGERA AND CO. yGENTAMICIN CRE 0.1% 00168007115 E FOUGERA AND CO. yGENTAMICIN OIN 0.1% 00168007815 E FOUGERA AND CO. ySULFACET SOD OIN 10% OP 00168007938 E FOUGERA AND CO. yHYDROCORT CRE 2.5% 00168008016 E FOUGERA AND CO. yHYDROCORT CRE 2.5% 00168008031 E FOUGERA AND CO. yNYSTAT/TRIAM CRE 00168008115 E FOUGERA AND CO. yNYSTAT/TRIAM CRE 00168008130 E FOUGERA AND CO. yNYSTAT/TRIAM CRE 00168008160 E FOUGERA AND CO. yNYSTAT/TRIAM OIN 00168008915 E FOUGERA AND CO. yNYSTAT/TRIAM OIN 00168008930 E FOUGERA AND CO. yNYSTAT/TRIAM OIN 00168008960 E FOUGERA AND CO. yKETOCONAZOLE CRE 2% 00168009915 E FOUGERA AND CO. yKETOCONAZOLE CRE 2% 00168009930 E FOUGERA AND CO. yKETOCONAZOLE CRE 2% 00168009960 E FOUGERA AND CO. yBACITR ZINC OIN 500/GM 00168011109 E FOUGERA AND CO. ySWIM EAR SOL OTIC 00168012662 E FOUGERA AND CO. ySWIM EAR SOL OTIC 00168012691 E FOUGERA AND CO. yFLUOCINONIDE SOL 0.05% 00168013460 E FOUGERA AND CO. yFLUOCINONIDE GEL 0.05% 00168013515 E FOUGERA AND CO. yFLUOCINONIDE GEL 0.05% 00168013560 E FOUGERA AND CO. yFLUOCINONIDE CRE 0.05% 00168013915 E FOUGERA AND CO. yFLUOCINONIDE CRE 0.05% 00168013930 E FOUGERA AND CO. yFLUOCINONIDE CRE 0.05% 00168013960 E FOUGERA AND CO. yFLUOCINONIDE OIN 0.05% 00168014015 E FOUGERA AND CO. yFLUOCINONIDE OIN 0.05% 00168014030 E FOUGERA AND CO. yFLUOCINONIDE OIN 0.05% 00168014060 E FOUGERA AND CO. yMICONAZOLE CRE 2% 00168014231 E FOUGERA AND CO. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCORT OIN 2.5% 00168014616 E FOUGERA AND CO. yHYDROCORT OIN 2.5% 00168014630 E FOUGERA AND CO. yPURALUBE OIN OP 00168015011 E FOUGERA AND CO. yPURALUBE OIN OP 00168015038 E FOUGERA AND CO. yHYDROCORT CRE 1% 00168015408 E FOUGERA AND CO. yHYDROCORT CRE 1% 00168015431 E FOUGERA AND CO. yATROPINE SUL SOL 1% OP 00168017215 E FOUGERA AND CO. yPURALUBE SOL TEARS OP 00168017715 E FOUGERA AND CO. yHYDROCORT OIN 1% 00168018131 E FOUGERA AND CO. yCLINDAMYCIN PAD 1% 00168020101 E FOUGERA AND CO. yCLINDAMYCIN SOL 1% 00168020130 E FOUGERA AND CO. yCLINDAMYCIN SOL 1% 00168020160 E FOUGERA AND CO. yCLINDAMYCIN GEL 1% 00168020230 E FOUGERA AND CO. yCLINDAMYCIN GEL 1% 00168020260 E FOUGERA AND CO. yCLINDAMYCIN LOT 1% 00168020360 E FOUGERA AND CO. yLIDOCAINE OIN 5% 00168020437 E FOUGERA AND CO. yERYTHROMYCIN SOL 2% 00168021560 E FOUGERA AND CO. yERYTHROMYCIN GEL 2% 00168021630 E FOUGERA AND CO. yERYTHROMYCIN GEL 2% 00168021660 E FOUGERA AND CO. yPOLYSORB CRE 00168021702 E FOUGERA AND CO. yPOLYSORB CRE 00168021716 E FOUGERA AND CO. yANALGESIC OIN BALM 00168021916 E FOUGERA AND CO. yANALGESIC OIN BALM 00168021931 E FOUGERA AND CO. yNEO/POLY/DEX OIN 0.1% OP 00168022138 E FOUGERA AND CO. yDIFLORASONE CRE 0.05% 00168024215 E FOUGERA AND CO. yDIFLORASONE CRE 0.05% 00168024230 E FOUGERA AND CO. yDIFLORASONE CRE 0.05% 00168024260 E FOUGERA AND CO. yDIFLORASONE OIN 0.05% 00168024315 E FOUGERA AND CO. yDIFLORASONE OIN 0.05% 00168024330 E FOUGERA AND CO. yDIFLORASONE OIN 0.05% 00168024360 E FOUGERA AND CO. yCLOTRIM/BETA CRE DIPROP 00168025815 E FOUGERA AND CO. yCLOTRIM/BETA CRE DIPROP 00168025846 E FOUGERA AND CO. yALCLOMETASON CRE 0.05% 00168026315 E FOUGERA AND CO. yALCLOMETASON CRE 0.05% 00168026345 E FOUGERA AND CO. yALCLOMETASON CRE 0.05% 00168026360 E FOUGERA AND CO. yALCLOMETASON OIN 0.05% 00168026415 E FOUGERA AND CO. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALCLOMETASON OIN 0.05% 00168026445 E FOUGERA AND CO. yALCLOMETASON OIN 0.05% 00168026460 E FOUGERA AND CO. yAUG BETAMET CRE 0.05% 00168026515 E FOUGERA AND CO. yAUG BETAMET CRE 0.05% 00168026550 E FOUGERA AND CO. yBETA DIPROP GEL 0.05% 00168026615 E FOUGERA AND CO. yBETA DIPROP GEL 0.05% 00168026650 E FOUGERA AND CO. yAUG BETAMET OIN 0.05% 00168026815 E FOUGERA AND CO. yAUG BETAMET OIN 0.05% 00168026850 E FOUGERA AND CO. yCLOBETASOL SOL 0.05% 00168026950 E FOUGERA AND CO. yMOMETASONE CRE 0.1% 00168027015 E FOUGERA AND CO. yMOMETASONE CRE 0.1% 00168027046 E FOUGERA AND CO. yBACIT/POLYMY OIN OP 00168027338 E FOUGERA AND CO. yAMCINONIDE CRE 0.1% 00168027815 E FOUGERA AND CO. yAMCINONIDE CRE 0.1% 00168027830 E FOUGERA AND CO. yAMCINONIDE CRE 0.1% 00168027860 E FOUGERA AND CO. yAMCINONIDE OIN 0.1% 00168027930 E FOUGERA AND CO. yAMCINONIDE OIN 0.1% 00168027960 E FOUGERA AND CO. yAMCINONIDE LOT 0.1% 00168028060 E FOUGERA AND CO. yHYDROCORT LOT 1% 00168028704 E FOUGERA AND CO. yHYDROCRTSONE LOT 2.5% 00168028802 E FOUGERA AND CO. yCLOBETASOL GEL 0.05% 00168029315 E FOUGERA AND CO. yCLOBETASOL GEL 0.05% 00168029330 E FOUGERA AND CO. yCLOBETASOL GEL 0.05% 00168029360 E FOUGERA AND CO. yDESONIDE OIN 0.05% 00168030915 E FOUGERA AND CO. yDESONIDE OIN 0.05% 00168030960 E FOUGERA AND CO. yDESONIDE LOT 0.05% 00168031002 E FOUGERA AND CO. yDESONIDE LOT 0.05% 00168031004 E FOUGERA AND CO. yECONAZOLE CRE 1% 00168031215 E FOUGERA AND CO. yECONAZOLE CRE 1% 00168031230 E FOUGERA AND CO. yECONAZOLE CRE 1% 00168031285 E FOUGERA AND CO. yCICLOPIROX CRE 0.77% 00168031315 E FOUGERA AND CO. yCICLOPIROX CRE 0.77% 00168031330 E FOUGERA AND CO. yCICLOPIROX CRE 0.77% 00168031390 E FOUGERA AND CO. yCICLOPIROX SUS 0.77% 00168031430 E FOUGERA AND CO. yCICLOPIROX SUS 0.77% 00168031460 E FOUGERA AND CO. yMETRONIDAZOL CRE 0.75% 00168032346 E FOUGERA AND CO. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NITROBID OIN 2% 00168032608 E FOUGERA AND CO. yNITROBID OIN 2% 00168032630 E FOUGERA AND CO. yNITROBID OIN 2% 00168032660 E FOUGERA AND CO. yFLUTICASONE CRE 0.05% 00168033215 E FOUGERA AND CO. yFLUTICASONE CRE 0.05% 00168033230 E FOUGERA AND CO. yFLUTICASONE CRE 0.05% 00168033260 E FOUGERA AND CO. yFLUTICASONE OIN 0.005% 00168033315 E FOUGERA AND CO. yFLUTICASONE OIN 0.005% 00168033330 E FOUGERA AND CO. yFLUTICASONE OIN 0.005% 00168033360 E FOUGERA AND CO. yTRIAMCINOLON LOT 0.025% 00168033660 E FOUGERA AND CO. yTRIAMCINOLON LOT 0.1% 00168033760 E FOUGERA AND CO. yMUPIROCIN OIN 2% 00168035209 E FOUGERA AND CO. yMUPIROCIN OIN 2% 00168035222 E FOUGERA AND CO. yHALOBETASOL CRE 0.05% 00168035515 E FOUGERA AND CO. yHALOBETASOL CRE 0.05% 00168035550 E FOUGERA AND CO. yHALOBETASOL OIN 0.05% 00168035615 E FOUGERA AND CO. yHALOBETASOL OIN 0.05% 00168035650 E FOUGERA AND CO. yLIDOC/PRILOC CRE 2.5-2.5% 00168035730 E FOUGERA AND CO. yLIDOC/PRILOC CRE 2.5-2.5% 00168035755 E FOUGERA AND CO. yLIDOC/PRILOC CRE 2.5-2.5% 00168035756 E FOUGERA AND CO. yCLOTRIM/BETA LOT DIPROP 00168037030 E FOUGERA AND CO. yPREDNICARBAT CRE 0.1% 00168038115 E FOUGERA AND CO. yPREDNICARBAT CRE 0.1% 00168038160 E FOUGERA AND CO. ySULFACETAMID SUS 10% 00168038204 E FOUGERA AND CO. yTRIMOX CAP 250MG 00003010151 E.R. SQUIBB & SONS, INC. yTRIMOX CAP 500MG 00003010951 E.R. SQUIBB & SONS, INC. yTRIMOX CAP 500MG 00003010970 E.R. SQUIBB & SONS, INC. yVELOSEF CAP 250MG 00003011350 E.R. SQUIBB & SONS, INC. yVELOSEF CAP 500MG 00003011450 E.R. SQUIBB & SONS, INC. yHALOG OIN 0.1% 00003024815 E.R. SQUIBB & SONS, INC. yHALOG OIN 0.1% 00003024820 E.R. SQUIBB & SONS, INC. yHALOG OIN 0.1% 00003024830 E.R. SQUIBB & SONS, INC. yHALOG SOL 0.1% 00003024915 E.R. SQUIBB & SONS, INC. yHALOG SOL 0.1% 00003024920 E.R. SQUIBB & SONS, INC. yKENALOG-40 INJ 40MG/ML 00003029305 E.R. SQUIBB & SONS, INC. yKENALOG-40 INJ 40MG/ML 00003029320 E.R. SQUIBB & SONS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KENALOG-40 INJ 40MG/ML 00003029328 E.R. SQUIBB & SONS, INC. yCAPOZIDE TAB 25/15MG 00003033850 E.R. SQUIBB & SONS, INC. yCAPOZIDE TAB 25/25MG 00003034950 E.R. SQUIBB & SONS, INC. yCAPOZIDE TAB 50/15MG 00003038450 E.R. SQUIBB & SONS, INC. yCAPOZIDE TAB 50/25MG 00003039050 E.R. SQUIBB & SONS, INC. yFUNGIZONE INJ 50MG 00003043730 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 12.5MG 00003045051 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 12.5MG 00003045054 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 12.5MG 00003045075 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 25MG 00003045250 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 25MG 00003045251 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 25MG 00003045275 E.R. SQUIBB & SONS, INC. yMYCOLOG II OIN 00003046650 E.R. SQUIBB & SONS, INC. yLOXAPINE CAP 25MG 00003047902 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 50MG 00003048250 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 50MG 00003048251 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 50MG 00003048275 E.R. SQUIBB & SONS, INC. yCAPOTEN TAB 100MG 00003048550 E.R. SQUIBB & SONS, INC. yKENALOG-10 INJ 10MG/ML 00003049420 E.R. SQUIBB & SONS, INC. yKENALOG AER SPRAY 00003050162 E.R. SQUIBB & SONS, INC. ySPRYCEL TAB 70MG 00003052411 E.R. SQUIBB & SONS, INC. ySPRYCEL TAB 20MG 00003052711 E.R. SQUIBB & SONS, INC. ySPRYCEL TAB 50MG 00003052811 E.R. SQUIBB & SONS, INC. yNIACIN TAB 500MG 00003053750 E.R. SQUIBB & SONS, INC. yPROLIXIN-DEC INJ 25MG/ML 00003056902 E.R. SQUIBB & SONS, INC. yMYCOSTATIN CRE 100000 00003057931 E.R. SQUIBB & SONS, INC. yMYCOSTATIN POW 100000 00003059320 E.R. SQUIBB & SONS, INC. yPENICILLN GK INJ 1MU 00003063460 E.R. SQUIBB & SONS, INC. yNYDRAZID TAB 100MG 00003063750 E.R. SQUIBB & SONS, INC. yNYDRAZID TAB 100MG 00003063780 E.R. SQUIBB & SONS, INC. ySUMYCIN TAB 250MG 00003066345 E.R. SQUIBB & SONS, INC. ySUMYCIN TAB 250MG 00003066375 E.R. SQUIBB & SONS, INC. yTESLAC TAB 50MG 00003069050 E.R. SQUIBB & SONS, INC. ySUCOSTRIN INJ 20MG/ML 00003071960 E.R. SQUIBB & SONS, INC. yPRONESTYL CAP 250MG 00003075853 E.R. SQUIBB & SONS, INC. yPRONESTYL CAP 250MG 00003075880 E.R. SQUIBB & SONS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SUMYCIN SYP 125/5ML 00003081550 E.R. SQUIBB & SONS, INC. yHYDREA CAP 500MG 00003083050 E.R. SQUIBB & SONS, INC. yTERFONYL SUS 500/5ML 00003088850 E.R. SQUIBB & SONS, INC. yHALOG CRE 0.1% 00003148215 E.R. SQUIBB & SONS, INC. yHALOG CRE 0.1% 00003148220 E.R. SQUIBB & SONS, INC. yHALOG CRE 0.1% 00003148230 E.R. SQUIBB & SONS, INC. yHALOG-E CRE 0.1% 00003149421 E.R. SQUIBB & SONS, INC. yHALOG-E CRE 0.1% 00003149431 E.R. SQUIBB & SONS, INC. yBARACLUDE TAB 0.5MG 00003161112 E.R. SQUIBB & SONS, INC. yBARACLUDE TAB 0.5MG 00003161113 E.R. SQUIBB & SONS, INC. yBARACLUDE TAB 1MG 00003161212 E.R. SQUIBB & SONS, INC. yBARACLUDE SOL .05MG/ML 00003161412 E.R. SQUIBB & SONS, INC. yTRIMOX SUS 125/5ML 00003173730 E.R. SQUIBB & SONS, INC. yTRIMOX SUS 125/5ML 00003173740 E.R. SQUIBB & SONS, INC. yTRIMOX SUS 125/5ML 00003173745 E.R. SQUIBB & SONS, INC. yTRIMOX DRO 50MG/ML 00003173815 E.R. SQUIBB & SONS, INC. yTRIMOX SUS 250/5ML 00003173830 E.R. SQUIBB & SONS, INC. yTRIMOX SUS 250/5ML 00003173840 E.R. SQUIBB & SONS, INC. yTRIMOX SUS 250/5ML 00003173845 E.R. SQUIBB & SONS, INC. yZERIT CAP 15MG 00003196401 E.R. SQUIBB & SONS, INC. yZERIT CAP 20MG 00003196501 E.R. SQUIBB & SONS, INC. yZERIT CAP 30MG 00003196601 E.R. SQUIBB & SONS, INC. yZERIT CAP 40MG 00003196701 E.R. SQUIBB & SONS, INC. yZERIT SOL 1MG/ML 00003196801 E.R. SQUIBB & SONS, INC. yORENCIA INJ 250MG 00003218710 E.R. SQUIBB & SONS, INC. yAMPICILLIN INJ 10GM 00003292120 E.R. SQUIBB & SONS, INC. ySENSI-CARE CRE MOISTURI 00003324403 E.R. SQUIBB & SONS, INC. yALOE VESTA LOT SKN COND 00003324802 E.R. SQUIBB & SONS, INC. yALOE VESTA LOT SKN COND 00003324804 E.R. SQUIBB & SONS, INC. yALOE VESTA LOT SKN COND 00003324809 E.R. SQUIBB & SONS, INC. yALOE VESTA LOT SKN COND 00003324811 E.R. SQUIBB & SONS, INC. yALOE VESTA OIN PROTECTV 00003324908 E.R. SQUIBB & SONS, INC. yALOE VESTA OIN PROTECTV 00003324913 E.R. SQUIBB & SONS, INC. yALOE VESTA OIN ANTIFUNG 00003325102 E.R. SQUIBB & SONS, INC. yALOE VESTA OIN ANTIFUNG 00003325105 E.R. SQUIBB & SONS, INC. ySENSI-CARE OIN 00003325614 E.R. SQUIBB & SONS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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REYATAZ CAP 100MG 00003362312 E.R. SQUIBB & SONS, INC. yREYATAZ CAP 150MG 00003362412 E.R. SQUIBB & SONS, INC. yREYATAZ CAP 200MG 00003363112 E.R. SQUIBB & SONS, INC. yALOE VESTA AER SKIN PRO 00003413401 E.R. SQUIBB & SONS, INC. yPRAVACHOL TAB 10MG 00003515405 E.R. SQUIBB & SONS, INC. yPRAVACHOL TAB 20MG 00003517805 E.R. SQUIBB & SONS, INC. yPRAVACHOL TAB 20MG 00003517875 E.R. SQUIBB & SONS, INC. yPRAVACHOL TAB 40MG 00003519410 E.R. SQUIBB & SONS, INC. yPRAVACHOL TAB 80MG 00003519510 E.R. SQUIBB & SONS, INC. yDROXIA CAP 200MG 00003633517 E.R. SQUIBB & SONS, INC. yDROXIA CAP 300MG 00003633617 E.R. SQUIBB & SONS, INC. yDROXIA CAP 400MG 00003633717 E.R. SQUIBB & SONS, INC. yLODRANE 12HR TAB 00095000601 ECR PHARMACEUTICALS yLODRANE XR SUS 00095000816 ECR PHARMACEUTICALS yPNEUMOTUSSIN TAB 2.5-300 00095006601 ECR PHARMACEUTICALS yPNEUMOTUSSIN SYP 2.5/200M 00095006716 ECR PHARMACEUTICALS yDEXPAK JR PAK 10 DAY 00095008635 ECR PHARMACEUTICALS yDEXPAK PAK 13 DAY 00095008651 ECR PHARMACEUTICALS yPANALGESIC LIQ GOLD 00095012002 ECR PHARMACEUTICALS yPANALGESIC LIQ GOLD 00095012004 ECR PHARMACEUTICALS yANAPLEX HD SOL 30-2-1.7 00095013004 ECR PHARMACEUTICALS yANAPLEX HD SOL 30-2-1.7 00095013016 ECR PHARMACEUTICALS yANAPLEX DM SYP 00095013116 ECR PHARMACEUTICALS yANAPLEX DMX SUS 00095013216 ECR PHARMACEUTICALS yNASATAB LA TAB 00095022501 ECR PHARMACEUTICALS yBUPAP TAB 650-50MG 00095024001 ECR PHARMACEUTICALS yBUPAP TAB 650-50MG 00095024005 ECR PHARMACEUTICALS yLODRANE 12D TAB 6-45MG 00095064501 ECR PHARMACEUTICALS yLODRANE 24 CAP 00095120006 ECR PHARMACEUTICALS yLODRANE 24D CAP 12-90MG 00095129006 ECR PHARMACEUTICALS yLODRANE D SUS 00095900816 ECR PHARMACEUTICALS yECEE PLUS TAB 00485002301 EDWARDS PHARMACEUTICALS, INC. ySENILEZOL ELX 00485003801 EDWARDS PHARMACEUTICALS, INC. yUROGESIC-BLU TAB 00485005101 EDWARDS PHARMACEUTICALS, INC. yED-TLC SYP 5-2-1.67 00485005216 EDWARDS PHARMACEUTICALS, INC. yED-TUSS HC SYP 00485005316 EDWARDS PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ED A-HIST TAB 8-20 CR 00485005401 EDWARDS PHARMACEUTICALS, INC. yED A-HIST LIQ 4-10/5ML 00485005516 EDWARDS PHARMACEUTICALS, INC. yED-APAP LIQ 80MG/2.5 00485005708 EDWARDS PHARMACEUTICALS, INC. yED-BRON G SYP 00485005916 EDWARDS PHARMACEUTICALS, INC. yED CYTE F TAB 00485006501 EDWARDS PHARMACEUTICALS, INC. yED-FLEX CAP 00485006601 EDWARDS PHARMACEUTICALS, INC. yED-A-HIST DM LIQ 00485007116 EDWARDS PHARMACEUTICALS, INC. yED-CHLOR-TAN TAB 8MG 00485007201 EDWARDS PHARMACEUTICALS, INC. yED CHLORPED SUS 2MG/ML 00485007402 EDWARDS PHARMACEUTICALS, INC. yED CHLORPED SUS D 00485007602 EDWARDS PHARMACEUTICALS, INC. yACIPHEX TAB 20MG 62856024330 EISAI INC. yACIPHEX TAB 20MG 62856024341 EISAI INC. yACIPHEX TAB 20MG 62856024390 EISAI INC. yARICEPT TAB 5MG 62856024530 EISAI INC. yARICEPT TAB 5MG 62856024541 EISAI INC. yARICEPT TAB 5MG 62856024590 EISAI INC. yARICEPT TAB 10MG 62856024630 EISAI INC. yARICEPT TAB 10MG 62856024641 EISAI INC. yARICEPT TAB 10MG 62856024690 EISAI INC. yZONEGRAN CAP 100MG 62856068010 EISAI INC. yZONEGRAN CAP 25MG 62856068110 EISAI INC. yARICEPT ODT TAB 5MG 62856083130 EISAI INC. yARICEPT ODT TAB 10MG 62856083230 EISAI INC. yZANAFLEX TAB 4MG 59075059415 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yMYOBLOC INJ 2500/0.5 59075071010 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yMYOBLOC INJ 10000/2 59075071210 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yPRIALT INJ 100MCG 59075072010 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yPRIALT INJ 500MCG 59075072210 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yPRIALT INJ 25MCG/ML 59075072310 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yTYSABRI INJ 59075073015 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yFROVA TAB 2.5MG 59075074089 ELAN PHARMACEUTICALS, INC./ATHENA NEURO yNAPRELAN TAB 500MG CR 00086009175 ELAN PHARMACEUTICALS, INC./CARNRICK LAB ySEROMYCIN CAP 250MG 00002060440 ELI LILLY AND COMPANY yQUINIDINE GL INJ 80MG/ML 00002140701 ELI LILLY AND COMPANY yCAPASTAT SUL INJ 1GM 00002148501 ELI LILLY AND COMPANY yGELATIN EMPT CAP SIZE 2 00002240902 ELI LILLY AND COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GELATIN EMPT CAP SIZE 4 00002241102 ELI LILLY AND COMPANY yGELATIN EMPT CAP SIZE 00 00002241302 ELI LILLY AND COMPANY yPROZAC WEEKL CAP 90MG 00002300475 ELI LILLY AND COMPANY yVANCOCIN HCL CAP 250MG 00002312642 ELI LILLY AND COMPANY ySTRATTERA CAP 10MG 00002322730 ELI LILLY AND COMPANY ySTRATTERA CAP 25MG 00002322830 ELI LILLY AND COMPANY ySTRATTERA CAP 40MG 00002322930 ELI LILLY AND COMPANY ySYMBYAX CAP 6-25MG 00002323130 ELI LILLY AND COMPANY ySYMBYAX CAP 6-25MG 00002323133 ELI LILLY AND COMPANY ySYMBYAX CAP 12-25MG 00002323230 ELI LILLY AND COMPANY ySYMBYAX CAP 12-25MG 00002323233 ELI LILLY AND COMPANY ySYMBYAX CAP 6-50MG 00002323330 ELI LILLY AND COMPANY ySYMBYAX CAP 6-50MG 00002323333 ELI LILLY AND COMPANY ySYMBYAX CAP 12-50MG 00002323430 ELI LILLY AND COMPANY ySYMBYAX CAP 12-50MG 00002323433 ELI LILLY AND COMPANY yCYMBALTA CAP 20MG 00002323560 ELI LILLY AND COMPANY yCYMBALTA CAP 60MG 00002323704 ELI LILLY AND COMPANY yCYMBALTA CAP 60MG 00002323730 ELI LILLY AND COMPANY yCYMBALTA CAP 60MG 00002323733 ELI LILLY AND COMPANY ySTRATTERA CAP 18MG 00002323830 ELI LILLY AND COMPANY ySTRATTERA CAP 60MG 00002323930 ELI LILLY AND COMPANY yCYMBALTA CAP 30MG 00002324030 ELI LILLY AND COMPANY yCYMBALTA CAP 30MG 00002324033 ELI LILLY AND COMPANY ySTRATTERA CAP 80MG 00002325030 ELI LILLY AND COMPANY ySTRATTERA CAP 100MG 00002325130 ELI LILLY AND COMPANY yZYPREXA TAB 2.5MG 00002411204 ELI LILLY AND COMPANY yZYPREXA TAB 2.5MG 00002411230 ELI LILLY AND COMPANY yZYPREXA TAB 2.5MG 00002411233 ELI LILLY AND COMPANY yZYPREXA TAB 2.5MG 00002411260 ELI LILLY AND COMPANY yZYPREXA TAB 5MG 00002411504 ELI LILLY AND COMPANY yZYPREXA TAB 5MG 00002411530 ELI LILLY AND COMPANY yZYPREXA TAB 5MG 00002411533 ELI LILLY AND COMPANY yZYPREXA TAB 5MG 00002411560 ELI LILLY AND COMPANY yZYPREXA TAB 7.5MG 00002411604 ELI LILLY AND COMPANY yZYPREXA TAB 7.5MG 00002411630 ELI LILLY AND COMPANY yZYPREXA TAB 7.5MG 00002411633 ELI LILLY AND COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZYPREXA TAB 7.5MG 00002411660 ELI LILLY AND COMPANY yZYPREXA TAB 10MG 00002411704 ELI LILLY AND COMPANY yZYPREXA TAB 10MG 00002411730 ELI LILLY AND COMPANY yZYPREXA TAB 10MG 00002411733 ELI LILLY AND COMPANY yZYPREXA TAB 10MG 00002411760 ELI LILLY AND COMPANY yEVISTA TAB 60MG 00002416502 ELI LILLY AND COMPANY yEVISTA TAB 60MG 00002416507 ELI LILLY AND COMPANY yEVISTA TAB 60MG 00002416530 ELI LILLY AND COMPANY yZYPREXA TAB 15MG 00002441504 ELI LILLY AND COMPANY yZYPREXA TAB 15MG 00002441530 ELI LILLY AND COMPANY yZYPREXA TAB 15MG 00002441533 ELI LILLY AND COMPANY yZYPREXA TAB 15MG 00002441560 ELI LILLY AND COMPANY yZYPREXA TAB 20MG 00002442004 ELI LILLY AND COMPANY yZYPREXA TAB 20MG 00002442030 ELI LILLY AND COMPANY yZYPREXA TAB 20MG 00002442033 ELI LILLY AND COMPANY yZYPREXA TAB 20MG 00002442060 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 5MG 00002445301 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 5MG 00002445385 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 10MG 00002445401 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 10MG 00002445485 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 15MG 00002445501 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 15MG 00002445585 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 20MG 00002445601 ELI LILLY AND COMPANY yZYPREXA ZYDI TAB 20MG 00002445685 ELI LILLY AND COMPANY yCIALIS TAB 5MG 00002446230 ELI LILLY AND COMPANY yCIALIS TAB 10MG 00002446330 ELI LILLY AND COMPANY yCIALIS TAB 20MG 00002446430 ELI LILLY AND COMPANY yREOPRO INJ 2MG/ML 00002714001 ELI LILLY AND COMPANY yHUMATROPE INJ 5MG 00002733501 ELI LILLY AND COMPANY yHUMATROPE INJ 5MG 00002733511 ELI LILLY AND COMPANY yHUMATROPE INJ 5MG 00002733516 ELI LILLY AND COMPANY yGEMZAR INJ 200MG 00002750101 ELI LILLY AND COMPANY yGEMZAR INJ 1 GM 00002750201 ELI LILLY AND COMPANY yHUMALOG INJ 100/ML 00002751001 ELI LILLY AND COMPANY yHUMALOG MIX SUS 75/25 00002751101 ELI LILLY AND COMPANY yHUMALOG MIX INJ 50/50 00002751201 ELI LILLY AND COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HUMALOG INJ 100/ML 00002751659 ELI LILLY AND COMPANY yXIGRIS INJ 5MG 00002755901 ELI LILLY AND COMPANY yXIGRIS INJ 20MG 00002756101 ELI LILLY AND COMPANY yZYPREXA INJ 10MG 00002759701 ELI LILLY AND COMPANY yALIMTA INJ 500MG 00002762301 ELI LILLY AND COMPANY yGLUCAGON KIT 1MG 00002803101 ELI LILLY AND COMPANY yHUMATROPE INJ 6MG 00002808901 ELI LILLY AND COMPANY yHUMATROPE INJ 12MG 00002809001 ELI LILLY AND COMPANY yHUMATROPE INJ 6MG 00002814701 ELI LILLY AND COMPANY yHUMATROPE INJ 12MG 00002814801 ELI LILLY AND COMPANY yHUMATROPE INJ 24MG 00002814901 ELI LILLY AND COMPANY yHUMULIN R INJ U-100 00002821501 ELI LILLY AND COMPANY yHUMULIN N INJ U-100 00002831501 ELI LILLY AND COMPANY yHUMULIN R INJ U-500 00002850101 ELI LILLY AND COMPANY yHUMULIN U INJ U-100 00002861501 ELI LILLY AND COMPANY yHUMULIN INJ 70/30 00002871501 ELI LILLY AND COMPANY yHUMALOG PEN INJ 100/ML 00002872501 ELI LILLY AND COMPANY yHUMALOG PEN INJ 100/ML 00002872559 ELI LILLY AND COMPANY yHUMULIN N PN INJ U-100 00002873001 ELI LILLY AND COMPANY yHUMULIN N PN INJ U-100 00002873059 ELI LILLY AND COMPANY yHUMULIN PEN INJ 70/30 00002877001 ELI LILLY AND COMPANY yHUMULIN PEN INJ 70/30 00002877059 ELI LILLY AND COMPANY yHUMALOG PEN INJ 50/50 00002879359 ELI LILLY AND COMPANY yHUMALOG PEN INJ 75/25 00002879459 ELI LILLY AND COMPANY yFORTEO SOL 750/3ML 00002897101 ELI LILLY AND COMPANY yHUMULIN INJ 50/50 00002951501 ELI LILLY AND COMPANY yDYFLEX-G TAB 200-200 38130001201 EMREX/ECONOMED PHARMACEUTICALS, INC. yENDOCET TAB 5-325MG 60951060270 ENDO PHARMACEUTICALS INC. yENDOCET TAB 5-325MG 60951060285 ENDO PHARMACEUTICALS INC. yCARB/LEVO TAB 10-100MG 60951060368 ENDO PHARMACEUTICALS INC. yCARB/LEVO TAB 25-100MG 60951060568 ENDO PHARMACEUTICALS INC. yCARB/LEVO TAB 25-100MG 60951060585 ENDO PHARMACEUTICALS INC. yCARB/LEVO TAB 25-250MG 60951060768 ENDO PHARMACEUTICALS INC. yCARB/LEVO TAB 25-250MG 60951060785 ENDO PHARMACEUTICALS INC. yMORPHINE SUL TAB 15MG ER 60951065270 ENDO PHARMACEUTICALS INC. yMORPHINE SUL TAB 30MG ER 60951065370 ENDO PHARMACEUTICALS INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MORPHINE SUL TAB 60MG ER 60951065570 ENDO PHARMACEUTICALS INC. yMORPHINE SUL TAB 100MG ER 60951065870 ENDO PHARMACEUTICALS INC. yMORPHINE SUL TAB 100MG ER 60951065885 ENDO PHARMACEUTICALS INC. yMORPHINE SUL TAB 200MG ER 60951065970 ENDO PHARMACEUTICALS INC. yENDOCET TAB 7.5-325M 60951070070 ENDO PHARMACEUTICALS INC. yOXYCODONE TAB 10MG CR 60951070270 ENDO PHARMACEUTICALS INC. yOXYCODONE TAB 20MG CR 60951070370 ENDO PHARMACEUTICALS INC. yOXYCODONE TAB 40MG CR 60951070570 ENDO PHARMACEUTICALS INC. yOXYCODONE TAB 80MG CR 60951071070 ENDO PHARMACEUTICALS INC. yENDOCET TAB 10-325MG 60951071270 ENDO PHARMACEUTICALS INC. yNITROGLYCER SUB 0.4MG 60951071862 ENDO PHARMACEUTICALS INC. yNITROGLYCER SUB 0.4MG 60951071870 ENDO PHARMACEUTICALS INC. yHYDROMORPHON TAB 4MG 60951075770 ENDO PHARMACEUTICALS INC. yHYDROMORPHON TAB 4MG 60951075785 ENDO PHARMACEUTICALS INC. yENDOCET TAB 7.5-500M 60951079670 ENDO PHARMACEUTICALS INC. yENDOCET TAB 10-650MG 60951079770 ENDO PHARMACEUTICALS INC. yFROVA TAB 2.5MG 63481002509 ENDO PHARMACEUTICALS, INC. yHYCODAN TAB 5MG 63481004270 ENDO PHARMACEUTICALS, INC. yHYCODAN TAB 5MG 63481004285 ENDO PHARMACEUTICALS, INC. yMOBAN TAB 5MG 63481007270 ENDO PHARMACEUTICALS, INC. yMOBAN TAB 10MG 63481007370 ENDO PHARMACEUTICALS, INC. yMOBAN TAB 25MG 63481007470 ENDO PHARMACEUTICALS, INC. yMOBAN TAB 50MG 63481007670 ENDO PHARMACEUTICALS, INC. ySYMMETREL TAB 100MG 63481010870 ENDO PHARMACEUTICALS, INC. ySYMMETREL TAB 100MG 63481010885 ENDO PHARMACEUTICALS, INC. yDEPODUR INJ 10MG/ML 63481011021 ENDO PHARMACEUTICALS, INC. yDEPODUR INJ 15/1.5ML 63481011521 ENDO PHARMACEUTICALS, INC. yDEPODUR INJ 20MG/2ML 63481012021 ENDO PHARMACEUTICALS, INC. yPERCODAN TAB 63481013570 ENDO PHARMACEUTICALS, INC. yHYCODAN SYP 5-1.5/5 63481023416 ENDO PHARMACEUTICALS, INC. yHYCOTUSS EXP SYP 5-100/5 63481023516 ENDO PHARMACEUTICALS, INC. yNUMORPHAN INJ 1MG/ML 63481044410 ENDO PHARMACEUTICALS, INC. yOPANA TAB 5MG 63481061270 ENDO PHARMACEUTICALS, INC. yOPANA TAB 10MG 63481061370 ENDO PHARMACEUTICALS, INC. yOPANA ER TAB 20MG 63481061770 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 7.5-500 63481062170 ENDO PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PERCOCET TAB 10-650MG 63481062270 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 5-325MG 63481062370 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 5-325MG 63481062375 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 5-325MG 63481062385 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 2.5-325 63481062770 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 2.5-325 63481062775 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 7.5-325M 63481062870 ENDO PHARMACEUTICALS, INC. yPERCOCET TAB 10-325MG 63481062970 ENDO PHARMACEUTICALS, INC. yZYDONE TAB 5-400MG 63481066870 ENDO PHARMACEUTICALS, INC. yZYDONE TAB 7.5-400 63481066970 ENDO PHARMACEUTICALS, INC. yOPANA ER TAB 10MG 63481067470 ENDO PHARMACEUTICALS, INC. yLIDODERM DIS 5% 63481068706 ENDO PHARMACEUTICALS, INC. yOPANA ER TAB 40MG 63481069370 ENDO PHARMACEUTICALS, INC. yZYDONE TAB 10-400MG 63481069870 ENDO PHARMACEUTICALS, INC. yOPANA ER TAB 5MG 63481090770 ENDO PHARMACEUTICALS, INC. yADAGEN INJ 250/ML 57665000101 ENZON PHARMACEUTICALS, INC. yONCASPAR INJ 750/ML 57665000202 ENZON PHARMACEUTICALS, INC. yABELCET INJ 5MG/ML 57665010141 ENZON PHARMACEUTICALS, INC. yLABETALOL TAB 100MG 00185001001 EON LABS, INC. yLABETALOL TAB 100MG 00185001005 EON LABS, INC. yFLUVOXAMINE TAB 25MG 00185001701 EON LABS, INC. yDESIPRAMINE TAB 25MG 00185001901 EON LABS, INC. yDESIPRAMINE TAB 25MG 00185001905 EON LABS, INC. yDESIPRAMINE TAB 25MG 00185001910 EON LABS, INC. yMIRTAZAPINE TAB 15MG 00185002010 EON LABS, INC. yMIRTAZAPINE TAB 15MG 00185002030 EON LABS, INC. yORPHENADRINE TAB 100MG ER 00185002201 EON LABS, INC. yORPHENADRINE TAB 100MG ER 00185002210 EON LABS, INC. yDIPHEN/ATROP TAB 2.5MG 00185002401 EON LABS, INC. yDIPHEN/ATROP TAB 2.5MG 00185002405 EON LABS, INC. yDIPHEN/ATROP TAB 2.5MG 00185002410 EON LABS, INC. yLISINOPRIL TAB 2.5MG 00185002501 EON LABS, INC. yLISINOPRIL TAB 2.5MG 00185002510 EON LABS, INC. yFLUVOXAMINE TAB 50MG 00185002701 EON LABS, INC. yFLUVOXAMINE TAB 50MG 00185002705 EON LABS, INC. yDESIPRAMINE TAB 10MG 00185002901 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DESIPRAMINE TAB 10MG 00185002910 EON LABS, INC. yRESERPINE TAB 0.1MG 00185003201 EON LABS, INC. yRESERPINE TAB 0.1MG 00185003210 EON LABS, INC. yTIZANIDINE TAB 2MG 00185003410 EON LABS, INC. yTIZANIDINE TAB 2MG 00185003451 EON LABS, INC. yNALTREXONE TAB 50MG 00185003901 EON LABS, INC. yNALTREXONE TAB 50MG 00185003930 EON LABS, INC. yMIDODRINE TAB 2.5MG 00185004001 EON LABS, INC. yFOSINOPRIL TAB 10MG 00185004109 EON LABS, INC. yFOSINOPRIL TAB 10MG 00185004110 EON LABS, INC. yFOSINOPRIL TAB 20MG 00185004209 EON LABS, INC. yFOSINOPRIL TAB 20MG 00185004210 EON LABS, INC. yMIDODRINE TAB 5MG 00185004301 EON LABS, INC. yMIDODRINE TAB 5MG 00185004305 EON LABS, INC. yBENAZEPRIL TAB 40MG 00185004801 EON LABS, INC. yBENAZEPRIL TAB 40MG 00185004805 EON LABS, INC. yBENAZEPRIL TAB 10MG 00185005301 EON LABS, INC. yBENAZEPRIL TAB 10MG 00185005305 EON LABS, INC. yMETOLAZONE TAB 5MG 00185005501 EON LABS, INC. yMETOLAZONE TAB 5MG 00185005510 EON LABS, INC. yCLONAZEPAM TAB 0.5MG 00185006301 EON LABS, INC. yCLONAZEPAM TAB 0.5MG 00185006305 EON LABS, INC. yCLONAZEPAM TAB 0.5MG 00185006310 EON LABS, INC. yCLONAZEPAM TAB 1MG 00185006401 EON LABS, INC. yCLONAZEPAM TAB 1MG 00185006405 EON LABS, INC. yCLONAZEPAM TAB 1MG 00185006410 EON LABS, INC. yCLONAZEPAM TAB 2MG 00185006501 EON LABS, INC. yCLONAZEPAM TAB 2MG 00185006505 EON LABS, INC. yCLONAZEPAM TAB 2MG 00185006510 EON LABS, INC. yLOVASTATIN TAB 10MG 00185007001 EON LABS, INC. yLOVASTATIN TAB 10MG 00185007005 EON LABS, INC. yLOVASTATIN TAB 10MG 00185007010 EON LABS, INC. yLOVASTATIN TAB 10MG 00185007060 EON LABS, INC. yLOVASTATIN TAB 20MG 00185007201 EON LABS, INC. yLOVASTATIN TAB 20MG 00185007210 EON LABS, INC. yLOVASTATIN TAB 20MG 00185007260 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LOVASTATIN TAB 40MG 00185007401 EON LABS, INC. yLOVASTATIN TAB 40MG 00185007410 EON LABS, INC. yLOVASTATIN TAB 40MG 00185007460 EON LABS, INC. yFLUOXETINE CAP 10MG 00185008001 EON LABS, INC. yFLUOXETINE CAP 10MG 00185008010 EON LABS, INC. yAMPHETAMINE TAB 5MG 00185008401 EON LABS, INC. yFLUOXETINE CAP 20MG 00185008501 EON LABS, INC. yFLUOXETINE CAP 20MG 00185008510 EON LABS, INC. yGABAPENTIN CAP 100MG 00185009101 EON LABS, INC. yGABAPENTIN CAP 100MG 00185009105 EON LABS, INC. yGABAPENTIN CAP 100MG 00185009110 EON LABS, INC. yGABAPENTIN CAP 300MG 00185009301 EON LABS, INC. yGABAPENTIN CAP 300MG 00185009305 EON LABS, INC. yGABAPENTIN CAP 300MG 00185009310 EON LABS, INC. yGABAPENTIN CAP 400MG 00185009401 EON LABS, INC. yGABAPENTIN CAP 400MG 00185009405 EON LABS, INC. yGABAPENTIN CAP 400MG 00185009410 EON LABS, INC. yLISINOPRIL TAB 10MG 00185010101 EON LABS, INC. yLISINOPRIL TAB 10MG 00185010110 EON LABS, INC. yLISINOPRIL TAB 10MG 00185010133 EON LABS, INC. yLISINOPRIL TAB 20MG 00185010201 EON LABS, INC. yLISINOPRIL TAB 20MG 00185010210 EON LABS, INC. yLISINOPRIL TAB 20MG 00185010233 EON LABS, INC. yLISINOPRIL TAB 30MG 00185010301 EON LABS, INC. yLISINOPRIL TAB 30MG 00185010310 EON LABS, INC. yLISINOPRIL TAB 40MG 00185010401 EON LABS, INC. yLISINOPRIL TAB 40MG 00185010410 EON LABS, INC. yGABAPENTIN TAB 600MG 00185010701 EON LABS, INC. yAMPHETAMINE TAB 10MG 00185011101 EON LABS, INC. ySMZ-TMP TAB 400-80MG 00185011105 EON LABS, INC. ySMZ/TMP DS TAB 800-160 00185011201 EON LABS, INC. ySMZ/TMP DS TAB 800-160 00185011205 EON LABS, INC. yGABAPENTIN TAB 800MG 00185011301 EON LABS, INC. yENALAPRIL TAB 2.5MG 00185011401 EON LABS, INC. yENALAPRIL TAB 2.5MG 00185011410 EON LABS, INC. yENALAPRIL TAB 2.5MG 00185011450 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TICLOPIDINE TAB 250MG 00185011505 EON LABS, INC. yTICLOPIDINE TAB 250MG 00185011530 EON LABS, INC. yTICLOPIDINE TAB 250MG 00185011560 EON LABS, INC. yLABETALOL TAB 200MG 00185011701 EON LABS, INC. yLABETALOL TAB 200MG 00185011705 EON LABS, INC. yLABETALOL TAB 300MG 00185011801 EON LABS, INC. yLABETALOL TAB 300MG 00185011805 EON LABS, INC. yNITROFURANTN CAP 100MG 00185012201 EON LABS, INC. yNITROFURANTN CAP 100MG 00185012210 EON LABS, INC. yCILOSTAZOL TAB 50MG 00185012360 EON LABS, INC. yBENAZEP/HCTZ TAB 5-6.25 00185012401 EON LABS, INC. yBUMETANIDE TAB 0.5MG 00185012801 EON LABS, INC. yBUMETANIDE TAB 0.5MG 00185012805 EON LABS, INC. yBUMETANIDE TAB 1MG 00185012901 EON LABS, INC. yBUMETANIDE TAB 1MG 00185012905 EON LABS, INC. yBUMETANIDE TAB 2MG 00185013001 EON LABS, INC. yBUMETANIDE TAB 2MG 00185013005 EON LABS, INC. yRESERPINE TAB 0.25MG 00185013401 EON LABS, INC. yRESERPINE TAB 0.25MG 00185013410 EON LABS, INC. yETODOLAC TAB 500MG 00185013901 EON LABS, INC. yETODOLAC TAB 500MG 00185013905 EON LABS, INC. yETODOLAC TAB 500MG 00185013910 EON LABS, INC. yETODOLAC TAB 400MG 00185014001 EON LABS, INC. yETODOLAC TAB 400MG 00185014005 EON LABS, INC. yETODOLAC TAB 400MG 00185014010 EON LABS, INC. yOXAPROZIN TAB 600MG 00185014101 EON LABS, INC. yOXAPROZIN TAB 600MG 00185014105 EON LABS, INC. yNABUMETONE TAB 500MG 00185014501 EON LABS, INC. yNABUMETONE TAB 500MG 00185014505 EON LABS, INC. yNABUMETONE TAB 750MG 00185014601 EON LABS, INC. yNABUMETONE TAB 750MG 00185014605 EON LABS, INC. yENALAPRIL TAB 10MG 00185014701 EON LABS, INC. yENALAPRIL TAB 10MG 00185014710 EON LABS, INC. yENALAPRIL TAB 10MG 00185014750 EON LABS, INC. yMIDODRINE TAB 10MG 00185014901 EON LABS, INC. yNIZATIDINE CAP 150MG 00185015005 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NIZATIDINE CAP 150MG 00185015060 EON LABS, INC. yENALAPR/HCTZ TAB 5-12.5MG 00185015101 EON LABS, INC. yLISINOP/HCTZ TAB 20-12.5 00185015201 EON LABS, INC. yLISINOP/HCTZ TAB 20-12.5 00185015210 EON LABS, INC. yANAGRELIDE CAP 0.5MG 00185015501 EON LABS, INC. yANAGRELIDE CAP 1MG 00185015601 EON LABS, INC. yFLUVOXAMINE TAB 100MG 00185015701 EON LABS, INC. yFLUVOXAMINE TAB 100MG 00185015705 EON LABS, INC. ySOTALOL HCL TAB 120MG 00185017001 EON LABS, INC. ySOTALOL HCL TAB 80MG 00185017101 EON LABS, INC. ySOTALOL HCL TAB 80MG 00185017105 EON LABS, INC. yENALAPR/HCTZ TAB 10-25MG 00185017201 EON LABS, INC. yENALAPR/HCTZ TAB 10-25MG 00185017210 EON LABS, INC. yLISINOP/HCTZ TAB 20-25MG 00185017301 EON LABS, INC. yLISINOP/HCTZ TAB 20-25MG 00185017310 EON LABS, INC. ySOTALOL HCL TAB 240MG 00185017401 EON LABS, INC. ySOTALOL HCL TAB 160MG 00185017701 EON LABS, INC. yZONISAMIDE CAP 25MG 00185019301 EON LABS, INC. yALPRAZOLAM TAB 0.5MG ER 00185019560 EON LABS, INC. yALPRAZOLAM TAB 1MG ER 00185019660 EON LABS, INC. yALPRAZOLAM TAB 2MG ER 00185019760 EON LABS, INC. yALPRAZOLAM TAB 3MG ER 00185019860 EON LABS, INC. yZONISAMIDE CAP 50MG 00185019901 EON LABS, INC. yZONISAMIDE CAP 100MG 00185020001 EON LABS, INC. yBENAZEP/HCTZ TAB 10-12.5 00185020401 EON LABS, INC. yMETHIMAZOLE TAB 5MG 00185020501 EON LABS, INC. yMETHIMAZOLE TAB 5MG 00185020510 EON LABS, INC. yMETHIMAZOLE TAB 10MG 00185021001 EON LABS, INC. yMETHIMAZOLE TAB 10MG 00185021010 EON LABS, INC. yBENAZEP/HCTZ TAB 20-12.5 00185021101 EON LABS, INC. yMIRTAZAPINE TAB 30MG 00185021210 EON LABS, INC. yMIRTAZAPINE TAB 30MG 00185021230 EON LABS, INC. yMETFORMIN TAB 500MG 00185021301 EON LABS, INC. yMETFORMIN TAB 500MG 00185021305 EON LABS, INC. yENALAPRIL TAB 20MG 00185021401 EON LABS, INC. yENALAPRIL TAB 20MG 00185021410 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRIL TAB 20MG 00185021450 EON LABS, INC. yMETFORMIN TAB 850MG 00185021501 EON LABS, INC. yMETFORMIN TAB 850MG 00185021505 EON LABS, INC. yMETFORMIN TAB 1000MG 00185022101 EON LABS, INC. yMETFORMIN TAB 1000MG 00185022105 EON LABS, INC. yMIRTAZAPINE TAB 45MG 00185022210 EON LABS, INC. yMIRTAZAPINE TAB 45MG 00185022230 EON LABS, INC. yCILOSTAZOL TAB 100MG 00185022305 EON LABS, INC. yCILOSTAZOL TAB 100MG 00185022360 EON LABS, INC. yOXANDROLONE TAB 2.5MG 00185027101 EON LABS, INC. yOXANDROLONE TAB 10MG 00185027260 EON LABS, INC. yCLARITHROMYC TAB 500MG 00185027560 EON LABS, INC. yBENAZEP/HCTZ TAB 20-25MG 00185027701 EON LABS, INC. yMETOPROLOL TAB 25MG ER 00185028101 EON LABS, INC. yNIZATIDINE CAP 300MG 00185030001 EON LABS, INC. yNIZATIDINE CAP 300MG 00185030030 EON LABS, INC. yTRAMADOL HCL TAB 50MG 00185031101 EON LABS, INC. yTRAMADOL HCL TAB 50MG 00185031110 EON LABS, INC. yFOSINOP/HCTZ TAB 10/12.5 00185034101 EON LABS, INC. yFOSINOP/HCTZ TAB 20/12.5 00185034201 EON LABS, INC. yCITALOPRAM TAB 10MG 00185037101 EON LABS, INC. yCITALOPRAM TAB 10MG 00185037110 EON LABS, INC. yCITALOPRAM TAB 20MG 00185037201 EON LABS, INC. yCITALOPRAM TAB 20MG 00185037210 EON LABS, INC. yCITALOPRAM TAB 40MG 00185037301 EON LABS, INC. yCITALOPRAM TAB 40MG 00185037310 EON LABS, INC. yAMPHETAMINE TAB 20MG 00185040101 EON LABS, INC. yAMPHETAMINE TAB 30MG 00185040401 EON LABS, INC. yBUPROPION TAB 100MG SR 00185041001 EON LABS, INC. yBUPROPION TAB 100MG SR 00185041005 EON LABS, INC. yBUPROPION TAB 100MG SR 00185041060 EON LABS, INC. yBUPROPION TAB 150MG SR 00185041501 EON LABS, INC. yBUPROPION TAB 150MG SR 00185041505 EON LABS, INC. yBUPROPION TAB 150MG SR 00185041560 EON LABS, INC. yCIPROFLOXACN TAB 250MG 00185044201 EON LABS, INC. yCIPROFLOXACN TAB 500MG 00185045101 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIPROFLOXACN TAB 750MG 00185047053 EON LABS, INC. yBENAZEPRIL TAB 5MG 00185050501 EON LABS, INC. yBENAZEPRIL TAB 5MG 00185050505 EON LABS, INC. yITRACONAZOLE CAP 100MG 00185055030 EON LABS, INC. yITRACONAZOLE CAP 100MG 00185055083 EON LABS, INC. yHYDROXYZ PAM CAP 25MG 00185061301 EON LABS, INC. yHYDROXYZ PAM CAP 25MG 00185061305 EON LABS, INC. yHYDROXYZ PAM CAP 50MG 00185061501 EON LABS, INC. yHYDROXYZ PAM CAP 50MG 00185061505 EON LABS, INC. yPHENTERMINE CAP 15MG 00185064401 EON LABS, INC. yPHENTERMINE CAP 15MG 00185064410 EON LABS, INC. yPHENTERMINE CAP 30MG 00185064701 EON LABS, INC. yPHENTERMINE CAP 30MG 00185064710 EON LABS, INC. yDIPHENHYDRAM CAP 25MG 00185064801 EON LABS, INC. yDIPHENHYDRAM CAP 25MG 00185064810 EON LABS, INC. yDIPHENHYDRAM CAP 25MG 00185064824 EON LABS, INC. yDIPHENHYDRAM CAP 50MG 00185064901 EON LABS, INC. yDIPHENHYDRAM CAP 50MG 00185064910 EON LABS, INC. yDIPHENHYDRAM CAP 50MG 00185064924 EON LABS, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00185070101 EON LABS, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00185070105 EON LABS, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00185070130 EON LABS, INC. yBISOPRL/HCTZ TAB 5/6.25MG 00185070401 EON LABS, INC. yBISOPRL/HCTZ TAB 5/6.25MG 00185070405 EON LABS, INC. yBISOPRL/HCTZ TAB 5/6.25MG 00185070430 EON LABS, INC. yBISOPRL/HCTZ TAB 10/6.25 00185070701 EON LABS, INC. yBISOPRL/HCTZ TAB 10/6.25 00185070705 EON LABS, INC. yBISOPRL/HCTZ TAB 10/6.25 00185070730 EON LABS, INC. yORPHENADRINE TAB CPD 00185071301 EON LABS, INC. yORPHENADRINE TAB CPD 00185071305 EON LABS, INC. yORPHEN CPD TAB DS 00185071401 EON LABS, INC. yORPHEN CPD TAB DS 00185071405 EON LABS, INC. yORPHEN CPD TAB DS 00185071410 EON LABS, INC. yINDOMETHACIN CAP 75MG ER 00185072001 EON LABS, INC. yINDOMETHACIN CAP 75MG ER 00185072005 EON LABS, INC. yINDOMETHACIN CAP 75MG ER 00185072060 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DESIPRAMINE TAB 50MG 00185072101 EON LABS, INC. yDESIPRAMINE TAB 50MG 00185072105 EON LABS, INC. yDESIPRAMINE TAB 50MG 00185072110 EON LABS, INC. yDESIPRAMINE TAB 75MG 00185072201 EON LABS, INC. yDESIPRAMINE TAB 75MG 00185072205 EON LABS, INC. yCARISOPR/ASA TAB 200-325 00185072401 EON LABS, INC. yCARISOPR/ASA TAB 200-325 00185072405 EON LABS, INC. yDESIPRAMINE TAB 100MG 00185073601 EON LABS, INC. yDESIPRAMINE TAB 100MG 00185073605 EON LABS, INC. yCARISOPRODOL TAB ASA/COD 00185074901 EON LABS, INC. yCARISOPRODOL TAB ASA/COD 00185074905 EON LABS, INC. ySULFADIAZINE TAB 500MG 00185075701 EON LABS, INC. ySULFADIAZINE TAB 500MG 00185075710 EON LABS, INC. yDESIPRAMINE TAB 150MG 00185076001 EON LABS, INC. yDESIPRAMINE TAB 150MG 00185076053 EON LABS, INC. yBISOPROL FUM TAB 5MG 00185077101 EON LABS, INC. yBISOPROL FUM TAB 5MG 00185077130 EON LABS, INC. yBISOPROL FUM TAB 10MG 00185077401 EON LABS, INC. yBISOPROL FUM TAB 10MG 00185077430 EON LABS, INC. yRIFAMPIN CAP 300MG 00185079901 EON LABS, INC. yRIFAMPIN CAP 300MG 00185079905 EON LABS, INC. yRIFAMPIN CAP 300MG 00185079930 EON LABS, INC. yRIFAMPIN CAP 300MG 00185079960 EON LABS, INC. yRIFAMPIN CAP 150MG 00185080101 EON LABS, INC. yRIFAMPIN CAP 150MG 00185080130 EON LABS, INC. yDOXYCYC MONO CAP 50MG 00185080501 EON LABS, INC. yDOXYCYC MONO CAP 100MG 00185081001 EON LABS, INC. yDOXYCYC MONO CAP 100MG 00185081052 EON LABS, INC. yDOXYCYC MONO CAP 100MG 00185081053 EON LABS, INC. yBENAZEPRIL TAB 20MG 00185082001 EON LABS, INC. yBENAZEPRIL TAB 20MG 00185082005 EON LABS, INC. yCYCLOSPORINE CAP MOD 25MG 00185093230 EON LABS, INC. yCYCLOSPORINE CAP MD 100MG 00185093330 EON LABS, INC. yCHOLESTYRAM POW 4GM LITE 00185093997 EON LABS, INC. yCHOLESTYRAM POW 4GM LITE 00185093998 EON LABS, INC. yCHOLESTYRAM POW 4GM 00185094097 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHOLESTYRAM POW 4GM 00185094098 EON LABS, INC. yQUINIDINE SU TAB 300MG 00185104701 EON LABS, INC. yQUINIDINE SU TAB 300MG 00185104710 EON LABS, INC. yBUPROPION TAB 200MG SR 00185111160 EON LABS, INC. yFLUTAMIDE CAP 125MG 00185112505 EON LABS, INC. yFLUTAMIDE CAP 125MG 00185112518 EON LABS, INC. yFLUTAMIDE CAP 125MG 00185112588 EON LABS, INC. yNITROGLYCER CAP 9MG CR 00185121701 EON LABS, INC. yNITROGLYCER CAP 9MG CR 00185121760 EON LABS, INC. yNITROGLYCER CAP 6.5MG CR 00185123501 EON LABS, INC. yNITROGLYCER CAP 6.5MG CR 00185123560 EON LABS, INC. yCPM/PSE CAP 8-120 CR 00185130401 EON LABS, INC. yCPM/PSE CAP 8-120 CR 00185130410 EON LABS, INC. ySUCRALFATE TAB 1GM 00185210001 EON LABS, INC. ySUCRALFATE TAB 1GM 00185210005 EON LABS, INC. yPHENDIMETRAZ TAB 35MG 00185405701 EON LABS, INC. yPHENDIMETRAZ TAB 35MG 00185405710 EON LABS, INC. yQUINIDINE SU TAB 200MG 00185434601 EON LABS, INC. yQUINIDINE SU TAB 200MG 00185434610 EON LABS, INC. yISONIAZID TAB 300MG 00185435001 EON LABS, INC. yISONIAZID TAB 300MG 00185435010 EON LABS, INC. yISONIAZID TAB 300MG 00185435030 EON LABS, INC. yISONIAZID TAB 100MG 00185435101 EON LABS, INC. yISONIAZID TAB 100MG 00185435110 EON LABS, INC. yISONIAZID TAB 100MG 00185435130 EON LABS, INC. yTIZANIDINE TAB 4MG 00185440010 EON LABS, INC. yTIZANIDINE TAB 4MG 00185440023 EON LABS, INC. yTIZANIDINE TAB 4MG 00185440051 EON LABS, INC. yMETFORMIN TAB 500MG ER 00185441601 EON LABS, INC. yMETFORMIN TAB 500MG ER 00185441605 EON LABS, INC. yPHENTERMINE CAP 30MG 00185500001 EON LABS, INC. yPHENTERMINE CAP 30MG 00185500010 EON LABS, INC. yMETOLAZONE TAB 2.5MG 00185505001 EON LABS, INC. yMETOLAZONE TAB 2.5MG 00185505010 EON LABS, INC. yPAPAVERINE CAP 150MG CR 00185515601 EON LABS, INC. yPAPAVERINE CAP 150MG CR 00185515610 EON LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NITROGLYCER CAP 2.5MG SR 00185517401 EON LABS, INC. yNITROGLYCER CAP 2.5MG SR 00185517460 EON LABS, INC. yPHENDIMETRAZ CAP 105MG ER 00185525401 EON LABS, INC. yPHENDIMETRAZ CAP 105MG ER 00185525410 EON LABS, INC. yFOLTRIN CAP 00185538001 EON LABS, INC. yFOLTRIN CAP 00185538010 EON LABS, INC. yFOLTRIN CAP 00185538076 EON LABS, INC. yFOLTRIN CAP 00185538088 EON LABS, INC. yLISINOPRIL TAB 5MG 00185540001 EON LABS, INC. yLISINOPRIL TAB 5MG 00185540010 EON LABS, INC. yMETOLAZONE TAB 10MG 00185560001 EON LABS, INC. yLISINOP/HCTZ TAB 10-12.5 00185710001 EON LABS, INC. yLISINOP/HCTZ TAB 10-12.5 00185710010 EON LABS, INC. yAZITHROMYCIN SUS 100/5ML 00185720370 EON LABS, INC. yAZITHROMYCIN SUS 200/5ML 00185720670 EON LABS, INC. yAZITHROMYCIN SUS 200/5ML 00185720969 EON LABS, INC. yAZITHROMYCIN SUS 200/5ML 00185721268 EON LABS, INC. yLEUPROLIDE INJ 1MG/0.2 00185740085 EON LABS, INC. yAMPI/SULBACT INJ 10-5GM 59911590001 ESI LEDERLE INC. yAMPI/SULBACT INJ 1-0.5GM 59911590102 ESI LEDERLE INC. yAMPI/SULBACT INJ 2-1GM 59911590202 ESI LEDERLE INC. yMILRINONE INJ 1MG/ML 59911590502 ESI LEDERLE INC. yMILRINONE INJ 1MG/ML 59911590602 ESI LEDERLE INC. yMILRINONE INJ DW5 59911590702 ESI LEDERLE INC. yMILRINONE INJ DW5 59911590802 ESI LEDERLE INC. yMIDAZOLAM SOL 1MG/ML 59911591102 ESI LEDERLE INC. yMIDAZOLAM SOL 1MG/ML 59911591202 ESI LEDERLE INC. yMIDAZOLAM SOL 1MG/ML 59911591302 ESI LEDERLE INC. yMIDAZOLAM SOL 5MG/ML 59911591402 ESI LEDERLE INC. yMIDAZOLAM SOL 5MG/ML 59911591502 ESI LEDERLE INC. yMIDAZOLAM SOL 5MG/ML 59911591602 ESI LEDERLE INC. yBUTORPHANOL SOL 10MG/ML 59911594401 ESI LEDERLE INC. yFAMOTIDINE INJ 10MG/ML 59911595002 ESI LEDERLE INC. yFAMOTIDINE INJ 10MG/ML 59911595004 ESI LEDERLE INC. yFAMOTIDINE INJ 10MG/ML 59911595102 ESI LEDERLE INC. yFAMOTIDINE INJ 10MG/ML 59911595104 ESI LEDERLE INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FAMOTIDINE INJ 10MG/ML 59911595202 ESI LEDERLE INC. yFAMOTIDINE INJ 10MG/ML 59911595204 ESI LEDERLE INC. yVINORELBINE INJ 10MG/ML 59911595801 ESI LEDERLE INC. yVINORELBINE INJ 10MG/ML 59911595901 ESI LEDERLE INC. yCEFOXITIN INJ 1GM 59911596302 ESI LEDERLE INC. yCEFOXITIN INJ 2GM 59911596402 ESI LEDERLE INC. yCEFOXITIN INJ 10GM 59911596502 ESI LEDERLE INC. yDIPYRIDAMOLE SOL 5MG/ML 59911706902 ESI LEDERLE INC. yPROQUIN XR TAB 500MG 15456000103 Esprit Pharma, Inc. yURO-KP-NEUTR TAB 15456010903 Esprit Pharma, Inc. yUROLENE BLUE TAB 65MG 15456050103 Esprit Pharma, Inc. yPROSED/DS TAB 15456080503 Esprit Pharma, Inc. yPROSED EC TAB 15456090990 Esprit Pharma, Inc. ySANCTURA TAB 20MG 15456098004 Esprit Pharma, Inc. yPOT CHLORIDE CAP 10MEQ ER 58177000104 ETHEX CORPORATION yPOT CHLORIDE CAP 10MEQ ER 58177000108 ETHEX CORPORATION yPOT CHLORIDE CAP 10MEQ ER 58177000109 ETHEX CORPORATION yPOT CHLORIDE CAP 10MEQ ER 58177000111 ETHEX CORPORATION yPOT CHLORIDE CAP 10MEQ ER 58177000112 ETHEX CORPORATION yDISOPYRAMIDE CAP 150MG ER 58177000204 ETHEX CORPORATION yNITROGLYCER CAP 2.5MG ER 58177000403 ETHEX CORPORATION yNITROGLYCER CAP 2.5MG ER 58177000404 ETHEX CORPORATION yNITROGLYCER CAP 6.5MG ER 58177000503 ETHEX CORPORATION yNITROGLYCER CAP 6.5MG ER 58177000504 ETHEX CORPORATION yNITROGLYCER CAP 9MG ER 58177000603 ETHEX CORPORATION yNITROGLYCER CAP 9MG ER 58177000604 ETHEX CORPORATION yHYOSCYAMINE CAP 0.375 ER 58177001704 ETHEX CORPORATION yBROMFENEX CAP 12-120CR 58177001904 ETHEX CORPORATION yBROMFENEX PD CAP 6-60MGCR 58177002004 ETHEX CORPORATION yMEPERIDINE/ CAP PROMETH 58177002704 ETHEX CORPORATION yPANGES MT 16 CAP 58177002804 ETHEX CORPORATION yPANGES CN 10 CAP 58177002904 ETHEX CORPORATION yPANGES CN 20 CAP 58177003004 ETHEX CORPORATION yPANGESTYM EC CAP 58177003104 ETHEX CORPORATION yPANGESTYM EC CAP 58177003106 ETHEX CORPORATION yOXYCODONE CAP 5MG 58177004104 ETHEX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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OXYCODONE CAP 5MG 58177004111 ETHEX CORPORATION yCONISON CAP 58177004403 ETHEX CORPORATION yCONISON CAP 58177004423 ETHEX CORPORATION yPSEUDOVENT CAP CR 58177004504 ETHEX CORPORATION yPSEUDOVENT CAP PED CR 58177004604 ETHEX CORPORATION yPANGES UL 12 CAP 58177004804 ETHEX CORPORATION yPANGES UL 18 CAP 58177004904 ETHEX CORPORATION yPANGES UL 20 CAP 58177005004 ETHEX CORPORATION yANEMAGEN OB CAP 58177005204 ETHEX CORPORATION yDILTIAZEM CAP 120MG/24 58177006109 ETHEX CORPORATION yDILTIAZEM CAP 120MG/24 58177006119 ETHEX CORPORATION yDILTIAZEM CAP 120MG/24 58177006126 ETHEX CORPORATION yDILTIAZEM CAP 180MG/24 58177006209 ETHEX CORPORATION yDILTIAZEM CAP 180MG/24 58177006219 ETHEX CORPORATION yDILTIAZEM CAP 180MG/24 58177006226 ETHEX CORPORATION yDILTIAZEM CAP 240MG/24 58177006309 ETHEX CORPORATION yDILTIAZEM CAP 240MG/24 58177006319 ETHEX CORPORATION yDILTIAZEM CAP 240MG/24 58177006326 ETHEX CORPORATION yDILTIAZEM CAP 300MG/24 58177006409 ETHEX CORPORATION yDILTIAZEM CAP 300MG/24 58177006419 ETHEX CORPORATION yDILTIAZEM CAP 300MG/24 58177006426 ETHEX CORPORATION yDILTIAZEM CAP 360MG/24 58177006509 ETHEX CORPORATION yDILTIAZEM CAP 360MG/24 58177006519 ETHEX CORPORATION yDILTIAZEM CAP 360MG/24 58177006526 ETHEX CORPORATION yDILTIAZEM CAP 420MG/24 58177006619 ETHEX CORPORATION yDILTIAZEM CAP 420MG/24 58177006626 ETHEX CORPORATION yNATACAPS CAP 58177007304 ETHEX CORPORATION yNATACAPS CAP 58177007311 ETHEX CORPORATION yBROMFENEX PE CAP PEDI 58177007604 ETHEX CORPORATION yBROMFENEX PE CAP 12-15MG 58177007704 ETHEX CORPORATION yPHENAVENT CAP 15-400MG 58177007819 ETHEX CORPORATION yPHENAVENT PE CAP 7.5-200 58177007904 ETHEX CORPORATION yPHENAVENT LA CAP 30-400MG 58177009519 ETHEX CORPORATION yPSEUDOVENT CAP 400 58177009604 ETHEX CORPORATION yISOSORB MONO TAB 120MG ER 58177020104 ETHEX CORPORATION yPOT CHLORIDE TAB 20MEQ CR 58177020204 ETHEX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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POT CHLORIDE TAB 20MEQ CR 58177020208 ETHEX CORPORATION yPOT CHLORIDE TAB 20MEQ CR 58177020209 ETHEX CORPORATION yPOT CHLORIDE TAB 20MEQ CR 58177020211 ETHEX CORPORATION yGUAIFENEX LA TAB 600MG 58177020508 ETHEX CORPORATION yGUAIFENEX TAB PSE 120 58177020804 ETHEX CORPORATION yPRENATAL MR TAB 90 FE 58177021204 ETHEX CORPORATION yPRENATAL MR TAB 90 FE 58177021211 ETHEX CORPORATION yGUAIFENEX DM TAB 30-600CR 58177021304 ETHEX CORPORATION yGUAIFENEX TAB PSE 60 58177021404 ETHEX CORPORATION yPRENATAL RX1 TAB 58177021604 ETHEX CORPORATION yPRENATAL RX1 TAB 58177021611 ETHEX CORPORATION yISOSORB MONO TAB 30MG ER 58177022204 ETHEX CORPORATION yISOSORB MONO TAB 30MG ER 58177022208 ETHEX CORPORATION yISOSORB MONO TAB 30MG ER 58177022211 ETHEX CORPORATION yISOSORB MONO TAB 30MG ER 58177022212 ETHEX CORPORATION yCODEINE/GG TAB 10-300 58177022304 ETHEX CORPORATION yNATALCARE TAB PLUS 58177022504 ETHEX CORPORATION yHISTA-VENT TAB DA 58177022704 ETHEX CORPORATION yHYOSCYAMINE TAB 0.375 ER 58177023704 ETHEX CORPORATION yISOSORB MONO TAB 60MG ER 58177023804 ETHEX CORPORATION yISOSORB MONO TAB 60MG ER 58177023808 ETHEX CORPORATION yISOSORB MONO TAB 60MG ER 58177023811 ETHEX CORPORATION yISOSORB MONO TAB 60MG ER 58177023812 ETHEX CORPORATION yHYOSCYAMINE SUB 0.125MG 58177025504 ETHEX CORPORATION yNATALCARE TAB PIC 58177025704 ETHEX CORPORATION yNATALCARE TAB PICFORTE 58177025804 ETHEX CORPORATION yBUSPIRONE TAB 10MG 58177026504 ETHEX CORPORATION yBUSPIRONE TAB 10MG 58177026508 ETHEX CORPORATION yDOXAZOSIN TAB 1MG 58177026604 ETHEX CORPORATION yDOXAZOSIN TAB 1MG 58177026608 ETHEX CORPORATION yDOXAZOSIN TAB 2MG 58177026704 ETHEX CORPORATION yDOXAZOSIN TAB 2MG 58177026708 ETHEX CORPORATION yDOXAZOSIN TAB 4MG 58177026804 ETHEX CORPORATION yDOXAZOSIN TAB 4MG 58177026808 ETHEX CORPORATION yDOXAZOSIN TAB 8MG 58177026904 ETHEX CORPORATION yDOXAZOSIN TAB 8MG 58177026908 ETHEX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYOSCYAMINE TAB 0.125MG 58177027404 ETHEX CORPORATION yPRENATAL Z TAB 58177027504 ETHEX CORPORATION yULTRA NATAL TAB CARE 58177029204 ETHEX CORPORATION yHYDROMORPHON TAB 2MG 58177029804 ETHEX CORPORATION yHYDROMORPHON TAB 2MG 58177029811 ETHEX CORPORATION yHYDROMORPHON TAB 4MG 58177029904 ETHEX CORPORATION yHYDROMORPHON TAB 4MG 58177029911 ETHEX CORPORATION yKETOROLAC TAB 10MG 58177030104 ETHEX CORPORATION yNAPROXEN DR TAB 375MG 58177030204 ETHEX CORPORATION yNAPROXEN DR TAB 500MG 58177030304 ETHEX CORPORATION yGUAIFENEX G TAB 1200 CR 58177030804 ETHEX CORPORATION yBUSPIRONE TAB 15MG 58177030904 ETHEX CORPORATION yBUSPIRONE TAB 15MG 58177030908 ETHEX CORPORATION yMORPHINE SUL TAB 15MG ER 58177031004 ETHEX CORPORATION yDEXTROAMPHET TAB 5MG 58177031104 ETHEX CORPORATION yDEXTROAMPHET TAB 10MG 58177031204 ETHEX CORPORATION yMORPHINE SUL TAB 15MG 58177031304 ETHEX CORPORATION yMORPHINE SUL TAB 30MG 58177031404 ETHEX CORPORATION yOXYCODONE TAB 5MG 58177031504 ETHEX CORPORATION yOXYCODONE TAB 5MG 58177031511 ETHEX CORPORATION yPRENATAL MTR TAB SELENIUM 58177031604 ETHEX CORPORATION yNATALCARE RX TAB 58177031705 ETHEX CORPORATION yMORPHINE SUL TAB 30MG ER 58177032004 ETHEX CORPORATION yNITROQUICK SUB 0.3MG 58177032304 ETHEX CORPORATION yNITROQUICK SUB 0.4MG 58177032404 ETHEX CORPORATION yNITROQUICK SUB 0.4MG 58177032418 ETHEX CORPORATION yNITROQUICK SUB 0.6MG 58177032504 ETHEX CORPORATION yNATATAB CFE TAB 58177032804 ETHEX CORPORATION yNATATAB CFE TAB 58177032811 ETHEX CORPORATION yNATATAB FA TAB 58177032904 ETHEX CORPORATION yMORPHINE SUL TAB 60MG ER 58177033004 ETHEX CORPORATION yPROPAFENONE TAB 150MG 58177033104 ETHEX CORPORATION yPROPAFENONE TAB 150MG 58177033111 ETHEX CORPORATION yPROPAFENONE TAB 150MG 58177033112 ETHEX CORPORATION yPROPAFENONE TAB 225MG 58177033204 ETHEX CORPORATION yPROPAFENONE TAB 300MG 58177033304 ETHEX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENAZEPRIL TAB 5MG 58177034104 ETHEX CORPORATION yBENAZEPRIL TAB 10MG 58177034204 ETHEX CORPORATION yBENAZEPRIL TAB 10MG 58177034208 ETHEX CORPORATION yBENAZEPRIL TAB 20MG 58177034304 ETHEX CORPORATION yBENAZEPRIL TAB 20MG 58177034308 ETHEX CORPORATION yBENAZEPRIL TAB 40MG 58177034404 ETHEX CORPORATION yBENAZEPRIL TAB 40MG 58177034408 ETHEX CORPORATION yADV NATALCAR TAB 58177035026 ETHEX CORPORATION yNUTRINATE CHW 58177035126 ETHEX CORPORATION yGUAIFENEX GP TAB 120/1200 58177037304 ETHEX CORPORATION yNATATAB RX TAB 29-1MG 58177037626 ETHEX CORPORATION yCARB/LEVO ER TAB 50-200MG 58177038304 ETHEX CORPORATION yGUAIFENEX PS TAB 80-800MG 58177041304 ETHEX CORPORATION yNATALCARE TAB THREE 58177041504 ETHEX CORPORATION yPLARETASE TAB 8000 58177041604 ETHEX CORPORATION yPLARETASE TAB 8000 58177041608 ETHEX CORPORATION yNATALCARE TAB GLOSSTAB 58177041826 ETHEX CORPORATION yHYOSCYAMINE TAB 0.125MG 58177042304 ETHEX CORPORATION yHISTA-VENT TAB 12HR 58177042604 ETHEX CORPORATION yETHEDENT CHW 0.25MG 58177043240 ETHEX CORPORATION yETHEDENT CHW 0.5MG 58177043309 ETHEX CORPORATION yETHEDENT CHW 0.5MG 58177043340 ETHEX CORPORATION yETHEDENT CHW 1MG 58177043409 ETHEX CORPORATION yETHEDENT CHW 1MG 58177043440 ETHEX CORPORATION yCARENATE 600 MIS COMBO PA 58177043738 ETHEX CORPORATION yPSEUDOVENT TAB DM 58177043804 ETHEX CORPORATION yCAL-NATE TAB 58177043904 ETHEX CORPORATION yCOMBGEN TAB 58177044004 ETHEX CORPORATION yPHENAVENT D TAB 40-1200 58177044404 ETHEX CORPORATION yOXYCODONE TAB 15MG 58177044504 ETHEX CORPORATION yOXYCODONE TAB 30MG 58177044604 ETHEX CORPORATION yHYDROMORPHON TAB 8MG 58177044904 ETHEX CORPORATION yADVANCED-RF TAB NATALCAR 58177045826 ETHEX CORPORATION yNUTRISPIRE TAB 58177046326 ETHEX CORPORATION yGUAIFENEX TAB PSE 85 58177047804 ETHEX CORPORATION yHYDROMORPHON TAB 2MG 58177062004 ETHEX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROMORPHON TAB 2MG 58177062011 ETHEX CORPORATION yHYDROMORPHON TAB 4MG 58177062104 ETHEX CORPORATION yHYDROMORPHON TAB 4MG 58177062111 ETHEX CORPORATION yOXYCODONE TAB 5MG 58177062504 ETHEX CORPORATION yOXYCODONE TAB 5MG 58177062511 ETHEX CORPORATION yHYDROQUINONE CRE 4% 58177080102 ETHEX CORPORATION yHYDROQUINONE CRE 4%/SUNS 58177080202 ETHEX CORPORATION yHYDROCORT/ CRE IODOQUIN 58177080302 ETHEX CORPORATION yETHEZYME OIN 58177080402 ETHEX CORPORATION yFLUTICASONE CRE 0.05% 58177080601 ETHEX CORPORATION yFLUTICASONE CRE 0.05% 58177080602 ETHEX CORPORATION yFLUTICASONE CRE 0.05% 58177080603 ETHEX CORPORATION yETHEZYME 830 OIN 58177081602 ETHEX CORPORATION yETHEDENT CRE DENTAL 58177083537 ETHEX CORPORATION yETHEDENT GEL 1.1% 58177083803 ETHEX CORPORATION yNYSTATIN POW 100000 58177083945 ETHEX CORPORATION yNYSTATIN POW 100000 58177083946 ETHEX CORPORATION yHISTINEX HC SYP 58177087707 ETHEX CORPORATION yHISTINEX HC SYP 58177087712 ETHEX CORPORATION yHYDROCOD/GG SYP 5-100/5 58177088107 ETHEX CORPORATION yHYDROCOD/GG SYP 5-100/5 58177088112 ETHEX CORPORATION yHISTINEX PV SYP 58177088307 ETHEX CORPORATION yMORPHINE SUL SOL 20MG/ML 58177088601 ETHEX CORPORATION yMORPHINE SUL SOL 20MG/ML 58177088603 ETHEX CORPORATION yMORPHINE SUL SOL 20MG/ML 58177088605 ETHEX CORPORATION yMORPHINE SUL SOL 20MG/ML 58177088656 ETHEX CORPORATION yMORPHINE SUL SOL 20MG/ML 58177088657 ETHEX CORPORATION yMORPHINE SUL SOL 5/0.25ML 58177088880 ETHEX CORPORATION yMORPHINE SUL SOL 10/0.5ML 58177088981 ETHEX CORPORATION yHYDRO-TUSSIN ELX DM 58177090607 ETHEX CORPORATION yPREDNISOLONE SYP 15MG/5ML 58177091005 ETHEX CORPORATION yPREDNISOLONE SYP 15MG/5ML 58177091007 ETHEX CORPORATION yPREDNISOLONE SYP 5MG/5ML 58177091203 ETHEX CORPORATION yETH-OXYDOSE CON 20MG/ML 58177091401 ETHEX CORPORATION yETH-OXYDOSE CON 20MG/ML 58177091456 ETHEX CORPORATION yHYDRO-TUSSIN SYP 15-2-3MG 58177091507 ETHEX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDRO-TUSSIN SYP XP 58177091607 ETHEX CORPORATION yTRI-VENT HC LIQ 58177092007 ETHEX CORPORATION yHYDRO-TUSSIN SYP CBX 58177092407 ETHEX CORPORATION yTRI-VENT DM SYP 58177092507 ETHEX CORPORATION yHYDRO-TUSSIN SYP DHC 58177092607 ETHEX CORPORATION yETHEXDERM LIQ BPW-5 58177092805 ETHEX CORPORATION yETHEXDERM LIQ BPW-10 58177092905 ETHEX CORPORATION yPREDNISOLONE SOL 15MG/5ML 58177093205 ETHEX CORPORATION yHYDRO-TUSSIN SYP HG 58177095407 ETHEX CORPORATION yCORTIC-ND DRO 00642001215 EVERETT LABORATORIES, INC. yCALCIFOL WAF 00642006630 EVERETT LABORATORIES, INC. yVITAFOL TAB 00642007212 EVERETT LABORATORIES, INC. yVITAFOL SYP 00642007416 EVERETT LABORATORIES, INC. ySELECT-OB CHW 00642007790 EVERETT LABORATORIES, INC. yVITAFOL-PN TAB 00642007812 EVERETT LABORATORIES, INC. yVITAFOL-OB TAB 65-1MG 00642007912 EVERETT LABORATORIES, INC. yREPAN TAB 00642016210 EVERETT LABORATORIES, INC. ySTROVITE TAB 00642020010 EVERETT LABORATORIES, INC. ySTROVITE PLU TAB 00642020110 EVERETT LABORATORIES, INC. ySTROVITE FOR SYP 00642020316 EVERETT LABORATORIES, INC. ySTROVITE FOR TAB 00642020410 EVERETT LABORATORIES, INC. ySTROVITE TAB ADVANCE 00642020810 EVERETT LABORATORIES, INC. yTUSSO-HC TAB 00642042110 EVERETT LABORATORIES, INC. yTUSSAFED-HCG SYP 00642045516 EVERETT LABORATORIES, INC. yTUSSAFED HC SYP 00642046016 EVERETT LABORATORIES, INC. yTUSSO-DF SYP 2.5-100 00642046816 EVERETT LABORATORIES, INC. yTUSSALL SYP 10-2-20 00642047016 EVERETT LABORATORIES, INC. yTUSSALL-ER TAB 20-6-30 00642047110 EVERETT LABORATORIES, INC. yTUSSO-XR SUS 00642061616 EVERETT LABORATORIES, INC. yTUSSO-DM TAB 00642063010 EVERETT LABORATORIES, INC. yTRITUSS-ER TAB 00642066110 EVERETT LABORATORIES, INC. yTRITUSS SYP 00642070016 EVERETT LABORATORIES, INC. yRENAX TAB 2.5MG 00642274690 EVERETT LABORATORIES, INC. yRENAX 5.5 TAB 00642275590 EVERETT LABORATORIES, INC. yEPIDRIN CAP 64125010101 EXCELLIUM PHARMACEUTICAL, INC. yEPIDRIN CAP 64125010102 EXCELLIUM PHARMACEUTICAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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EPERBEL-S TAB 64125010201 EXCELLIUM PHARMACEUTICAL, INC. yCOLCHICINE TAB 0.6MG 64125010401 EXCELLIUM PHARMACEUTICAL, INC. yCOLCHICINE TAB 0.6MG 64125010410 EXCELLIUM PHARMACEUTICAL, INC. yASPIRIN TAB 800MG CR 64125010601 EXCELLIUM PHARMACEUTICAL, INC. yHYOSCYAMINE TAB 0.375MG 64125011001 EXCELLIUM PHARMACEUTICAL, INC. yFUROSEMIDE TAB 20MG 64125011601 EXCELLIUM PHARMACEUTICAL, INC. yFUROSEMIDE TAB 20MG 64125011610 EXCELLIUM PHARMACEUTICAL, INC. yFUROSEMIDE TAB 40MG 64125011701 EXCELLIUM PHARMACEUTICAL, INC. yFUROSEMIDE TAB 40MG 64125011710 EXCELLIUM PHARMACEUTICAL, INC. yFUROSEMIDE TAB 80MG 64125011801 EXCELLIUM PHARMACEUTICAL, INC. yFUROSEMIDE TAB 80MG 64125011805 EXCELLIUM PHARMACEUTICAL, INC. yGUAIFENESIN TAB /DM ER 64125012601 EXCELLIUM PHARMACEUTICAL, INC. yBELLA ALK/PB TAB 16.2MG 64125012810 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 30MG 64125090101 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 30MG 64125090110 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 60MG 64125090201 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 60MG 64125090210 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 100MG 64125090301 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 100MG 64125090310 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 15MG 64125091501 EXCELLIUM PHARMACEUTICAL, INC. yPHENOBARB TAB 15MG 64125091510 EXCELLIUM PHARMACEUTICAL, INC. yOFLOXACIN SOL 0.3% 61314001205 FALCON PHARMACEUTICALS LTD. yOFLOXACIN SOL 0.3% 61314001210 FALCON PHARMACEUTICALS LTD. yPROPARACAINE SOL 0.5% OP 61314001601 FALCON PHARMACEUTICALS LTD. yTRIFLURIDINE SOL 1% OP 61314004475 FALCON PHARMACEUTICALS LTD. yBRIMONIDINE SOL 0.2% OP 61314014305 FALCON PHARMACEUTICALS LTD. yBRIMONIDINE SOL 0.2% OP 61314014310 FALCON PHARMACEUTICALS LTD. yBRIMONIDINE SOL 0.2% OP 61314014315 FALCON PHARMACEUTICALS LTD. yPILOCARPINE SOL 1% OP 61314020315 FALCON PHARMACEUTICALS LTD. yPILOCARPINE SOL 2% OP 61314020415 FALCON PHARMACEUTICALS LTD. yPILOCARPINE SOL 4% OP 61314020615 FALCON PHARMACEUTICALS LTD. yPILOCARPINE SOL 6% OP 61314020815 FALCON PHARMACEUTICALS LTD. yTIMOLOL GEL SOL 0.25% OP 61314022405 FALCON PHARMACEUTICALS LTD. yTIMOLOL GEL SOL 0.5% OP 61314022505 FALCON PHARMACEUTICALS LTD. yTIMOLOL GEL SOL 0.5% OP 61314022525 FALCON PHARMACEUTICALS LTD. yTIMOLOL MAL SOL 0.25% OP 61314022605 FALCON PHARMACEUTICALS LTD. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TIMOLOL MAL SOL 0.25% OP 61314022610 FALCON PHARMACEUTICALS LTD. yTIMOLOL MAL SOL 0.25% OP 61314022615 FALCON PHARMACEUTICALS LTD. yTIMOLOL MAL SOL 0.5% OP 61314022705 FALCON PHARMACEUTICALS LTD. yTIMOLOL MAL SOL 0.5% OP 61314022710 FALCON PHARMACEUTICALS LTD. yTIMOLOL MAL SOL 0.5% OP 61314022715 FALCON PHARMACEUTICALS LTD. yLEVOBUNOLOL SOL 0.5% OP 61314022905 FALCON PHARMACEUTICALS LTD. yLEVOBUNOLOL SOL 0.5% OP 61314022910 FALCON PHARMACEUTICALS LTD. yLEVOBUNOLOL SOL 0.5% OP 61314022915 FALCON PHARMACEUTICALS LTD. yCROMOLYN SOD SOL 4% OP 61314023710 FALCON PHARMACEUTICALS LTD. yCARTEOLOL SOL OPHTH 1% 61314023805 FALCON PHARMACEUTICALS LTD. yCARTEOLOL SOL OPHTH 1% 61314023810 FALCON PHARMACEUTICALS LTD. yCARTEOLOL SOL OPHTH 1% 61314023815 FALCON PHARMACEUTICALS LTD. yBETAXOLOL SOL 0.5% OP 61314024501 FALCON PHARMACEUTICALS LTD. yBETAXOLOL SOL 0.5% OP 61314024502 FALCON PHARMACEUTICALS LTD. yBETAXOLOL SOL 0.5% OP 61314024503 FALCON PHARMACEUTICALS LTD. yDEXAMETH PHO SOL 0.1% OP 61314029405 FALCON PHARMACEUTICALS LTD. ySULF/PRED NA SOL OP 61314029705 FALCON PHARMACEUTICALS LTD. ySULF/PRED NA SOL OP 61314029710 FALCON PHARMACEUTICALS LTD. yATROPINE SUL SOL 1% OP 61314030301 FALCON PHARMACEUTICALS LTD. yATROPINE SUL SOL 1% OP 61314030302 FALCON PHARMACEUTICALS LTD. yPHENYLEPHRIN SOL 2.5% OP 61314034201 FALCON PHARMACEUTICALS LTD. yPHENYLEPHRIN SOL 2.5% OP 61314034202 FALCON PHARMACEUTICALS LTD. yTROPICAMIDE SOL 0.5% OP 61314035401 FALCON PHARMACEUTICALS LTD. yTROPICAMIDE SOL 1% OP 61314035501 FALCON PHARMACEUTICALS LTD. yTROPICAMIDE SOL 1% OP 61314035502 FALCON PHARMACEUTICALS LTD. yCYCLOPENTOL SOL 1% OP 61314039601 FALCON PHARMACEUTICALS LTD. yCYCLOPENTOL SOL 1% OP 61314039603 FALCON PHARMACEUTICALS LTD. yMETIPRANOLOL SOL 0.3% OPH 61314044705 FALCON PHARMACEUTICALS LTD. yMETIPRANOLOL SOL 0.3% OPH 61314044710 FALCON PHARMACEUTICALS LTD. yPOLYMYXIN B/ SOL TRIMETHP 61314062810 FALCON PHARMACEUTICALS LTD. yNEO/POLY/DEX SUS 0.1% OP 61314063006 FALCON PHARMACEUTICALS LTD. yNEO/POLY/DEX OIN 0.1% OP 61314063136 FALCON PHARMACEUTICALS LTD. yGENTAMICIN SOL 0.3% OP 61314063305 FALCON PHARMACEUTICALS LTD. yPREDNISOLONE SUS 1% OP 61314063705 FALCON PHARMACEUTICALS LTD. yPREDNISOLONE SUS 1% OP 61314063710 FALCON PHARMACEUTICALS LTD. yPREDNISOLONE SUS 1% OP 61314063715 FALCON PHARMACEUTICALS LTD. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NEO/POLY/HC SUS OP 61314064175 FALCON PHARMACEUTICALS LTD. yTOBRAMYCIN SOL 0.3% OP 61314064305 FALCON PHARMACEUTICALS LTD. yNEO/POLY/HC SUS 1% OTIC 61314064510 FALCON PHARMACEUTICALS LTD. yNEO/POLY/HC SOL 1% OTIC 61314064610 FALCON PHARMACEUTICALS LTD. ySULFACET SOD SOL 10% OP 61314070101 FALCON PHARMACEUTICALS LTD. yNAT VEG LAX POW 50% 52735050954 FAMILY PHARMACY - AMERISOURCE/BERGEN yFIBER LAX POW 52735054186 FAMILY PHARMACY - AMERISOURCE/BERGEN yFIBER LAX POW 52735063518 FAMILY PHARMACY - AMERISOURCE/BERGEN yK-PEC LIQ 750MG/15 52735063929 FAMILY PHARMACY - AMERISOURCE/BERGEN yTHERAPEUTIC GEL BLUE 52735071644 FAMILY PHARMACY - AMERISOURCE/BERGEN yTRANDATE TAB 100MG 60976034643 FARO PHARMACEUTICALS, INC. yTRANDATE TAB 100MG 60976034644 FARO PHARMACEUTICALS, INC. yTRANDATE TAB 100MG 60976034647 FARO PHARMACEUTICALS, INC. yIMURAN TAB 50MG 60976059755 FARO PHARMACEUTICALS, INC. yZYLOPRIM TAB 100MG 60976099655 FARO PHARMACEUTICALS, INC. yZYLOPRIM TAB 300MG 60976099855 FARO PHARMACEUTICALS, INC. yZYLOPRIM TAB 300MG 60976099870 FARO PHARMACEUTICALS, INC. yPARAGARD IUD T380A 50907038006 FEI WOMEN'S HEALTH LLC yPARAGARD IUD T380A 50907038007 FEI WOMEN'S HEALTH LLC yKRONOFED-A CAP 8-120 CR 00496038202 FERNDALE LABORATORIES INC. yKRONOFED-A CAP 8-120 CR 00496038210 FERNDALE LABORATORIES INC. yKRONOFED-A CAP JR 00496043402 FERNDALE LABORATORIES INC. yKRONOFED-A CAP JR 00496043410 FERNDALE LABORATORIES INC. yLIQUI-DOSS EMU 00496052002 FERNDALE LABORATORIES INC. yPRAMOSONE CRE 1% 00496071603 FERNDALE LABORATORIES INC. yPRAMOSONE CRE 1% 00496071604 FERNDALE LABORATORIES INC. yPRAMOSONE CRE 2.5% 00496071703 FERNDALE LABORATORIES INC. yPRAMOSONE CRE 2.5% 00496071704 FERNDALE LABORATORIES INC. yPRAMOSONE LOT 2.5% 00496072604 FERNDALE LABORATORIES INC. yPRAMOSONE LOT 2.5% 00496072606 FERNDALE LABORATORIES INC. yPRAMOSONE LOT 1% 00496072903 FERNDALE LABORATORIES INC. yPRAMOSONE LOT 1% 00496072904 FERNDALE LABORATORIES INC. yPRAMOSONE LOT 1% 00496072906 FERNDALE LABORATORIES INC. yPRAX LOT 1% 00496074803 FERNDALE LABORATORIES INC. yPRAX LOT 1% 00496074804 FERNDALE LABORATORIES INC. yPRAX LOT 1% 00496074815 FERNDALE LABORATORIES INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PRAMOSONE OIN 1% 00496076304 FERNDALE LABORATORIES INC. yPRAMOSONE OIN 2.5% 00496077704 FERNDALE LABORATORIES INC. yANALPRAM-HC CRE 1% 00496077804 FERNDALE LABORATORIES INC. yANALPRAM-HC CRE 1% 00496077864 FERNDALE LABORATORIES INC. yANALPRAM-HC CRE LIPOCRM 00496080004 FERNDALE LABORATORIES INC. yANALPRAM-HC CRE LIPOCRM 00496080064 FERNDALE LABORATORIES INC. yLOCOID CRE 0.1% 00496080215 FERNDALE LABORATORIES INC. yLOCOID CRE 0.1% 00496080245 FERNDALE LABORATORIES INC. yLOCOID OIN 0.1% 00496080315 FERNDALE LABORATORIES INC. yLOCOID OIN 0.1% 00496080345 FERNDALE LABORATORIES INC. yLOCOID SOL 0.1% 00496080420 FERNDALE LABORATORIES INC. yLOCOID SOL 0.1% 00496080460 FERNDALE LABORATORIES INC. yCAPSAICIN CRE 0.025% 00496081002 FERNDALE LABORATORIES INC. ySBR LIPOCREA CRE 00496081901 FERNDALE LABORATORIES INC. ySBR LIPOCREA CRE 00496081930 FERNDALE LABORATORIES INC. yLOCOID LIPO CRE 0.1% 00496082115 FERNDALE LABORATORIES INC. yLOCOID LIPO CRE 0.1% 00496082125 FERNDALE LABORATORIES INC. yLOCOID LIPO CRE 0.1% 00496082145 FERNDALE LABORATORIES INC. yANALPRAM-HC LOT 2.5% 00496082904 FERNDALE LABORATORIES INC. yCLINAC OC GEL 00496083645 FERNDALE LABORATORIES INC. yCLINAC OC GEL 00496083690 FERNDALE LABORATORIES INC. yPRO-Q SKIN AER PROTECT 00496084202 FERNDALE LABORATORIES INC. yPRO-Q SKIN AER PROTECT 00496084205 FERNDALE LABORATORIES INC. yDECUBITENE OIL SPRAY 00496084502 FERNDALE LABORATORIES INC. yCLINAC BPO GEL 7% 00496085745 FERNDALE LABORATORIES INC. yCLINAC BPO GEL 7% 00496085790 FERNDALE LABORATORIES INC. yHYDROCORTISO CRE 2.5% 00496085904 FERNDALE LABORATORIES INC. yNOURIVA REPR CRE 00496086530 FERNDALE LABORATORIES INC. yLMX 4 CRE 4% 00496088205 FERNDALE LABORATORIES INC. yLMX 4 PLUS KIT 4% 00496088207 FERNDALE LABORATORIES INC. yLMX 4 CRE 4% 00496088215 FERNDALE LABORATORIES INC. yLMX 4 CRE 4% 00496088230 FERNDALE LABORATORIES INC. yLMX 5 CRE 5% 00496088315 FERNDALE LABORATORIES INC. yLMX 5 CRE 5% 00496088330 FERNDALE LABORATORIES INC. yACTHREL INJ 100MCG 55566030201 FERRING PHARMACEUTICALS, INC. yNOVAREL INJ 10000UNT 55566150101 FERRING PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DESMOPRESSIN SOL 0.01% 55566502001 FERRING PHARMACEUTICALS, INC. yDESMOPRESSIN SOL 0.01% 55566502002 FERRING PHARMACEUTICALS, INC. yDESMOPRESSIN INJ 4MCG/ML 55566503001 FERRING PHARMACEUTICALS, INC. yDESMOPRESSIN INJ 4MCG/ML 55566504001 FERRING PHARMACEUTICALS, INC. yREPRONEX INJ 75UNIT 55566718502 FERRING PHARMACEUTICALS, INC. yMENOPUR INJ 75UNIT 55566750102 FERRING PHARMACEUTICALS, INC. yBRAVELLE INJ 75UNIT 55566850502 FERRING PHARMACEUTICALS, INC. yBRAVELLE INJ 75UNIT 55566850506 FERRING PHARMACEUTICALS, INC. yFRESHKOTE DRO 15821010115 FOCUS LABORATORIES, INC. yTHYROLAR-1/4 TAB 15MG 00456004001 FOREST LABORATORIES, INC. yTHYROLAR-1/2 TAB 30MG 00456004501 FOREST LABORATORIES, INC. yTHYROLAR-1 TAB 60MG 00456005001 FOREST LABORATORIES, INC. yTHYROLAR-2 TAB 120MG 00456005501 FOREST LABORATORIES, INC. yTHYROLAR-3 TAB 180MG 00456006001 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 15MG 00456045701 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 30MG 00456045800 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 30MG 00456045801 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 30MG 00456045863 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 60MG 00456045900 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 60MG 00456045901 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 60MG 00456045963 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 90MG 00456046001 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 120MG 00456046100 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 120MG 00456046101 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 120MG 00456046163 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 180MG 00456046200 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 180MG 00456046201 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 240MG 00456046301 FOREST LABORATORIES, INC. yARMOUR THYRO TAB 300MG 00456046401 FOREST LABORATORIES, INC. yFLUMADINE TAB 100MG 00456052101 FOREST LABORATORIES, INC. yBANALG LOT 00456052316 FOREST LABORATORIES, INC. yBANALG LOT 00456052321 FOREST LABORATORIES, INC. yBANALG HOSP LOT STRENGTH 00456052521 FOREST LABORATORIES, INC. yFLUMADINE SYP 50MG/5ML 00456052708 FOREST LABORATORIES, INC. yELIXOPHYLLIN ELX 80/15ML 00456064416 FOREST LABORATORIES, INC. yELIXOPHYL GG SOL 100-100 00456064808 FOREST LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ELIXOPHYL GG SOL 100-100 00456064816 FOREST LABORATORIES, INC. yKAY CIEL POW 20MEQ 00456066270 FOREST LABORATORIES, INC. yKAY CIEL POW 20MEQ 00456066271 FOREST LABORATORIES, INC. yAEROBID-M AER 250MCG 00456067099 FOREST LABORATORIES, INC. yAEROBID AER 250MCG 00456067299 FOREST LABORATORIES, INC. yESGIC-PLUS TAB 00456067801 FOREST LABORATORIES, INC. yESGIC-PLUS CAP 00456067901 FOREST LABORATORIES, INC. yTESSALON PER CAP 100MG 00456068801 FOREST LABORATORIES, INC. yTESSALON PER CAP 100MG 00456068802 FOREST LABORATORIES, INC. yTESSALON CAP 200MG 00456069801 FOREST LABORATORIES, INC. yCEBO #1 CAP BLUE 00456070701 FOREST LABORATORIES, INC. yCEBO #2 CAP GREEN 00456070801 FOREST LABORATORIES, INC. yCEBO #3 CAP ORANGE 00456070901 FOREST LABORATORIES, INC. yLEVOTHROID TAB 25MCG 00456132000 FOREST LABORATORIES, INC. yLEVOTHROID TAB 25MCG 00456132001 FOREST LABORATORIES, INC. yLEVOTHROID TAB 50MCG 00456132100 FOREST LABORATORIES, INC. yLEVOTHROID TAB 50MCG 00456132101 FOREST LABORATORIES, INC. yLEVOTHROID TAB 75MCG 00456132200 FOREST LABORATORIES, INC. yLEVOTHROID TAB 75MCG 00456132201 FOREST LABORATORIES, INC. yLEVOTHROID TAB 100MCG 00456132300 FOREST LABORATORIES, INC. yLEVOTHROID TAB 100MCG 00456132301 FOREST LABORATORIES, INC. yLEVOTHROID TAB 125MCG 00456132400 FOREST LABORATORIES, INC. yLEVOTHROID TAB 125MCG 00456132401 FOREST LABORATORIES, INC. yLEVOTHROID TAB 150MCG 00456132500 FOREST LABORATORIES, INC. yLEVOTHROID TAB 150MCG 00456132501 FOREST LABORATORIES, INC. yLEVOTHROID TAB 175MCG 00456132600 FOREST LABORATORIES, INC. yLEVOTHROID TAB 175MCG 00456132601 FOREST LABORATORIES, INC. yLEVOTHROID TAB 200MCG 00456132700 FOREST LABORATORIES, INC. yLEVOTHROID TAB 200MCG 00456132701 FOREST LABORATORIES, INC. yLEVOTHROID TAB 300MCG 00456132800 FOREST LABORATORIES, INC. yLEVOTHROID TAB 300MCG 00456132801 FOREST LABORATORIES, INC. yLEVOTHROID TAB 88MCG 00456132900 FOREST LABORATORIES, INC. yLEVOTHROID TAB 88MCG 00456132901 FOREST LABORATORIES, INC. yLEVOTHROID TAB 112MCG 00456133000 FOREST LABORATORIES, INC. yLEVOTHROID TAB 112MCG 00456133001 FOREST LABORATORIES, INC. yLEVOTHROID TAB 137MCG 00456133100 FOREST LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LEVOTHROID TAB 137MCG 00456133101 FOREST LABORATORIES, INC. yLEXAPRO TAB 5MG 00456200501 FOREST LABORATORIES, INC. yLEXAPRO TAB 10MG 00456201001 FOREST LABORATORIES, INC. yLEXAPRO TAB 10MG 00456201063 FOREST LABORATORIES, INC. yLEXAPRO TAB 20MG 00456202001 FOREST LABORATORIES, INC. yLEXAPRO TAB 20MG 00456202063 FOREST LABORATORIES, INC. yLEXAPRO SOL 5MG/5ML 00456210108 FOREST LABORATORIES, INC. yTIAZAC CAP 120MG/24 00456261200 FOREST LABORATORIES, INC. yTIAZAC CAP 120MG/24 00456261230 FOREST LABORATORIES, INC. yTIAZAC CAP 120MG/24 00456261263 FOREST LABORATORIES, INC. yTIAZAC CAP 120MG/24 00456261290 FOREST LABORATORIES, INC. yTIAZAC CAP 180MG/24 00456261300 FOREST LABORATORIES, INC. yTIAZAC CAP 180MG/24 00456261330 FOREST LABORATORIES, INC. yTIAZAC CAP 180MG/24 00456261363 FOREST LABORATORIES, INC. yTIAZAC CAP 180MG/24 00456261390 FOREST LABORATORIES, INC. yTIAZAC CAP 240MG/24 00456261400 FOREST LABORATORIES, INC. yTIAZAC CAP 240MG/24 00456261430 FOREST LABORATORIES, INC. yTIAZAC CAP 240MG/24 00456261463 FOREST LABORATORIES, INC. yTIAZAC CAP 240MG/24 00456261490 FOREST LABORATORIES, INC. yTIAZAC CAP 300MG/24 00456261500 FOREST LABORATORIES, INC. yTIAZAC CAP 300MG/24 00456261530 FOREST LABORATORIES, INC. yTIAZAC CAP 300MG/24 00456261563 FOREST LABORATORIES, INC. yTIAZAC CAP 300MG/24 00456261590 FOREST LABORATORIES, INC. yTIAZAC CAP 360MG/24 00456261600 FOREST LABORATORIES, INC. yTIAZAC CAP 360MG/24 00456261630 FOREST LABORATORIES, INC. yTIAZAC CAP 360MG/24 00456261663 FOREST LABORATORIES, INC. yTIAZAC CAP 360MG/24 00456261690 FOREST LABORATORIES, INC. yTIAZAC CAP 420MG/24 00456261700 FOREST LABORATORIES, INC. yTIAZAC CAP 420MG/24 00456261730 FOREST LABORATORIES, INC. yTIAZAC CAP 420MG/24 00456261790 FOREST LABORATORIES, INC. yNAMENDA TAB 5-10MG 00456320014 FOREST LABORATORIES, INC. yNAMENDA SOL 10MG/5ML 00456320212 FOREST LABORATORIES, INC. yNAMENDA TAB 5MG 00456320560 FOREST LABORATORIES, INC. yNAMENDA TAB 5MG 00456320563 FOREST LABORATORIES, INC. yNAMENDA TAB 10MG 00456321060 FOREST LABORATORIES, INC. yNAMENDA TAB 10MG 00456321063 FOREST LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CAMPRAL TAB 333MG 00456333001 FOREST LABORATORIES, INC. yCAMPRAL TAB 333MG 00456333060 FOREST LABORATORIES, INC. yCAMPRAL TAB 333MG 00456333063 FOREST LABORATORIES, INC. yCELEXA TAB 10MG 00456401001 FOREST LABORATORIES, INC. yCELEXA TAB 20MG 00456402001 FOREST LABORATORIES, INC. yCELEXA TAB 20MG 00456402063 FOREST LABORATORIES, INC. yCELEXA TAB 40MG 00456404001 FOREST LABORATORIES, INC. yCELEXA TAB 40MG 00456404063 FOREST LABORATORIES, INC. yCELEXA SOL 10MG/5ML 00456413008 FOREST LABORATORIES, INC. yMONUROL PAK GRANULES 00456430008 FOREST LABORATORIES, INC. yTHEOCAP CAP 200MG CR 00456430201 FOREST LABORATORIES, INC. yTHEOCAP CAP 300MG CR 00456430301 FOREST LABORATORIES, INC. yTHEOCHRON TAB 100MG CR 00456431001 FOREST LABORATORIES, INC. yTHEOCHRON TAB 200MG CR 00456432000 FOREST LABORATORIES, INC. yTHEOCHRON TAB 200MG CR 00456432001 FOREST LABORATORIES, INC. yTHEOCHRON TAB 200MG CR 00456432002 FOREST LABORATORIES, INC. yTHEOCHRON TAB 300MG CR 00456433000 FOREST LABORATORIES, INC. yTHEOCHRON TAB 300MG CR 00456433001 FOREST LABORATORIES, INC. yTHEOCHRON TAB 300MG CR 00456433002 FOREST LABORATORIES, INC. yCOMBUNOX TAB 5/400MG 00456520001 FOREST LABORATORIES, INC. yISOPTIN SR TAB 120MG 13551020101 FSC LABORATORIES, INC. yISOPTIN SR TAB 180MG 13551030101 FSC LABORATORIES, INC. yISOPTIN SR TAB 240MG 13551040101 FSC LABORATORIES, INC. yISOPTIN SR TAB 240MG 13551040105 FSC LABORATORIES, INC. yPRIMSOL SOL 50MG/5ML 13551050105 FSC LABORATORIES, INC. yGLYCERIN SUP 3GM 00713010102 G&W LABORATORIES, INC ySANI-SUPP SUP 3GM 00713010109 G&W LABORATORIES, INC yGLYCERIN SUP 3GM 00713010113 G&W LABORATORIES, INC ySANI-SUPP SUP 3GM 00713010125 G&W LABORATORIES, INC yGLYCERIN SUP 3GM 00713010126 G&W LABORATORIES, INC ySANI-SUPP SUP 3GM 00713010150 G&W LABORATORIES, INC yGLYCERIN SUP 3GM 00713010151 G&W LABORATORIES, INC ySANI-SUPP SUP 1.5GM 00713010209 G&W LABORATORIES, INC yGLYCERIN SUP 1.5GM 00713010213 G&W LABORATORIES, INC ySANI-SUPP SUP 1.5GM 00713010225 G&W LABORATORIES, INC yGLYCERIN SUP 1.5GM 00713010226 G&W LABORATORIES, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TEBAMIDE SUP 100MG 00713010709 G&W LABORATORIES, INC yTEBAMIDE SUP 200MG 00713010809 G&W LABORATORIES, INC yTEBAMIDE SUP 200MG 00713010850 G&W LABORATORIES, INC yBISAC-EVAC SUP 10MG 00713010901 G&W LABORATORIES, INC yBISAC-EVAC SUP 10MG 00713010905 G&W LABORATORIES, INC yBISAC-EVAC SUP 10MG 00713010908 G&W LABORATORIES, INC yBISAC-EVAC SUP 10MG 00713010910 G&W LABORATORIES, INC yBISAC-EVAC SUP 10MG 00713010912 G&W LABORATORIES, INC yBISAC-EVAC SUP 10MG 00713010950 G&W LABORATORIES, INC yACEPHEN SUP 120MG 00713011801 G&W LABORATORIES, INC yACEPHEN SUP 120MG 00713011811 G&W LABORATORIES, INC yACEPHEN SUP 120MG 00713011812 G&W LABORATORIES, INC yACEPHEN SUP 120MG 00713011850 G&W LABORATORIES, INC yACEPHEN SUP 120MG 00713011866 G&W LABORATORIES, INC yPROMETHEGAN SUP 50MG 00713013212 G&W LABORATORIES, INC yPROCHLORPER SUP 25MG 00713013512 G&W LABORATORIES, INC yACEPHEN SUP 325MG 00713016401 G&W LABORATORIES, INC yACEPHEN SUP 325MG 00713016411 G&W LABORATORIES, INC yACEPHEN SUP 325MG 00713016412 G&W LABORATORIES, INC yACEPHEN SUP 325MG 00713016450 G&W LABORATORIES, INC yACEPHEN SUP 325MG 00713016466 G&W LABORATORIES, INC yACEPHEN SUP 650MG 00713016501 G&W LABORATORIES, INC yACEPHEN SUP 650MG 00713016505 G&W LABORATORIES, INC yACEPHEN SUP 650MG 00713016512 G&W LABORATORIES, INC yACEPHEN SUP 650MG 00713016550 G&W LABORATORIES, INC yMIGERGOT SUP 2/100 00713016612 G&W LABORATORIES, INC yMICONAZOLE SUP 100MG 00713019757 G&W LABORATORIES, INC yMICONAZOLE CRE 2% 00713025237 G&W LABORATORIES, INC yDIAPER RASH OIN 40% 00713025804 G&W LABORATORIES, INC yMICONAZOLE CRE 2% 00713026731 G&W LABORATORIES, INC yTRIPLE ANTIB OIN 00713026831 G&W LABORATORIES, INC yPAIN RELIEVE CRE RUB 00713028304 G&W LABORATORIES, INC yPAIN RELIEVE CRE RUB 00713028338 G&W LABORATORIES, INC yHYDROCORT OIN 1% 00713028831 G&W LABORATORIES, INC yHYDROCORT OIN ALOE 1% 00713029031 G&W LABORATORIES, INC yHYDROCORT/ CRE ALOE 1% 00713029131 G&W LABORATORIES, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TOLNAFTATE CRE 1% 00713029231 G&W LABORATORIES, INC yZINC OXIDE OIN 20% 00713029332 G&W LABORATORIES, INC yALLERGY CRE 2% 00713029531 G&W LABORATORIES, INC yFORMULATION OIN R 00713029831 G&W LABORATORIES, INC yFORMULATION OIN R 00713029832 G&W LABORATORIES, INC ySANI-PADS PAD 00713030898 G&W LABORATORIES, INC yDOCUSOFT S CAP 100MG 00713040560 G&W LABORATORIES, INC yDOCUSOFT S CAP 100MG 00713040599 G&W LABORATORIES, INC yBISAC-EVAC TAB 5MG EC 00713041625 G&W LABORATORIES, INC yANTI-DIARRHE TAB 2MG 00713041812 G&W LABORATORIES, INC yANTI-DIARRHE TAB 2MG 00713041821 G&W LABORATORIES, INC yANTI-DIARRHE TAB 2MG 00713041824 G&W LABORATORIES, INC yANTI-DIARRHE TAB 2MG 00713041848 G&W LABORATORIES, INC yANTI-DIARRHE TAB 2MG 00713041866 G&W LABORATORIES, INC yANTI-DIARRHE TAB 2MG 00713041879 G&W LABORATORIES, INC yFEMILAX TAB 5MG EC 00713042230 G&W LABORATORIES, INC yFEMILAX TAB 5MG EC 00713042260 G&W LABORATORIES, INC yANUCORT-HC SUP 25MG 00713050301 G&W LABORATORIES, INC yANUCORT-HC SUP 25MG 00713050312 G&W LABORATORIES, INC yANUCORT-HC SUP 25MG 00713050324 G&W LABORATORIES, INC yPROMETHEGAN SUP 25MG 00713052612 G&W LABORATORIES, INC yCHLORAL HYDR SUP 500MG 00713053301 G&W LABORATORIES, INC yCHLORAL HYDR SUP 500MG 00713053325 G&W LABORATORIES, INC yFORMULATION SUP R 00713053512 G&W LABORATORIES, INC yFORMULATION SUP R 00713053524 G&W LABORATORIES, INC yFORMULATION SUP R 00713053548 G&W LABORATORIES, INC yPROMETHEGAN SUP 12.5MG 00713053612 G&W LABORATORIES, INC yFORMULATION CRE R 00713060434 G&W LABORATORIES, INC yFORMULATION CRE R 00713060435 G&W LABORATORIES, INC yTRIPLE ANTIB OIN PLUS 00713062231 G&W LABORATORIES, INC yCARLESTA OIN 00713062304 G&W LABORATORIES, INC yCARLESTA OIN 00713062332 G&W LABORATORIES, INC yMUSCLE RUB CRE ULT STR 00713062504 G&W LABORATORIES, INC yHYDROCORT/ CRE ALOE 1% 00713062631 G&W LABORATORIES, INC yFLUTICASONE CRE 0.05% 00713063115 G&W LABORATORIES, INC yFLUTICASONE CRE 0.05% 00713063131 G&W LABORATORIES, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUTICASONE CRE 0.05% 00713063160 G&W LABORATORIES, INC yFLUTICASONE OIN 0.005% 00713063215 G&W LABORATORIES, INC yFLUTICASONE OIN 0.005% 00713063231 G&W LABORATORIES, INC yFLUTICASONE OIN 0.005% 00713063260 G&W LABORATORIES, INC yMOMETASONE CRE 0.1% 00713063415 G&W LABORATORIES, INC yMOMETASONE CRE 0.1% 00713063437 G&W LABORATORIES, INC yMOMETASONE OIN 0.1% 00713063515 G&W LABORATORIES, INC yMOMETASONE OIN 0.1% 00713063537 G&W LABORATORIES, INC yBENZAC AC GEL 5% 00299362560 GALDERMA LABORATORIES, L.P. yBENZAC AC GEL 10% 00299363060 GALDERMA LABORATORIES, L.P. yBENZAC AC LIQ WASH 5% 00299364008 GALDERMA LABORATORIES, L.P. yBENZAC AC LIQ WASH 10% 00299364508 GALDERMA LABORATORIES, L.P. yBENZAC W LIQ 5% WASH 00299367008 GALDERMA LABORATORIES, L.P. yBENZAC W LIQ 10% WASH 00299367208 GALDERMA LABORATORIES, L.P. yMETROGEL GEL 1% 00299382045 GALDERMA LABORATORIES, L.P. yMETROGEL GEL 1% 00299382060 GALDERMA LABORATORIES, L.P. yMETROGEL GEL 0.75% 00299383545 GALDERMA LABORATORIES, L.P. yMETROCREAM CRE 0.75% 00299383645 GALDERMA LABORATORIES, L.P. yMETROLOTION LOT 0.75% 00299383802 GALDERMA LABORATORIES, L.P. yROSANIL EMU CLEANSER 00299383906 GALDERMA LABORATORIES, L.P. yCLOBEX SHA 0.05% 00299384704 GALDERMA LABORATORIES, L.P. yCLOBEX LOT 0.05% 00299384802 GALDERMA LABORATORIES, L.P. yCLOBEX LOT 0.05% 00299384804 GALDERMA LABORATORIES, L.P. yCLOBEX SPR 0.05% 00299384902 GALDERMA LABORATORIES, L.P. yCLINDAGEL GEL 1% 00299450040 GALDERMA LABORATORIES, L.P. yCLINDAGEL GEL 1% 00299450075 GALDERMA LABORATORIES, L.P. yCAPEX SHA 0.01% 00299550004 GALDERMA LABORATORIES, L.P. yDESOWEN LOT 0.05% 00299576502 GALDERMA LABORATORIES, L.P. yDESOWEN LOT 0.05% 00299576504 GALDERMA LABORATORIES, L.P. yDESOWEN CRE 0.05% 00299577060 GALDERMA LABORATORIES, L.P. yDESOWEN OIN 0.05% 00299577560 GALDERMA LABORATORIES, L.P. yDIFFERIN GEL 0.1% 00299591045 GALDERMA LABORATORIES, L.P. yDIFFERIN CRE 0.1% 00299591545 GALDERMA LABORATORIES, L.P. yTRI-LUMA CRE 00299595030 GALDERMA LABORATORIES, L.P. yPOLYETHYLENE LIQ GLY 400 51552000306 GALLIPOT INCORPORATED yPOLYETHYLENE LIQ GLY 400 51552000308 GALLIPOT INCORPORATED y

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POLY GLYCOL MIS 8000 51552000406 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552000501 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552000503 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552000504 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552000505 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552000507 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000601 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000603 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000604 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000605 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000606 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000607 GALLIPOT INCORPORATED yPROGESTERONE POW 51552000609 GALLIPOT INCORPORATED yFATTYBLEND MIS 51552000706 GALLIPOT INCORPORATED yPEG BLEND OIN 51552000805 GALLIPOT INCORPORATED yPEG BLEND OIN 51552000806 GALLIPOT INCORPORATED yPEG BLEND OIN 51552000809 GALLIPOT INCORPORATED yPODOPHYLLIN POW 51552001604 GALLIPOT INCORPORATED yPOLY GLYCOL LIQ 1450 51552001902 GALLIPOT INCORPORATED yPOLY GLYCOL LIQ 1450 51552001904 GALLIPOT INCORPORATED yPOLY GLYCOL LIQ 1450 51552001906 GALLIPOT INCORPORATED yHYDROCORT POW 51552002001 GALLIPOT INCORPORATED yHYDROCORT POW 51552002002 GALLIPOT INCORPORATED yHYDROCORT POW 51552002003 GALLIPOT INCORPORATED yHYDROCORT POW 51552002004 GALLIPOT INCORPORATED yHYDROCORT POW 51552002005 GALLIPOT INCORPORATED yHYDROCORT POW 51552002007 GALLIPOT INCORPORATED yHYDROCORT AC POW 51552002101 GALLIPOT INCORPORATED yHYDROCORT AC POW 51552002102 GALLIPOT INCORPORATED yHYDROCORT AC POW 51552002103 GALLIPOT INCORPORATED yHYDROCORT AC POW 51552002104 GALLIPOT INCORPORATED yHYDROCORT AC POW 51552002105 GALLIPOT INCORPORATED yHYDROCORT AC POW 51552002107 GALLIPOT INCORPORATED yBETAMETH DIP POW 51552002201 GALLIPOT INCORPORATED yBETAMETH DIP POW 51552002202 GALLIPOT INCORPORATED yBETAMETH DIP POW 51552002203 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETAMETH DIP POW 51552002209 GALLIPOT INCORPORATED yBETAMETH VAL POW 51552002301 GALLIPOT INCORPORATED yBETAMETH VAL POW 51552002302 GALLIPOT INCORPORATED yBETAMETH VAL POW 51552002303 GALLIPOT INCORPORATED yDEXAMETHASON POW ACETATE 51552002401 GALLIPOT INCORPORATED yDEXAMETHASON POW ACETATE 51552002402 GALLIPOT INCORPORATED yDEXAMETHASON POW ACETATE 51552002403 GALLIPOT INCORPORATED yDEXAMETHASON POW ACETATE 51552002404 GALLIPOT INCORPORATED yDEXAMETHASON POW ACETATE 51552002405 GALLIPOT INCORPORATED yDEXAMETH SOD POW PHOSPHAT 51552002501 GALLIPOT INCORPORATED yDEXAMETH SOD POW PHOSPHAT 51552002502 GALLIPOT INCORPORATED yDEXAMETH SOD POW PHOSPHAT 51552002503 GALLIPOT INCORPORATED yDEXAMETH SOD POW PHOSPHAT 51552002504 GALLIPOT INCORPORATED yDEXAMETH SOD POW PHOSPHAT 51552002505 GALLIPOT INCORPORATED yDEXAMETH SOD POW PHOSPHAT 51552002506 GALLIPOT INCORPORATED yPREDNISOLONE POW ANHYDROU 51552002602 GALLIPOT INCORPORATED yPREDNISOLONE POW ANHYDROU 51552002604 GALLIPOT INCORPORATED yPREDNISOLONE POW ANHYDROU 51552002605 GALLIPOT INCORPORATED yPREDNISOL AC POW 51552002702 GALLIPOT INCORPORATED yPREDNISOL AC POW 51552002704 GALLIPOT INCORPORATED yPREDNISOL AC POW 51552002705 GALLIPOT INCORPORATED yPREDNISONE POW 51552002801 GALLIPOT INCORPORATED yPREDNISONE POW 51552002802 GALLIPOT INCORPORATED yPREDNISONE POW 51552002804 GALLIPOT INCORPORATED yPREDNISONE POW 51552002805 GALLIPOT INCORPORATED yPREDNISONE POW 51552002806 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002901 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002902 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002904 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002905 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002906 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002907 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002908 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552002909 GALLIPOT INCORPORATED yTESTOST PROP POW 51552003001 GALLIPOT INCORPORATED yTESTOST PROP POW 51552003002 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TESTOST PROP POW 51552003004 GALLIPOT INCORPORATED yTESTOST PROP POW 51552003005 GALLIPOT INCORPORATED yTESTOST PROP POW 51552003007 GALLIPOT INCORPORATED yTESTOST PROP POW 51552003008 GALLIPOT INCORPORATED yTESTOST PROP POW 51552003009 GALLIPOT INCORPORATED yMETHYLTESTOS POW 51552003101 GALLIPOT INCORPORATED yMETHYLTESTOS POW 51552003102 GALLIPOT INCORPORATED yMETHYLTESTOS POW 51552003103 GALLIPOT INCORPORATED yMETHYLTESTOS POW 51552003104 GALLIPOT INCORPORATED yMETHYLTESTOS POW 51552003105 GALLIPOT INCORPORATED yMETHYLTESTOS POW 51552003109 GALLIPOT INCORPORATED yTRIAMCINOLON POW ACETONID 51552003301 GALLIPOT INCORPORATED yTRIAMCINOLON POW ACETONID 51552003302 GALLIPOT INCORPORATED yTRIAMCINOLON POW ACETONID 51552003303 GALLIPOT INCORPORATED yTRIAMCINOLON POW ACETONID 51552003305 GALLIPOT INCORPORATED yOXALIC ACID CRY 51552003404 GALLIPOT INCORPORATED yCORTISONE AC POW MICRO 51552003501 GALLIPOT INCORPORATED yMETHOCEL E4M POW PREMIUM 51552003704 GALLIPOT INCORPORATED yMETHOCEL E4M POW PREMIUM 51552003705 GALLIPOT INCORPORATED yMETHOCEL E4M POW PREMIUM 51552003706 GALLIPOT INCORPORATED yMETRONIDAZOL POW 51552003803 GALLIPOT INCORPORATED yMETRONIDAZOL POW 51552003804 GALLIPOT INCORPORATED yMETRONIDAZOL POW 51552003805 GALLIPOT INCORPORATED yMETRONIDAZOL POW 51552003806 GALLIPOT INCORPORATED ySUCRALFATE POW 51552003905 GALLIPOT INCORPORATED ySUCRALFATE POW 51552003906 GALLIPOT INCORPORATED ySUCRALFATE POW 51552003907 GALLIPOT INCORPORATED yPOT PERMANGT GRA 51552004004 GALLIPOT INCORPORATED yNYSTATIN POW 51552004101 GALLIPOT INCORPORATED yNYSTATIN POW 51552004102 GALLIPOT INCORPORATED yNYSTATIN POW 51552004103 GALLIPOT INCORPORATED yNYSTATIN POW 51552004104 GALLIPOT INCORPORATED yNYSTATIN POW 51552004105 GALLIPOT INCORPORATED yNYSTATIN POW 51552004106 GALLIPOT INCORPORATED yGLYCOPYRROL POW 51552004201 GALLIPOT INCORPORATED yGLYCOPYRROL POW 51552004202 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALBUTEROL POW SULFATE 51552004402 GALLIPOT INCORPORATED yALBUTEROL POW SULFATE 51552004404 GALLIPOT INCORPORATED yALBUTEROL POW SULFATE 51552004405 GALLIPOT INCORPORATED yALBUTEROL POW SULFATE 51552004407 GALLIPOT INCORPORATED yMENTHOL CRY 51552004504 GALLIPOT INCORPORATED yMENTHOL CRY 51552004505 GALLIPOT INCORPORATED yMENTHOL CRY 51552004506 GALLIPOT INCORPORATED yBORIC ACID GRA 51552004604 GALLIPOT INCORPORATED yCITRIC ACID GRA ANHYDROU 51552004804 GALLIPOT INCORPORATED yCITRIC ACID GRA ANHYDROU 51552004806 GALLIPOT INCORPORATED yCITRIC ACID GRA ANHYDROU 51552004807 GALLIPOT INCORPORATED yCITRIC ACID GRA ANHYDROU 51552004809 GALLIPOT INCORPORATED yTRICHLOROACE CRY ACID 51552004902 GALLIPOT INCORPORATED yTRICHLOROACE CRY ACID 51552004904 GALLIPOT INCORPORATED yTRICHLOROACE CRY ACID 51552004906 GALLIPOT INCORPORATED yEUGENOL SOL 51552005004 GALLIPOT INCORPORATED yACETIC ACID SOL 3% 51552005106 GALLIPOT INCORPORATED yACETIC ACID SOL 3% 51552005108 GALLIPOT INCORPORATED yRESORCINOL POW 51552005204 GALLIPOT INCORPORATED yRESORCINOL POW 51552005205 GALLIPOT INCORPORATED ySALICYLIC POW ACID 51552005303 GALLIPOT INCORPORATED ySALICYLIC POW ACID 51552005304 GALLIPOT INCORPORATED ySALICYLIC POW ACID 51552005306 GALLIPOT INCORPORATED ySALICYLIC POW ACID 51552005309 GALLIPOT INCORPORATED yACETIC ACID SOL 5% 51552005506 GALLIPOT INCORPORATED yACETIC ACID SOL 5% 51552005508 GALLIPOT INCORPORATED yFLUOCINONIDE POW MICRONIZ 51552005601 GALLIPOT INCORPORATED yFLUOCINONIDE POW MICRONIZ 51552005602 GALLIPOT INCORPORATED yUREA POW 51552005704 GALLIPOT INCORPORATED yUREA POW 51552005706 GALLIPOT INCORPORATED yUREA POW 51552005708 GALLIPOT INCORPORATED ySODIUM POW BICARBON 51552005906 GALLIPOT INCORPORATED ySODIUM POW BICARBON 51552005909 GALLIPOT INCORPORATED yBETAMETHASON POW SOD PHOS 51552006401 GALLIPOT INCORPORATED yBETAMETHASON POW SOD PHOS 51552006402 GALLIPOT INCORPORATED yBETAMETHASON POW SOD PHOS 51552006403 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETAMETHASON POW SOD PHOS 51552006405 GALLIPOT INCORPORATED yBETAMETHASON POW SOD PHOS 51552006409 GALLIPOT INCORPORATED yACACIA POW 51552006504 GALLIPOT INCORPORATED yACACIA POW 51552006506 GALLIPOT INCORPORATED yHYDROQUINONE POW 51552006604 GALLIPOT INCORPORATED yHYDROQUINONE POW 51552006606 GALLIPOT INCORPORATED yHYDROQUINONE POW 51552006609 GALLIPOT INCORPORATED yPODOPHYLLUM POW RESIN 51552006809 GALLIPOT INCORPORATED ySOD METABISU GRA ANHYDR 51552006905 GALLIPOT INCORPORATED yPOT HYDROXID SOL 10% 51552007106 GALLIPOT INCORPORATED yPROCHLORPER POW MALEATE 51552007405 GALLIPOT INCORPORATED yPROCHLORPER POW MALEATE 51552007409 GALLIPOT INCORPORATED yISOPROPAMIDE POW IODIDE 51552007503 GALLIPOT INCORPORATED yCITRIC ACID GRA MONOHYD 51552007604 GALLIPOT INCORPORATED ySOD CHLORIDE GRA 51552007706 GALLIPOT INCORPORATED ySOD CHLORIDE GRA 51552007708 GALLIPOT INCORPORATED ySOD CHLORIDE GRA 51552007709 GALLIPOT INCORPORATED yCHLORHEX GLU SOL 20% 51552007805 GALLIPOT INCORPORATED yCHLORHEX GLU SOL 20% 51552007806 GALLIPOT INCORPORATED yCHLORHEX GLU SOL 20% 51552007808 GALLIPOT INCORPORATED yCHLORHEX GLU SOL 20% 51552007809 GALLIPOT INCORPORATED yMETAPROTEREN POW SULFATE 51552007902 GALLIPOT INCORPORATED yMETAPROTEREN POW SULFATE 51552007904 GALLIPOT INCORPORATED yMETAPROTEREN POW SULFATE 51552007905 GALLIPOT INCORPORATED yMETAPROTEREN POW SULFATE 51552007906 GALLIPOT INCORPORATED yMETAPROTEREN POW SULFATE 51552007907 GALLIPOT INCORPORATED ySOD HYDROXID MIS PELLETS 51552008006 GALLIPOT INCORPORATED yPOT NITRATE GRA PURIFIED 51552008204 GALLIPOT INCORPORATED yACETAMIN POW 51552008602 GALLIPOT INCORPORATED yACETAMIN POW 51552008604 GALLIPOT INCORPORATED yACETAMIN POW 51552008606 GALLIPOT INCORPORATED yACETAMIN POW 51552008607 GALLIPOT INCORPORATED yACETAMIN POW 51552008609 GALLIPOT INCORPORATED yPOLYSORBATE LIQ 80 51552009205 GALLIPOT INCORPORATED yPOLYSORBATE LIQ 80 51552009206 GALLIPOT INCORPORATED yPOLYSORBATE LIQ 80 51552009208 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COCONUT OIL 51552009304 GALLIPOT INCORPORATED yGLYCERIN LIQ 99.5% 51552009404 GALLIPOT INCORPORATED yGLYCERIN LIQ 99.5% 51552009406 GALLIPOT INCORPORATED yGLYCERIN LIQ 99.5% 51552009408 GALLIPOT INCORPORATED yGELATIN POW 51552009504 GALLIPOT INCORPORATED ySORBITOL SOL 70% 51552009606 GALLIPOT INCORPORATED ySORBITOL SOL 70% 51552009608 GALLIPOT INCORPORATED yPABA POW 51552009704 GALLIPOT INCORPORATED yBUTYLAT HYDR CRY 51552009805 GALLIPOT INCORPORATED yBUTYLAT HYDR CRY 51552009806 GALLIPOT INCORPORATED yCAROXYMETHY GRA SODIUM 51552009904 GALLIPOT INCORPORATED yXANTHAN GUM POW 51552010002 GALLIPOT INCORPORATED yXANTHAN GUM POW 51552010005 GALLIPOT INCORPORATED yXANTHAN GUM POW 51552010008 GALLIPOT INCORPORATED yXANTHAN GUM POW 51552010009 GALLIPOT INCORPORATED yMETHYLPARABE POW 51552010104 GALLIPOT INCORPORATED yPROPYPARABEN POW 51552010204 GALLIPOT INCORPORATED yPROPYLENE GL SOL 51552010306 GALLIPOT INCORPORATED yPROPYLENE GL SOL 51552010308 GALLIPOT INCORPORATED yTESTOSTERONE POW CYPIONAT 51552010402 GALLIPOT INCORPORATED yTESTOSTERONE POW CYPIONAT 51552010404 GALLIPOT INCORPORATED yTESTOSTERONE POW CYPIONAT 51552010405 GALLIPOT INCORPORATED ySOD PERBORAT GRA 51552010504 GALLIPOT INCORPORATED yLIDOCAINE POW HCL 51552010604 GALLIPOT INCORPORATED yLIDOCAINE POW HCL 51552010605 GALLIPOT INCORPORATED yLIDOCAINE POW HCL 51552010606 GALLIPOT INCORPORATED yLIDOCAINE POW HCL 51552010607 GALLIPOT INCORPORATED yLIDOCAINE POW HCL 51552010609 GALLIPOT INCORPORATED yCARBOPOL 940 POW RESIN 51552010704 GALLIPOT INCORPORATED yCOAL TAR SOL USP/NF 51552011404 GALLIPOT INCORPORATED yLACTIC ACID SOL 85% 51552011604 GALLIPOT INCORPORATED yCOLLODION LIQ FLEXIBLE 51552011704 GALLIPOT INCORPORATED yCOLLODION LIQ FLEXIBLE 51552011706 GALLIPOT INCORPORATED yPHENOL LIQ 51552011803 GALLIPOT INCORPORATED yPHENOL LIQ 51552011804 GALLIPOT INCORPORATED ySIMETHICONE LIQ 51552011904 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RETINOIC ACD POW 51552012001 GALLIPOT INCORPORATED yRETINOIC ACD POW 51552012003 GALLIPOT INCORPORATED yRETINOIC ACD POW 51552012004 GALLIPOT INCORPORATED yRETINOIC ACD POW 51552012005 GALLIPOT INCORPORATED yDEXTROMETHOR CRY MONOHYDR 51552012103 GALLIPOT INCORPORATED yDEXTROMETHOR CRY MONOHYDR 51552012104 GALLIPOT INCORPORATED yDEXTROMETHOR CRY MONOHYDR 51552012105 GALLIPOT INCORPORATED yDEXTROMETHOR CRY MONOHYDR 51552012107 GALLIPOT INCORPORATED yMICONAZOLE POW NITRATE 51552012202 GALLIPOT INCORPORATED yMICONAZOLE POW NITRATE 51552012204 GALLIPOT INCORPORATED yMICONAZOLE POW NITRATE 51552012205 GALLIPOT INCORPORATED yDEXTROSE POW MONOHYD 51552012306 GALLIPOT INCORPORATED yDIPHENHYDRAM POW 51552012402 GALLIPOT INCORPORATED yDIPHENHYDRAM POW 51552012404 GALLIPOT INCORPORATED yDIPHENHYDRAM POW 51552012405 GALLIPOT INCORPORATED yDIPHENHYDRAM POW 51552012406 GALLIPOT INCORPORATED yPSEUDOEPHED POW 51552012502 GALLIPOT INCORPORATED yPSEUDOEPHED POW 51552012504 GALLIPOT INCORPORATED yPSEUDOEPHED POW 51552012505 GALLIPOT INCORPORATED yPSEUDOEPHED POW 51552012506 GALLIPOT INCORPORATED ySILICA GEL 51552012605 GALLIPOT INCORPORATED ySILICA GEL 51552012607 GALLIPOT INCORPORATED ySILICA GEL 51552012609 GALLIPOT INCORPORATED yTANNIC ACID POW 51552012704 GALLIPOT INCORPORATED yALMOND OIL SWEET 51552012804 GALLIPOT INCORPORATED yALMOND OIL SWEET 51552012806 GALLIPOT INCORPORATED yALMOND OIL SWEET 51552012808 GALLIPOT INCORPORATED yCAPSAICIN POW 51552012901 GALLIPOT INCORPORATED yBENZOCAINE POW 51552013002 GALLIPOT INCORPORATED yBENZOCAINE POW 51552013004 GALLIPOT INCORPORATED yBENZOCAINE POW 51552013006 GALLIPOT INCORPORATED yPHENOL CRY 51552013102 GALLIPOT INCORPORATED yPHENOL CRY 51552013104 GALLIPOT INCORPORATED ySULFUR POW SUBLIMED 51552013304 GALLIPOT INCORPORATED yFLUOCINOLONE POW ACETONID 51552013401 GALLIPOT INCORPORATED yFLUOCINOLONE POW ACETONID 51552013402 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENTONITE POW 51552013504 GALLIPOT INCORPORATED yLACTOSE POW 51552013601 GALLIPOT INCORPORATED yLACTOSE POW 51552013605 GALLIPOT INCORPORATED yLACTOSE POW 51552013606 GALLIPOT INCORPORATED yLACTOSE POW 51552013608 GALLIPOT INCORPORATED yCLOTRIMAZOLE CRY 51552013802 GALLIPOT INCORPORATED yCLOTRIMAZOLE CRY 51552013804 GALLIPOT INCORPORATED yCLOTRIMAZOLE CRY 51552013805 GALLIPOT INCORPORATED yCHLORPROMAZ POW HCL 51552013904 GALLIPOT INCORPORATED yCHLORPROMAZ POW HCL 51552013905 GALLIPOT INCORPORATED yGUAIFENESIN POW 51552014005 GALLIPOT INCORPORATED yGUAIFENESIN POW 51552014006 GALLIPOT INCORPORATED yHYOSCYAMINE POW SULFATE 51552014102 GALLIPOT INCORPORATED yHYOSCYAMINE POW SULFATE 51552014104 GALLIPOT INCORPORATED yTHIAMINE HCL POW 51552014304 GALLIPOT INCORPORATED yTHIAMINE HCL POW 51552014305 GALLIPOT INCORPORATED yPOT BROMIDE GRA 51552014404 GALLIPOT INCORPORATED yPOT BROMIDE GRA 51552014406 GALLIPOT INCORPORATED yPOT BROMIDE GRA 51552014409 GALLIPOT INCORPORATED yLIDOCAINE POW 51552014504 GALLIPOT INCORPORATED yLIDOCAINE POW 51552014505 GALLIPOT INCORPORATED yLIDOCAINE POW 51552014506 GALLIPOT INCORPORATED ySOD FLUORIDE POW 51552014604 GALLIPOT INCORPORATED ySOD FLUORIDE POW 51552014606 GALLIPOT INCORPORATED yPROMETHAZINE POW HCL 51552014701 GALLIPOT INCORPORATED yPROMETHAZINE POW HCL 51552014702 GALLIPOT INCORPORATED yPROMETHAZINE POW HCL 51552014704 GALLIPOT INCORPORATED yPROMETHAZINE POW HCL 51552014705 GALLIPOT INCORPORATED yPYRIDOXINE POW HCL 51552014904 GALLIPOT INCORPORATED yGREEN SOAP TIN 51552015104 GALLIPOT INCORPORATED yBENZALKONIUM CON 50% 51552015304 GALLIPOT INCORPORATED yBENZALKONIUM CON 50% 51552015306 GALLIPOT INCORPORATED yBENZALKONIUM CON 50% 51552015308 GALLIPOT INCORPORATED yATROPINE POW SULFATE 51552015602 GALLIPOT INCORPORATED yATROPINE POW SULFATE 51552015604 GALLIPOT INCORPORATED yBISMUTH POW SUBNITRA 51552016204 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ASCORBIC ACD POW 51552016304 GALLIPOT INCORPORATED yASCORBIC ACD GRA 51552016404 GALLIPOT INCORPORATED yASCORBIC ACD GRA 51552016407 GALLIPOT INCORPORATED yORANGE CONC LIQ 51552016603 GALLIPOT INCORPORATED yBENZOIN TIN PLAIN 51552017701 GALLIPOT INCORPORATED yBENZOIN TIN PLAIN 51552017704 GALLIPOT INCORPORATED yBENZOIN TIN PLAIN 51552017706 GALLIPOT INCORPORATED yCAFFEINE POW CITRATED 51552017805 GALLIPOT INCORPORATED yCAFFEINE POW CITRATED 51552017806 GALLIPOT INCORPORATED yALLANTOIN POW 51552017905 GALLIPOT INCORPORATED yMETOCLOPRAM POW MONOHYDR 51552018003 GALLIPOT INCORPORATED yMETOCLOPRAM POW MONOHYDR 51552018004 GALLIPOT INCORPORATED yMETOCLOPRAM POW MONOHYDR 51552018005 GALLIPOT INCORPORATED yERGOTAMINE POW TARTRATE 51552018101 GALLIPOT INCORPORATED yERGOTAMINE POW TARTRATE 51552018102 GALLIPOT INCORPORATED yERGOTAMINE POW TARTRATE 51552018109 GALLIPOT INCORPORATED yEUCALYPTUS OIL 51552018202 GALLIPOT INCORPORATED yGLYCOLIC ACD CRY 51552018304 GALLIPOT INCORPORATED yGLYCOLIC ACD CRY 51552018305 GALLIPOT INCORPORATED yALUMINUM CL CRY 51552018505 GALLIPOT INCORPORATED yALUMINUM CL CRY 51552018506 GALLIPOT INCORPORATED ySOD SACCHARI POW 51552018704 GALLIPOT INCORPORATED ySOD SACCHARI POW 51552018706 GALLIPOT INCORPORATED yERGONOVINE POW MALEATE 51552018801 GALLIPOT INCORPORATED yERGONOVINE POW MALEATE 51552018802 GALLIPOT INCORPORATED yERGONOVINE POW MALEATE 51552018807 GALLIPOT INCORPORATED yERGONOVINE POW MALEATE 51552018808 GALLIPOT INCORPORATED ySULFACET SOD POW 51552019005 GALLIPOT INCORPORATED ySULFACET SOD POW 51552019006 GALLIPOT INCORPORATED ySODIUM CITRA GRA 51552019105 GALLIPOT INCORPORATED yIODINE SOL STRONG 51552019404 GALLIPOT INCORPORATED yIODINE SOL STRONG 51552019406 GALLIPOT INCORPORATED yKAOLIN POW 51552019506 GALLIPOT INCORPORATED yKAOLIN POW 51552019509 GALLIPOT INCORPORATED yCAFFEINE POW ANHYDROU 51552020005 GALLIPOT INCORPORATED yCAFFEINE POW ANHYDROU 51552020006 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACETYLCYST POW 51552020104 GALLIPOT INCORPORATED yACETYLCYST POW 51552020105 GALLIPOT INCORPORATED yACETYLCYST POW 51552020107 GALLIPOT INCORPORATED yBISMUTH POW SUBGALLA 51552020205 GALLIPOT INCORPORATED yFORMALDEHYDE SOL 37% 51552020504 GALLIPOT INCORPORATED ySULFUR POW PRECIPIT 51552020806 GALLIPOT INCORPORATED yACETIC ACID SOL GLACIAL 51552020906 GALLIPOT INCORPORATED yMETHYLCELLUL POW 4000CPS 51552021004 GALLIPOT INCORPORATED yACETIC ACID SOL 36% 51552021106 GALLIPOT INCORPORATED yMETHYLCELLUL POW 400CPS 51552021204 GALLIPOT INCORPORATED yMAGN CHLORID POW 51552021306 GALLIPOT INCORPORATED yMAGN CHLORID POW 51552021309 GALLIPOT INCORPORATED yPOT SORBATE CRY 51552021404 GALLIPOT INCORPORATED yALUM AMMONIU POW 51552021803 GALLIPOT INCORPORATED yALUM AMMONIU POW 51552021804 GALLIPOT INCORPORATED yALUM AMMONIU POW 51552021806 GALLIPOT INCORPORATED yZINC SULFATE POW 51552022003 GALLIPOT INCORPORATED yZINC SULFATE POW 51552022006 GALLIPOT INCORPORATED yZINC SULFATE POW 51552022009 GALLIPOT INCORPORATED ySOD BENZOATE POW 51552022106 GALLIPOT INCORPORATED yCALAMINE POW 51552022304 GALLIPOT INCORPORATED yBENZOIC ACID CRY 51552022504 GALLIPOT INCORPORATED yAMMON CARBON MIS CHIPS 51552022604 GALLIPOT INCORPORATED yAMMON CARBON MIS CHIPS 51552022606 GALLIPOT INCORPORATED yCETYL ALCOHO GRA 51552022705 GALLIPOT INCORPORATED yBENZOIN CMPD TIN 51552022803 GALLIPOT INCORPORATED yBENZOIN CMPD TIN 51552022804 GALLIPOT INCORPORATED yEPHEDRINE POW HCL 51552022904 GALLIPOT INCORPORATED yEPHEDRINE POW HCL 51552022905 GALLIPOT INCORPORATED yCALCIUM CARB POW LIGHT 51552023106 GALLIPOT INCORPORATED yCALCIUM CARB POW LIGHT 51552023108 GALLIPOT INCORPORATED yCALCIUM CARB POW LIGHT 51552023109 GALLIPOT INCORPORATED yPHENYLEPHRIN CRY 51552023202 GALLIPOT INCORPORATED yPHENYLEPHRIN CRY 51552023204 GALLIPOT INCORPORATED yPHENYLEPHRIN CRY 51552023205 GALLIPOT INCORPORATED yDIHYDROERGOT POW MESYLATE 51552023301 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIHYDROERGOT POW MESYLATE 51552023302 GALLIPOT INCORPORATED yDIHYDROERGOT POW MESYLATE 51552023305 GALLIPOT INCORPORATED yPOTASSIUM GRA IODIDE 51552023504 GALLIPOT INCORPORATED yPOTASSIUM GRA IODIDE 51552023506 GALLIPOT INCORPORATED yRASPBERRY LIQ FLAVOR 51552023603 GALLIPOT INCORPORATED yACETONE SOL 51552023804 GALLIPOT INCORPORATED yACETONE SOL 51552023806 GALLIPOT INCORPORATED yACETONE SOL 51552023808 GALLIPOT INCORPORATED yPETROLATUM GEL WHITE 51552023906 GALLIPOT INCORPORATED yBENZALDEHYDE ELX 51552024105 GALLIPOT INCORPORATED yBENZALDEHYDE ELX 51552024106 GALLIPOT INCORPORATED ySULFACET SOD POW 51552024405 GALLIPOT INCORPORATED ySULFACET SOD POW 51552024406 GALLIPOT INCORPORATED yALUMINUM ACE POW 51552024604 GALLIPOT INCORPORATED yALUMINUM ACE POW 51552024606 GALLIPOT INCORPORATED yOLIVE OIL 51552025006 GALLIPOT INCORPORATED yANTHRALIN POW 51552025303 GALLIPOT INCORPORATED yANTHRALIN POW 51552025304 GALLIPOT INCORPORATED yANTHRALIN POW 51552025305 GALLIPOT INCORPORATED ySODIUM BUTYR POW 51552025405 GALLIPOT INCORPORATED ySODIUM BUTYR POW 51552025406 GALLIPOT INCORPORATED ySODIUM BUTYR POW 51552025407 GALLIPOT INCORPORATED ySULFAPYRIDIN POW 51552025505 GALLIPOT INCORPORATED ySULFAPYRIDIN POW 51552025506 GALLIPOT INCORPORATED yETHYL ALCOHO SOL 100% 51552025608 GALLIPOT INCORPORATED yCOTTONSEED OIL 51552025806 GALLIPOT INCORPORATED yOLEIC ACID LIQ 51552025906 GALLIPOT INCORPORATED yEPHEDRINE POW SULFATE 51552026004 GALLIPOT INCORPORATED yEPHEDRINE POW SULFATE 51552026005 GALLIPOT INCORPORATED yEPHEDRINE POW SULFATE 51552026006 GALLIPOT INCORPORATED yEPHEDRINE POW SULFATE 51552026007 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 85% 51552026106 GALLIPOT INCORPORATED yINDOMETHACIN POW 51552026202 GALLIPOT INCORPORATED yINDOMETHACIN POW 51552026204 GALLIPOT INCORPORATED yINDOMETHACIN POW 51552026205 GALLIPOT INCORPORATED ySOD LAURYL POW SULFATE 51552026304 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LECITHIN GRA 51552026501 GALLIPOT INCORPORATED yLECITHIN GRA 51552026502 GALLIPOT INCORPORATED yLECITHIN GRA 51552026506 GALLIPOT INCORPORATED yLECITHIN GRA 51552026509 GALLIPOT INCORPORATED yDOCUSATE SOD POW 51552026705 GALLIPOT INCORPORATED yDOCUSATE POW SODIUM 51552026706 GALLIPOT INCORPORATED yTARTARIC ACD POW 51552026804 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552026904 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552026905 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552026909 GALLIPOT INCORPORATED yAMMONIUM CAR POW 51552027004 GALLIPOT INCORPORATED yAMMONIUM CAR POW 51552027006 GALLIPOT INCORPORATED yBISMUTH POW CITRATE 51552027104 GALLIPOT INCORPORATED yNITROFURAZON POW 51552027204 GALLIPOT INCORPORATED yNITROFURAZON POW 51552027205 GALLIPOT INCORPORATED ySPIRONOLACT POW 51552027601 GALLIPOT INCORPORATED ySPIRONOLACT POW 51552027602 GALLIPOT INCORPORATED ySPIRONOLACT POW 51552027604 GALLIPOT INCORPORATED ySPIRONOLACT POW 51552027605 GALLIPOT INCORPORATED yTRIAMCINOLON POW DIACETAT 51552027801 GALLIPOT INCORPORATED yTRIAMCINOLON POW DIACETAT 51552027802 GALLIPOT INCORPORATED yTRIAMCINOLON POW DIACETAT 51552027803 GALLIPOT INCORPORATED yBORAX GRA TECHNIC 51552028104 GALLIPOT INCORPORATED yL-GLUTAMINE POW 51552028504 GALLIPOT INCORPORATED yL-GLUTAMINE POW 51552028505 GALLIPOT INCORPORATED yL-GLUTAMINE POW 51552028507 GALLIPOT INCORPORATED yCHOCOLATE CON FLAVOR 51552028903 GALLIPOT INCORPORATED yCHERRY SYP CONCENTR 51552029003 GALLIPOT INCORPORATED ySULFANILAMID POW 51552029405 GALLIPOT INCORPORATED ySULFANILAMID POW 51552029406 GALLIPOT INCORPORATED yCALCIUM LACT POW PENTAHYD 51552029506 GALLIPOT INCORPORATED yFERRIC SUBSU POW 51552029604 GALLIPOT INCORPORATED yL-LYSINE POW 51552030005 GALLIPOT INCORPORATED yMETHACHOLINE POW CHLORIDE 51552030101 GALLIPOT INCORPORATED y5-AMINOSALIC POW ACID 51552030204 GALLIPOT INCORPORATED y5-AMINOSALIC POW ACID 51552030205 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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5-AMINOSALIC POW ACID 51552030206 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030401 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030402 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030403 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030404 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030405 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030406 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030407 GALLIPOT INCORPORATED yAMPHOTERICIN POW B 51552030409 GALLIPOT INCORPORATED ySULFADIAZINE POW 51552030505 GALLIPOT INCORPORATED ySULFADIAZINE POW 51552030506 GALLIPOT INCORPORATED ySULFADIAZINE POW 51552030509 GALLIPOT INCORPORATED yCANTHARIDIN POW 51552030601 GALLIPOT INCORPORATED yCANTHARIDIN POW 51552030602 GALLIPOT INCORPORATED yCANTHARIDIN POW 51552030603 GALLIPOT INCORPORATED yCANTHARIDIN POW 51552030604 GALLIPOT INCORPORATED yKETOPROFEN POW 51552030704 GALLIPOT INCORPORATED yKETOPROFEN POW 51552030705 GALLIPOT INCORPORATED yKETOPROFEN POW 51552030706 GALLIPOT INCORPORATED yKETOPROFEN POW 51552030707 GALLIPOT INCORPORATED yAMINOPHYLLIN POW ANHYDROU 51552031305 GALLIPOT INCORPORATED yAMINOPHYLLIN POW ANHYDROU 51552031306 GALLIPOT INCORPORATED yICHTHAMMOL POW 51552031404 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 50% 51552031602 GALLIPOT INCORPORATED yPERUVIAN BAL LIQ 51552031704 GALLIPOT INCORPORATED yTERPIN HYD CRY 51552031904 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552032302 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552032304 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552032305 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552032306 GALLIPOT INCORPORATED yTETRACAINE POW HCL 51552032307 GALLIPOT INCORPORATED yAMMONIUM POW BICARBON 51552033804 GALLIPOT INCORPORATED yAMMONIUM GRA BICARBON 51552033806 GALLIPOT INCORPORATED yBORIC ACID POW 51552034303 GALLIPOT INCORPORATED yBORIC ACID POW 51552034304 GALLIPOT INCORPORATED yBORIC ACID POW 51552034306 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRAGACANTH POW 51552035204 GALLIPOT INCORPORATED yLIOTHYRONINE POW SODIUM 51552035401 GALLIPOT INCORPORATED yLIOTHYRONINE POW SODIUM 51552035402 GALLIPOT INCORPORATED yLIOTHYRONINE POW SODIUM 51552035409 GALLIPOT INCORPORATED ySACCHARIN POW 51552035604 GALLIPOT INCORPORATED yQUINACRINE POW 51552035804 GALLIPOT INCORPORATED yQUINACRINE POW 51552035805 GALLIPOT INCORPORATED yDHEA POW 51552035902 GALLIPOT INCORPORATED yDHEA POW 51552035904 GALLIPOT INCORPORATED yDHEA POW 51552035906 GALLIPOT INCORPORATED yDHEA POW 51552035907 GALLIPOT INCORPORATED yDHEA POW 51552035909 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 80% 51552036403 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 80% 51552036406 GALLIPOT INCORPORATED yUNDECYLENIC LIQ ACID USP 51552036616 GALLIPOT INCORPORATED yGLYCOLIC ACD SOL 70% 51552036904 GALLIPOT INCORPORATED yCHLOROQUINE POW PHOSPHAT 51552037302 GALLIPOT INCORPORATED yCHLOROQUINE POW PHOSPHAT 51552037304 GALLIPOT INCORPORATED yCHLOROQUINE POW PHOSPHAT 51552037305 GALLIPOT INCORPORATED yEPSOM SALT GRA 51552037604 GALLIPOT INCORPORATED yIBUPROFEN POW 51552037804 GALLIPOT INCORPORATED yIBUPROFEN POW 51552037805 GALLIPOT INCORPORATED yIBUPROFEN POW 51552037806 GALLIPOT INCORPORATED yIBUPROFEN POW 51552037807 GALLIPOT INCORPORATED yMANNITOL POW 51552038005 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038101 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038102 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038103 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038104 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038105 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038106 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038108 GALLIPOT INCORPORATED yESTRIOL POW MICRONIZ 51552038109 GALLIPOT INCORPORATED yESTRADIOL POW 51552038401 GALLIPOT INCORPORATED yESTRADIOL POW 51552038402 GALLIPOT INCORPORATED yESTRADIOL POW 51552038403 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ESTRADIOL POW 51552038404 GALLIPOT INCORPORATED yESTRADIOL POW 51552038405 GALLIPOT INCORPORATED yESTRADIOL POW 51552038406 GALLIPOT INCORPORATED yESTRADIOL POW 51552038407 GALLIPOT INCORPORATED yESTRADIOL POW 51552038408 GALLIPOT INCORPORATED yESTRADIOL POW 51552038409 GALLIPOT INCORPORATED yCOPPER SULF CRY 51552038504 GALLIPOT INCORPORATED yACETIC ACID SOL 50% 51552038606 GALLIPOT INCORPORATED yACETIC ACID SOL 50% 51552038608 GALLIPOT INCORPORATED yIPRATROPIUM POW BROMIDE 51552039301 GALLIPOT INCORPORATED yIPRATROPIUM POW BROMIDE 51552039302 GALLIPOT INCORPORATED yIPRATROPIUM POW BROMIDE 51552039304 GALLIPOT INCORPORATED yIPRATROPIUM POW BROMIDE 51552039305 GALLIPOT INCORPORATED yCLINDAMYCIN POW 51552039401 GALLIPOT INCORPORATED yCLINDAMYCIN POW 51552039402 GALLIPOT INCORPORATED yCAMPHOR CRY 51552039604 GALLIPOT INCORPORATED yCAMPHOR CRY 51552039606 GALLIPOT INCORPORATED yPROCAINAMIDE POW 51552039706 GALLIPOT INCORPORATED yL-VALINE POW 51552039804 GALLIPOT INCORPORATED yL-VALINE POW 51552039805 GALLIPOT INCORPORATED yNAPROXEN POW 51552040104 GALLIPOT INCORPORATED yNAPROXEN POW 51552040105 GALLIPOT INCORPORATED yL-ISOLEUCINE POW 51552041204 GALLIPOT INCORPORATED yL-ISOLEUCINE POW 51552041205 GALLIPOT INCORPORATED yL-ISOLEUCINE POW 51552041207 GALLIPOT INCORPORATED yCASTOR OIL 51552041404 GALLIPOT INCORPORATED yPAPAVERINE POW HCL 51552041602 GALLIPOT INCORPORATED yPAPAVERINE POW HCL 51552041604 GALLIPOT INCORPORATED yPAPAVERINE POW HCL 51552041605 GALLIPOT INCORPORATED yPAPAVERINE POW HCL 51552041607 GALLIPOT INCORPORATED yFOLIC ACID POW 51552041803 GALLIPOT INCORPORATED yFOLIC ACID POW 51552041804 GALLIPOT INCORPORATED yFOLIC ACID POW 51552041805 GALLIPOT INCORPORATED yFOLIC ACID POW 51552041807 GALLIPOT INCORPORATED yPOTASH POW SULFURAT 51552041904 GALLIPOT INCORPORATED yCROMOLYN SOD POW 51552042302 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CROMOLYN SOD POW 51552042304 GALLIPOT INCORPORATED yCROMOLYN SOD POW 51552042305 GALLIPOT INCORPORATED yCROMOLYN SOD POW 51552042307 GALLIPOT INCORPORATED yCINNAMON OIL 51552042504 GALLIPOT INCORPORATED yDEXAMETHASON POW MICRONIZ 51552043001 GALLIPOT INCORPORATED yDEXAMETHASON POW MICRONIZ 51552043002 GALLIPOT INCORPORATED yDEXAMETHASON POW MICRONIZ 51552043004 GALLIPOT INCORPORATED yTIMOLOL POW MALEATE 51552043301 GALLIPOT INCORPORATED yTIMOLOL POW MALEATE 51552043309 GALLIPOT INCORPORATED yCAROXYMETHY GRA SOD/128 51552043604 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552043802 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552043804 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552043805 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552043806 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552043807 GALLIPOT INCORPORATED ySORBIC ACID POW 51552044104 GALLIPOT INCORPORATED ySCOPOLAMINE POW HBR 51552044401 GALLIPOT INCORPORATED ySCOPOLAMINE POW HBR 51552044402 GALLIPOT INCORPORATED ySCOPOLAMINE POW HBR 51552044409 GALLIPOT INCORPORATED yESTRONE CRY USP 51552044501 GALLIPOT INCORPORATED yESTRONE CRY USP 51552044502 GALLIPOT INCORPORATED yESTRONE CRY USP 51552044504 GALLIPOT INCORPORATED yESTRONE CRY USP 51552044507 GALLIPOT INCORPORATED yESTRONE CRY USP 51552044508 GALLIPOT INCORPORATED yESTRONE CRY USP 51552044509 GALLIPOT INCORPORATED yTERBUTALINE POW SULFATE 51552044603 GALLIPOT INCORPORATED yTERBUTALINE POW SULFATE 51552044604 GALLIPOT INCORPORATED yTERBUTALINE POW SULFATE 51552044605 GALLIPOT INCORPORATED ySOD PHOSPHAT GRA DIBASIC 51552044704 GALLIPOT INCORPORATED ySOD BISULFIT GRA 51552044804 GALLIPOT INCORPORATED ySOD BISULFIT GRA 51552044806 GALLIPOT INCORPORATED ySOD BISULFIT GRA 51552044809 GALLIPOT INCORPORATED yMERBROMIN POW 51552045004 GALLIPOT INCORPORATED yMERBROMIN POW 51552045005 GALLIPOT INCORPORATED yDESONIDE POW MICRONIZ 51552045101 GALLIPOT INCORPORATED yEPINEPHRINE POW BITARTRA 51552045402 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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EPINEPHRINE POW BITARTRA 51552045405 GALLIPOT INCORPORATED yEPINEPHRINE POW BITARTRA 51552045409 GALLIPOT INCORPORATED yBISMUTH SUBC POW 51552045504 GALLIPOT INCORPORATED yBUPIVACAINE POW HCL 51552045601 GALLIPOT INCORPORATED yBUPIVACAINE POW HCL 51552045602 GALLIPOT INCORPORATED yBUPIVACAINE POW HCL 51552045604 GALLIPOT INCORPORATED yBUPIVACAINE POW HCL 51552045605 GALLIPOT INCORPORATED yBUPIVACAINE POW HCL 51552045607 GALLIPOT INCORPORATED yPIROXICAM POW 51552045702 GALLIPOT INCORPORATED yPIROXICAM POW 51552045704 GALLIPOT INCORPORATED yPIROXICAM POW 51552045705 GALLIPOT INCORPORATED yPIROXICAM POW 51552045706 GALLIPOT INCORPORATED yCHLORAMPHEN POW 51552046104 GALLIPOT INCORPORATED yCHLORAMPHEN POW 51552046105 GALLIPOT INCORPORATED yTETRACYCLINE POW 51552046304 GALLIPOT INCORPORATED yTETRACYCLINE POW 51552046305 GALLIPOT INCORPORATED yAMITRIPTYLIN POW HCL 51552046402 GALLIPOT INCORPORATED yAMITRIPTYLIN POW HCL 51552046404 GALLIPOT INCORPORATED yAMITRIPTYLIN POW HCL 51552046405 GALLIPOT INCORPORATED yAMITRIPTYLIN POW HCL 51552046406 GALLIPOT INCORPORATED yMETRONIDAZOL POW BENZOATE 51552046502 GALLIPOT INCORPORATED yMETRONIDAZOL POW BENZOATE 51552046504 GALLIPOT INCORPORATED yMETRONIDAZOL POW BENZOATE 51552046505 GALLIPOT INCORPORATED yMETRONIDAZOL POW BENZOATE 51552046506 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 25% 51552046902 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 25% 51552046906 GALLIPOT INCORPORATED yMAG CITRATE POW DIBASIC 51552047204 GALLIPOT INCORPORATED yPILOCARPINE CRY HCL 51552047701 GALLIPOT INCORPORATED yPILOCARPINE CRY HCL 51552047702 GALLIPOT INCORPORATED yPILOCARPINE CRY HCL 51552047704 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 90% 51552047802 GALLIPOT INCORPORATED yCLONIDINE POW 51552048001 GALLIPOT INCORPORATED yCLONIDINE POW 51552048002 GALLIPOT INCORPORATED yCLONIDINE POW 51552048004 GALLIPOT INCORPORATED yCLONIDINE POW 51552048005 GALLIPOT INCORPORATED yTHIABENDAZOL POW 51552048105 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DICLOFENAC POW SODIUM 51552048204 GALLIPOT INCORPORATED yDICLOFENAC POW SODIUM 51552048205 GALLIPOT INCORPORATED yDICLOFENAC POW SODIUM 51552048206 GALLIPOT INCORPORATED yDICLOFENAC POW SODIUM 51552048207 GALLIPOT INCORPORATED yCYCLOBENZAPR POW HCL 51552048302 GALLIPOT INCORPORATED yCYCLOBENZAPR POW HCL 51552048304 GALLIPOT INCORPORATED yCYCLOBENZAPR POW HCL 51552048305 GALLIPOT INCORPORATED yTHEOPHYLLINE POW ANHYDROU 51552048705 GALLIPOT INCORPORATED yTHEOPHYLLINE POW ANHYDROU 51552048706 GALLIPOT INCORPORATED yNAPHAZOLINE CRY HCL 51552048802 GALLIPOT INCORPORATED yNAPHAZOLINE CRY HCL 51552048804 GALLIPOT INCORPORATED yESTRADIOL POW BENZOATE 51552049101 GALLIPOT INCORPORATED yESTRADIOL POW BENZOATE 51552049102 GALLIPOT INCORPORATED yGLYCINE POW 51552049205 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 75% 51552049302 GALLIPOT INCORPORATED yPHENTOLAMINE POW MESYLATE 51552049601 GALLIPOT INCORPORATED yPHENTOLAMINE POW MESYLATE 51552049602 GALLIPOT INCORPORATED yPHENTOLAMINE POW MESYLATE 51552049603 GALLIPOT INCORPORATED yPHENTOLAMINE POW MESYLATE 51552049604 GALLIPOT INCORPORATED yPHENTOLAMINE POW MESYLATE 51552049605 GALLIPOT INCORPORATED yPHENTOLAMINE POW MESYLATE 51552049609 GALLIPOT INCORPORATED yCOPPER POW GLUCONAT 51552049704 GALLIPOT INCORPORATED yPROSTAGLAND POW E1 51552049801 GALLIPOT INCORPORATED yPROSTAGLAND POW E1 51552049803 GALLIPOT INCORPORATED yPROSTAGLAND POW E1 51552049809 GALLIPOT INCORPORATED yZINC STEARAT POW FCC 51552050004 GALLIPOT INCORPORATED yPROCAINE HCL CRY 51552050505 GALLIPOT INCORPORATED yPROCAINE HCL CRY 51552050506 GALLIPOT INCORPORATED yMAGN OXIDE POW HEAVY 51552050606 GALLIPOT INCORPORATED yTRANEXAMIC POW ACID 51552051305 GALLIPOT INCORPORATED yTRANEXAMIC POW ACID 51552051307 GALLIPOT INCORPORATED yTRANEXAMIC POW ACID 51552051309 GALLIPOT INCORPORATED yAMMONIUM GRA CHLORIDE 51552051404 GALLIPOT INCORPORATED yCALCIUM GLUC POW 51552051506 GALLIPOT INCORPORATED yCALCIUM GLUC POW 51552051509 GALLIPOT INCORPORATED yISOPROTEREN POW SULFATE 51552051702 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ISOPROTEREN POW SULFATE 51552051704 GALLIPOT INCORPORATED yHALOPERIDOL POW 51552051901 GALLIPOT INCORPORATED yHALOPERIDOL POW 51552051902 GALLIPOT INCORPORATED yVERAPAMIL POW HCL USP 51552052504 GALLIPOT INCORPORATED yVERAPAMIL POW HCL USP 51552052505 GALLIPOT INCORPORATED yVERAPAMIL POW HCL USP 51552052506 GALLIPOT INCORPORATED yVERAPAMIL POW HCL USP 51552052507 GALLIPOT INCORPORATED yEPINEPHRINE POW 51552052603 GALLIPOT INCORPORATED yEPINEPHRINE POW 51552052605 GALLIPOT INCORPORATED yPEG BASE OIN 51552052706 GALLIPOT INCORPORATED yCHLORAL CRY HYDRATE 51552052804 GALLIPOT INCORPORATED yCHLORAL CRY HYDRATE 51552052806 GALLIPOT INCORPORATED yCHLORAL CRY HYDRATE 51552052809 GALLIPOT INCORPORATED yCLINDAMYCIN CRY PHOSPHAT 51552052902 GALLIPOT INCORPORATED yCLINDAMYCIN CRY PHOSPHAT 51552052903 GALLIPOT INCORPORATED yCIMETIDINE POW 51552053102 GALLIPOT INCORPORATED yCIMETIDINE POW 51552053104 GALLIPOT INCORPORATED yCIMETIDINE POW 51552053105 GALLIPOT INCORPORATED yCIMETIDINE POW 51552053106 GALLIPOT INCORPORATED yCIMETIDINE POW 51552053107 GALLIPOT INCORPORATED yPHENYTOIN POW SODIUM 51552053204 GALLIPOT INCORPORATED yDHEA POW 51552053302 GALLIPOT INCORPORATED yDHEA POW 51552053304 GALLIPOT INCORPORATED yDHEA POW 51552053306 GALLIPOT INCORPORATED yDHEA POW 51552053307 GALLIPOT INCORPORATED yDHEA POW 51552053309 GALLIPOT INCORPORATED yMINOXIDIL POW 51552053602 GALLIPOT INCORPORATED yMINOXIDIL POW 51552053604 GALLIPOT INCORPORATED yMINOXIDIL POW 51552053605 GALLIPOT INCORPORATED yALPRAZOLAM POW USP 51552053704 GALLIPOT INCORPORATED yALPRAZOLAM POW USP 51552053705 GALLIPOT INCORPORATED yNAPROXEN POW SODIUM 51552054004 GALLIPOT INCORPORATED yDIMERCAPTOSU POW ACID 51552054502 GALLIPOT INCORPORATED yDIMERCAPTOSU POW ACID 51552054504 GALLIPOT INCORPORATED yDIMERCAPTOSU POW ACID 51552054505 GALLIPOT INCORPORATED yDIMERCAPTOSU POW ACID 51552054509 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMM MERCURY POW 51552054604 GALLIPOT INCORPORATED yAMM MERCURY POW 51552054606 GALLIPOT INCORPORATED yAMM MERCURY POW 51552054609 GALLIPOT INCORPORATED yPOLOX GEL 20% 51552054905 GALLIPOT INCORPORATED yPOLOX GEL 20% 51552054906 GALLIPOT INCORPORATED yPOLOX GEL 20% 51552054908 GALLIPOT INCORPORATED yLIPOIL OIL 51552055004 GALLIPOT INCORPORATED yLIPOIL OIL 51552055006 GALLIPOT INCORPORATED yLIPOIL OIL 51552055008 GALLIPOT INCORPORATED yPHENYTOIN POW 51552055304 GALLIPOT INCORPORATED yPHENYTOIN POW 51552055305 GALLIPOT INCORPORATED yGLUTATHIONE CRY 51552055404 GALLIPOT INCORPORATED yERYTHROMYCIN POW 51552055504 GALLIPOT INCORPORATED yERYTHROMYCIN POW 51552055505 GALLIPOT INCORPORATED yNIACIN POW 51552055907 GALLIPOT INCORPORATED yDIENESTROL POW 51552056001 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552056401 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552056402 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552056404 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552056405 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552056407 GALLIPOT INCORPORATED yNITROFURANTN POW ANHYDR 51552056604 GALLIPOT INCORPORATED yNITROFURANTN POW ANHYDR 51552056605 GALLIPOT INCORPORATED yPRIMAQUINE POW PHOSPHAT 51552056702 GALLIPOT INCORPORATED yPRIMAQUINE POW PHOSPHAT 51552056704 GALLIPOT INCORPORATED yPRIMAQUINE POW PHOSPHAT 51552056705 GALLIPOT INCORPORATED yLIVER CONCEN LIQ 51552056803 GALLIPOT INCORPORATED yALOE VERA POW 51552057102 GALLIPOT INCORPORATED yETHOXY ETHNL LIQ REAGENT 51552057505 GALLIPOT INCORPORATED yETHOXY ETHNL LIQ REAGENT 51552057506 GALLIPOT INCORPORATED yETHOXY ETHNL LIQ REAGENT 51552057508 GALLIPOT INCORPORATED yCHLORAMPHENI POW PALMITAT 51552057602 GALLIPOT INCORPORATED yCHLORAMPHENI POW PALMITAT 51552057604 GALLIPOT INCORPORATED yCHLORAMPHENI POW PALMITAT 51552057605 GALLIPOT INCORPORATED y2-DEOXY-D POW -GLUCOSE 51552057901 GALLIPOT INCORPORATED y2-DEOXY-D POW -GLUCOSE 51552057902 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MALIC ACID POW FCC 51552058307 GALLIPOT INCORPORATED yHISTAMINE CRY DIPHOSPH 51552058502 GALLIPOT INCORPORATED yHISTAMINE CRY DIPHOSPH 51552058504 GALLIPOT INCORPORATED yEDTA DISODIU POW USP 51552058804 GALLIPOT INCORPORATED yPOLOX GEL 30% 51552058906 GALLIPOT INCORPORATED yPOLOX GEL 30% 51552058908 GALLIPOT INCORPORATED yGLUCOSAMINE POW SULFATE 51552059204 GALLIPOT INCORPORATED yGLUCOSAMINE POW SULFATE 51552059205 GALLIPOT INCORPORATED yGLUCOSAMINE POW SULFATE 51552059207 GALLIPOT INCORPORATED yPHENOXYBENZA POW 51552059901 GALLIPOT INCORPORATED yPHENOXYBENZA POW 51552059902 GALLIPOT INCORPORATED y2-NITROANILI POW 51552060006 GALLIPOT INCORPORATED yMETHYLPRED POW 51552060302 GALLIPOT INCORPORATED yQUININE SULF POW DIHYDRAT 51552060403 GALLIPOT INCORPORATED yQUININE SULF POW DIHYDRAT 51552060404 GALLIPOT INCORPORATED yCLOBETASOL POW PROPIONA 51552060501 GALLIPOT INCORPORATED yCLOBETASOL POW PROPIONA 51552060502 GALLIPOT INCORPORATED yCLOBETASOL POW PROPIONA 51552060509 GALLIPOT INCORPORATED yL-METHIONINE POW 51552061005 GALLIPOT INCORPORATED yFLUNISOLIDE POW ANHYDR 51552061101 GALLIPOT INCORPORATED yFLUNISOLIDE POW ANHYDR 51552061102 GALLIPOT INCORPORATED yFLUNISOLIDE POW ANHYDR 51552061109 GALLIPOT INCORPORATED yBACLOFEN POW 51552061302 GALLIPOT INCORPORATED yBACLOFEN POW 51552061304 GALLIPOT INCORPORATED yBACLOFEN POW 51552061305 GALLIPOT INCORPORATED yPYRIMETHAMIN POW 51552061705 GALLIPOT INCORPORATED yPYRIMETHAMIN POW 51552061707 GALLIPOT INCORPORATED yLACTOSE POW ANHYDROU 51552061806 GALLIPOT INCORPORATED yIVERMECTIN POW 51552061902 GALLIPOT INCORPORATED yIVERMECTIN POW 51552061904 GALLIPOT INCORPORATED yIVERMECTIN POW 51552061905 GALLIPOT INCORPORATED yRANITIDINE POW HCL 51552062002 GALLIPOT INCORPORATED yRANITIDINE POW HCL 51552062004 GALLIPOT INCORPORATED yRANITIDINE POW HCL 51552062005 GALLIPOT INCORPORATED yRANITIDINE POW HCL 51552062007 GALLIPOT INCORPORATED yPIRACETAM POW 51552062204 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PIRACETAM POW 51552062205 GALLIPOT INCORPORATED yPIRACETAM POW 51552062206 GALLIPOT INCORPORATED yPIRACETAM POW 51552062207 GALLIPOT INCORPORATED yPIRACETAM POW 51552062209 GALLIPOT INCORPORATED yALMOND OIL POW BITTER 51552062504 GALLIPOT INCORPORATED yKETOCONAZOLE POW 51552062702 GALLIPOT INCORPORATED yKETOCONAZOLE POW 51552062703 GALLIPOT INCORPORATED yKETOCONAZOLE POW 51552062704 GALLIPOT INCORPORATED yKETOCONAZOLE POW 51552062705 GALLIPOT INCORPORATED yBETAMETH ACE POW MICRONIZ 51552062801 GALLIPOT INCORPORATED yBETAMETH ACE POW MICRONIZ 51552062802 GALLIPOT INCORPORATED yBETAMETH ACE POW MICRONIZ 51552062805 GALLIPOT INCORPORATED yHYDROXYTRYPT POW 51552063002 GALLIPOT INCORPORATED yHYDROXYTRYPT POW 51552063004 GALLIPOT INCORPORATED yHYDROXYTRYPT POW 51552063005 GALLIPOT INCORPORATED yHYDROXYTRYPT POW 51552063006 GALLIPOT INCORPORATED yOXYTOCIN POW USP 51552063109 GALLIPOT INCORPORATED yMETHOXSALEN POW USP 51552063601 GALLIPOT INCORPORATED yMETHOXSALEN POW USP 51552063602 GALLIPOT INCORPORATED yPRILOCAINE POW HCL 51552063804 GALLIPOT INCORPORATED yPRILOCAINE POW HCL 51552063805 GALLIPOT INCORPORATED yPRILOCAINE POW HCL 51552063806 GALLIPOT INCORPORATED ySARDINE LIQ FLAVOR 51552063909 GALLIPOT INCORPORATED yPLASTICIZED OIN BASE 51552064102 GALLIPOT INCORPORATED yPROGESTERONE POW MILLED 51552064304 GALLIPOT INCORPORATED yPROGESTERONE POW MILLED 51552064305 GALLIPOT INCORPORATED yPROGESTERONE POW MILLED 51552064307 GALLIPOT INCORPORATED yCOENZYME Q10 POW 51552064604 GALLIPOT INCORPORATED yCOENZYME Q10 POW 51552064607 GALLIPOT INCORPORATED yBENZALKONIUM SOL 17% 51552064806 GALLIPOT INCORPORATED yBENZALKONIUM SOL 17% 51552064808 GALLIPOT INCORPORATED yL-CARNITINE POW 51552064905 GALLIPOT INCORPORATED yL-CARNITINE POW 51552064907 GALLIPOT INCORPORATED yAPOMORPHINE POW HCL 51552065201 GALLIPOT INCORPORATED yAPOMORPHINE POW HCL 51552065202 GALLIPOT INCORPORATED yAPOMORPHINE POW HCL 51552065204 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARBAMAZEPIN POW USP 51552065304 GALLIPOT INCORPORATED yCARBAMAZEPIN POW USP 51552065305 GALLIPOT INCORPORATED yBIOTIN POW 51552065401 GALLIPOT INCORPORATED yBIOTIN POW 51552065402 GALLIPOT INCORPORATED yBIOTIN POW 51552065405 GALLIPOT INCORPORATED yBELLADONNA POW LEAF 51552065504 GALLIPOT INCORPORATED yBELLADONNA POW LEAF 51552065506 GALLIPOT INCORPORATED yCYCLOSPORINE POW 51552066301 GALLIPOT INCORPORATED yCYCLOSPORINE POW 51552066302 GALLIPOT INCORPORATED yCYCLOSPORINE POW 51552066304 GALLIPOT INCORPORATED yCYCLOSPORINE POW USP 51552066305 GALLIPOT INCORPORATED yCYCLOSPORINE POW 51552066306 GALLIPOT INCORPORATED yL-CITRULLINE POW 51552066505 GALLIPOT INCORPORATED yL-CITRULLINE POW 51552066507 GALLIPOT INCORPORATED yPROBUCOL POW 51552066604 GALLIPOT INCORPORATED yPROBUCOL POW 51552066605 GALLIPOT INCORPORATED yMEGESTROL POW ACETATE 51552066701 GALLIPOT INCORPORATED yMEGESTROL POW ACETATE 51552066702 GALLIPOT INCORPORATED yMEGESTROL POW ACETATE 51552066704 GALLIPOT INCORPORATED yMEGESTROL POW ACETATE 51552066705 GALLIPOT INCORPORATED yBUDESONIDE POW MICRONIZ 51552066801 GALLIPOT INCORPORATED yBUDESONIDE POW MICRONIZ 51552066802 GALLIPOT INCORPORATED yBUDESONIDE POW MICRONIZ 51552066809 GALLIPOT INCORPORATED yPILOCARPINE POW NITRATE 51552066901 GALLIPOT INCORPORATED yPILOCARPINE POW NITRATE 51552066902 GALLIPOT INCORPORATED yACYCLOVIR POW USP 51552067101 GALLIPOT INCORPORATED yACYCLOVIR POW USP 51552067102 GALLIPOT INCORPORATED yACYCLOVIR POW USP 51552067103 GALLIPOT INCORPORATED yACYCLOVIR POW USP 51552067104 GALLIPOT INCORPORATED yACYCLOVIR POW USP 51552067105 GALLIPOT INCORPORATED yACYCLOVIR POW USP 51552067106 GALLIPOT INCORPORATED yGINKGO BILOB POW 51552067205 GALLIPOT INCORPORATED yLINCOMYCIN POW HCL 51552067405 GALLIPOT INCORPORATED yLINCOMYCIN POW HCL 51552067407 GALLIPOT INCORPORATED yHYDROPHILIC OIN 51552067506 GALLIPOT INCORPORATED yDIMENHYDRIN POW USP 51552067604 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIMENHYDRIN POW USP 51552067605 GALLIPOT INCORPORATED yHYDROCODONE POW BITARTRA 51552067701 GALLIPOT INCORPORATED yHYDROCODONE POW BITARTRA 51552067702 GALLIPOT INCORPORATED yHYDROCODONE POW BITARTRA 51552067704 GALLIPOT INCORPORATED yHYDROCODONE POW BITARTRA 51552067706 GALLIPOT INCORPORATED yMORPHINE POW SULFATE 51552067804 GALLIPOT INCORPORATED yMORPHINE POW SULFATE 51552067806 GALLIPOT INCORPORATED yMINERAL OIL LIGHT 51552068006 GALLIPOT INCORPORATED yMINERAL OIL LIGHT 51552068008 GALLIPOT INCORPORATED yHYDROMORPHON POW HCL 51552068201 GALLIPOT INCORPORATED yHYDROMORPHON POW HCL 51552068202 GALLIPOT INCORPORATED yHYDROMORPHON POW HCL 51552068203 GALLIPOT INCORPORATED yHYDROMORPHON POW HCL 51552068204 GALLIPOT INCORPORATED yTINIDAZOLE POW 51552068305 GALLIPOT INCORPORATED yCHOLESTYRAMI POW RESIN 51552068402 GALLIPOT INCORPORATED yOXYCODONE POW HCL 51552068501 GALLIPOT INCORPORATED yOXYCODONE POW HCL 51552068502 GALLIPOT INCORPORATED yOXYCODONE POW HCL 51552068504 GALLIPOT INCORPORATED yOXYCODONE POW HCL 51552068506 GALLIPOT INCORPORATED yMEPERIDINE POW 51552068601 GALLIPOT INCORPORATED yMEPERIDINE POW 51552068602 GALLIPOT INCORPORATED yMEPERIDINE POW 51552068604 GALLIPOT INCORPORATED yMEPERIDINE POW 51552068606 GALLIPOT INCORPORATED yFENTANYL POW CITRATE 51552068701 GALLIPOT INCORPORATED yFENTANYL POW CITRATE 51552068702 GALLIPOT INCORPORATED yFENTANYL POW CITRATE 51552068709 GALLIPOT INCORPORATED yCODEINE POW PHOSPHAT 51552068802 GALLIPOT INCORPORATED yCODEINE POW PHOSPHAT 51552068803 GALLIPOT INCORPORATED yCODEINE POW PHOSPHAT 51552068804 GALLIPOT INCORPORATED yCODEINE POW PHOSPHAT 51552068806 GALLIPOT INCORPORATED yCAPSICUM TIN 51552069105 GALLIPOT INCORPORATED ySIMPLE SYP USP 51552069206 GALLIPOT INCORPORATED ySIMPLE SYP USP 51552069208 GALLIPOT INCORPORATED yZINC OXIDE OIN 20% 51552069306 GALLIPOT INCORPORATED yZINC OXIDE PST 25% 51552069406 GALLIPOT INCORPORATED yKETAMINE HCL POW 51552069702 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KETAMINE HCL POW 51552069704 GALLIPOT INCORPORATED yKETAMINE HCL POW 51552069705 GALLIPOT INCORPORATED yKETAMINE HCL POW 51552069707 GALLIPOT INCORPORATED yL-ARGININE POW 51552069805 GALLIPOT INCORPORATED yL-ARGININE POW 51552069807 GALLIPOT INCORPORATED yEMOLLIENT CRE BASE 51552069906 GALLIPOT INCORPORATED yTRICHLOR ACD SOL 70% 51552070906 GALLIPOT INCORPORATED ySQUARIC ACID POW DI-N-BUT 51552071201 GALLIPOT INCORPORATED yALUM POTASS GRA 51552071406 GALLIPOT INCORPORATED yALUM POTASS POW SULFATE 51552071409 GALLIPOT INCORPORATED yRIFAMPIN POW USP 51552071504 GALLIPOT INCORPORATED yRIFAMPIN POW USP 51552071505 GALLIPOT INCORPORATED yRIFAMPIN POW USP 51552071506 GALLIPOT INCORPORATED yTROCHIBASE POW 51552071905 GALLIPOT INCORPORATED yTROCHIBASE POW 51552071906 GALLIPOT INCORPORATED yNIFEDIPINE POW USP 51552072002 GALLIPOT INCORPORATED yNIFEDIPINE POW USP 51552072004 GALLIPOT INCORPORATED yNIFEDIPINE POW USP 51552072005 GALLIPOT INCORPORATED yLOZIBASE MIS 51552072302 GALLIPOT INCORPORATED yLOZIBASE MIS 51552072306 GALLIPOT INCORPORATED yCARBOMER GEL 940 51552072405 GALLIPOT INCORPORATED yCARBOHOL GEL 940 51552072705 GALLIPOT INCORPORATED yMETHADONE POW 51552072801 GALLIPOT INCORPORATED yMETHADONE POW 51552072802 GALLIPOT INCORPORATED yMETHADONE POW 51552072804 GALLIPOT INCORPORATED yLORAZEPAM POW 51552072901 GALLIPOT INCORPORATED yLORAZEPAM POW 51552072902 GALLIPOT INCORPORATED yLORAZEPAM POW 51552072904 GALLIPOT INCORPORATED yLORAZEPAM POW USP 51552072905 GALLIPOT INCORPORATED yLORAZEPAM POW 51552072909 GALLIPOT INCORPORATED yPRAMOXINE POW HCL 51552073004 GALLIPOT INCORPORATED yHYDROXYZINE POW HCL 51552073104 GALLIPOT INCORPORATED yHYDROXYZINE POW HCL 51552073105 GALLIPOT INCORPORATED yFLUOROURACIL POW USP 51552073301 GALLIPOT INCORPORATED yFLUOROURACIL POW USP 51552073302 GALLIPOT INCORPORATED yFLUOROURACIL POW USP 51552073304 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUOROURACIL POW USP 51552073305 GALLIPOT INCORPORATED yPREDNISOLONE POW SOD PHOS 51552073502 GALLIPOT INCORPORATED yPREDNISOLONE POW SOD PHOS 51552073505 GALLIPOT INCORPORATED yNALTREXONE POW HCL 51552073701 GALLIPOT INCORPORATED yNALTREXONE POW HCL 51552073702 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552073804 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552073805 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552073806 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552073807 GALLIPOT INCORPORATED yDILTIAZEM POW 51552074002 GALLIPOT INCORPORATED yDILTIAZEM POW 51552074004 GALLIPOT INCORPORATED yDICYCLOMINE POW 51552074104 GALLIPOT INCORPORATED yL-THYROXINE POW 51552074201 GALLIPOT INCORPORATED yL-THYROXINE POW 51552074202 GALLIPOT INCORPORATED yPYRUVIC ACID POW 51552074404 GALLIPOT INCORPORATED yPHENOBARBIT POW USP 51552074502 GALLIPOT INCORPORATED yPHENOBARBIT POW USP 51552074504 GALLIPOT INCORPORATED yPHENOBARBIT POW USP 51552074506 GALLIPOT INCORPORATED yPHENOBARBIT POW USP 51552074509 GALLIPOT INCORPORATED yDIBUCAINE POW 51552074702 GALLIPOT INCORPORATED yDIBUCAINE POW 51552074704 GALLIPOT INCORPORATED yAMYLASE-A POW 51552074805 GALLIPOT INCORPORATED yACRIFLAVINE POW HCL 51552074904 GALLIPOT INCORPORATED yHYDROPHILIC OIN PETROLAT 51552075306 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552075704 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552075705 GALLIPOT INCORPORATED yPREGNENOLONE POW 51552075708 GALLIPOT INCORPORATED yBETA CAROTEN POW 51552075802 GALLIPOT INCORPORATED yBETA CAROTEN POW 51552075804 GALLIPOT INCORPORATED yPOVIDONE POW IODINE 51552075905 GALLIPOT INCORPORATED yPOVIDONE POW IODINE 51552075906 GALLIPOT INCORPORATED y6-AMINOCAPRO POW ACID 51552076305 GALLIPOT INCORPORATED y6-AMINOCAPRO POW ACID 51552076307 GALLIPOT INCORPORATED yBUPRENORPHIN POW 51552076501 GALLIPOT INCORPORATED yBUPRENORPHIN POW 51552076502 GALLIPOT INCORPORATED yBUPRENORPHIN POW 51552076506 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BUPRENORPHIN POW 51552076509 GALLIPOT INCORPORATED ySULINDAC POW 51552076604 GALLIPOT INCORPORATED yTRIAMCINOLON POW 51552076801 GALLIPOT INCORPORATED yNIACINAMIDE POW 51552077106 GALLIPOT INCORPORATED yPHOSPHATIDYL POW 20% 51552077307 GALLIPOT INCORPORATED yASPARTAME POW 51552077409 GALLIPOT INCORPORATED yGENTAMICIN POW SULFATE 51552077501 GALLIPOT INCORPORATED yGENTAMICIN POW SULFATE 51552077502 GALLIPOT INCORPORATED yGENTAMICIN POW SULFATE 51552077504 GALLIPOT INCORPORATED yGENTAMICIN POW SULFATE 51552077505 GALLIPOT INCORPORATED yTRAZODONE POW 51552077802 GALLIPOT INCORPORATED yTRAZODONE POW 51552077804 GALLIPOT INCORPORATED yAZATHIOPRINE POW 51552077902 GALLIPOT INCORPORATED yAZATHIOPRINE POW 51552077904 GALLIPOT INCORPORATED yAZATHIOPRINE POW 51552077905 GALLIPOT INCORPORATED yDIETHYLSTILB POW 51552078001 GALLIPOT INCORPORATED yDIETHYLSTILB POW 51552078002 GALLIPOT INCORPORATED yL-TYROSINE POW 51552078805 GALLIPOT INCORPORATED yTOBRAMYCIN POW SULFATE 51552078901 GALLIPOT INCORPORATED yTOBRAMYCIN POW SULFATE 51552078902 GALLIPOT INCORPORATED yTOBRAMYCIN POW SULFATE 51552078904 GALLIPOT INCORPORATED yTOBRAMYCIN POW SULFATE 51552078905 GALLIPOT INCORPORATED yMEDROXYPROG POW MICRONIZ 51552079001 GALLIPOT INCORPORATED yMEDROXYPROG POW MICRONIZ 51552079002 GALLIPOT INCORPORATED yMEDROXYPROG POW MICRONIZ 51552079004 GALLIPOT INCORPORATED yLIPOIC ACID POW 51552079104 GALLIPOT INCORPORATED yERGOLOID POW MESYLATE 51552079801 GALLIPOT INCORPORATED yERGOLOID POW MESYLATE 51552079802 GALLIPOT INCORPORATED yDMPS POW 51552079902 GALLIPOT INCORPORATED yHYDRALAZINE POW HCL 51552080205 GALLIPOT INCORPORATED yINDOLE-3-CAR POW 51552080604 GALLIPOT INCORPORATED yINDOLE-3-CAR POW 51552080605 GALLIPOT INCORPORATED yINDOLE-3-CAR POW 51552080607 GALLIPOT INCORPORATED yCHERRY SYP CONCENTR 51552080706 GALLIPOT INCORPORATED yRIBAVIRIN POW USP 51552081304 GALLIPOT INCORPORATED yRIBAVIRIN POW USP 51552081305 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CALCIUM POW CITRATE 51552081907 GALLIPOT INCORPORATED yBUSPIRONE POW HCL 51552082102 GALLIPOT INCORPORATED yBUSPIRONE POW HCL 51552082103 GALLIPOT INCORPORATED yMETHIMAZOLE POW 51552082202 GALLIPOT INCORPORATED yMETHIMAZOLE POW 51552082204 GALLIPOT INCORPORATED yPHOSPHATIDYL POW CHOLINE 51552082307 GALLIPOT INCORPORATED yBETAHISTINE POW DIHCL 51552082602 GALLIPOT INCORPORATED yBETAHISTINE POW DIHCL 51552082604 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082901 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082903 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082904 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082905 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082906 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082907 GALLIPOT INCORPORATED yPROGESTERONE POW MICRONIZ 51552082908 GALLIPOT INCORPORATED yU-BASE LOT 51552083706 GALLIPOT INCORPORATED yTAMOXIFEN POW CITRATE 51552083802 GALLIPOT INCORPORATED yORPHENADRINE POW CITRATE 51552083905 GALLIPOT INCORPORATED y4-CHLORO-M- POW CRESOL 51552084004 GALLIPOT INCORPORATED yMELATONIN POW 51552084404 GALLIPOT INCORPORATED yMECLIZINE POW HCL 51552084805 GALLIPOT INCORPORATED yDERMA-G LIQ MILD 51552085403 GALLIPOT INCORPORATED yACETAZOLAMID CRY 51552085502 GALLIPOT INCORPORATED yACETAZOLAMID CRY 51552085504 GALLIPOT INCORPORATED yACETAZOLAMID CRY 51552085505 GALLIPOT INCORPORATED yALGINIC ACID POW 51552085609 GALLIPOT INCORPORATED yWITEPSOL H15 MIS 51552085806 GALLIPOT INCORPORATED yERGOCALCIFRL POW 51552086101 GALLIPOT INCORPORATED yERGOCALCIFRL POW 51552086102 GALLIPOT INCORPORATED yCHRYSIN POW 51552086604 GALLIPOT INCORPORATED yCHRYSIN POW 51552086605 GALLIPOT INCORPORATED yCHRYSIN POW 51552086606 GALLIPOT INCORPORATED yCHRYSIN POW 51552086607 GALLIPOT INCORPORATED yMETHYL SULF CRY 51552086705 GALLIPOT INCORPORATED yMETHYL SULF CRY 51552086706 GALLIPOT INCORPORATED yANTIMONY POT POW TARTRATE 51552086804 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PARALDEHYDE LIQ 51552086909 GALLIPOT INCORPORATED yCYPROHEPTADI POW USP 51552087104 GALLIPOT INCORPORATED yCYPROHEPTADI POW USP 51552087105 GALLIPOT INCORPORATED yCYPROHEPTADI POW USP 51552087106 GALLIPOT INCORPORATED ySOYBEAN OIL REFINED 51552087306 GALLIPOT INCORPORATED ySTEVIA POW EXTRACT 51552087504 GALLIPOT INCORPORATED ySTEVIA POW EXTRACT 51552087505 GALLIPOT INCORPORATED ySTEVIA POW EXTRACT 51552087506 GALLIPOT INCORPORATED yPFCB CRE 51552087606 GALLIPOT INCORPORATED yRIBOFLAVIN POW 51552087704 GALLIPOT INCORPORATED yRIBOFLAVIN POW 51552087705 GALLIPOT INCORPORATED yBETHANECHOL POW CHLORIDE 51552087902 GALLIPOT INCORPORATED yBETHANECHOL POW CHLORIDE 51552087904 GALLIPOT INCORPORATED yCOCAINE HCL POW 51552088101 GALLIPOT INCORPORATED yCOCAINE HCL POW 51552088102 GALLIPOT INCORPORATED yBECLOMETHASO POW DIPROPIO 51552088301 GALLIPOT INCORPORATED yBECLOMETHASO POW DIPROPIO 51552088302 GALLIPOT INCORPORATED yBECLOMETHASO POW DIPROPIO 51552088309 GALLIPOT INCORPORATED yMAGNESIUM POW STEARATE 51552088706 GALLIPOT INCORPORATED yESTRADIOL POW VALERATE 51552088801 GALLIPOT INCORPORATED yESTRADIOL POW VALERATE 51552088802 GALLIPOT INCORPORATED yESTRADIOL POW VALERATE 51552088804 GALLIPOT INCORPORATED ySUFENTANIL POW CITRATE 51552088902 GALLIPOT INCORPORATED ySUFENTANIL POW CITRATE 51552088903 GALLIPOT INCORPORATED ySUFENTANIL POW CITRATE 51552088904 GALLIPOT INCORPORATED ySUFENTANIL POW CITRATE 51552088909 GALLIPOT INCORPORATED yBROMPHENIR POW MALEATE 51552089402 GALLIPOT INCORPORATED yBROMPHENIR POW MALEATE 51552089404 GALLIPOT INCORPORATED yBROMPHENIR POW MALEATE 51552089405 GALLIPOT INCORPORATED ySPEEDEGEL GEL 51552089506 GALLIPOT INCORPORATED yETHYL ALCOHO SOL 95% 51552089705 GALLIPOT INCORPORATED yETHYL ALCOHO SOL 95% 51552089706 GALLIPOT INCORPORATED yCHOLESTEROL POW ACETATE 51552089904 GALLIPOT INCORPORATED yCHOLESTEROL POW ACETATE 51552089906 GALLIPOT INCORPORATED yGABAPENTIN POW 51552090202 GALLIPOT INCORPORATED yGABAPENTIN POW 51552090204 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GABAPENTIN POW 51552090205 GALLIPOT INCORPORATED yGABAPENTIN POW 51552090206 GALLIPOT INCORPORATED yGABAPENTIN POW 51552090207 GALLIPOT INCORPORATED yZINC GLUCONA POW 51552090306 GALLIPOT INCORPORATED yURSODIOL POW 51552090604 GALLIPOT INCORPORATED yURSODIOL POW 51552090605 GALLIPOT INCORPORATED yURSODIOL POW 51552090606 GALLIPOT INCORPORATED yBUTALBITAL POW 51552090702 GALLIPOT INCORPORATED yBUTALBITAL POW 51552090704 GALLIPOT INCORPORATED yPROPRANOLOL POW HCL 51552091004 GALLIPOT INCORPORATED yPROPRANOLOL POW HCL 51552091005 GALLIPOT INCORPORATED yPRAZIQUANTEL POW 51552091107 GALLIPOT INCORPORATED yFLUDROCORT POW ACETATE 51552091201 GALLIPOT INCORPORATED yKANAMYCIN POW SULFATE 51552091301 GALLIPOT INCORPORATED yKANAMYCIN POW SULFATE 51552091302 GALLIPOT INCORPORATED yATENOLOL POW 51552091404 GALLIPOT INCORPORATED yATENOLOL POW 51552091405 GALLIPOT INCORPORATED yMETOPROLOL POW TARTRATE 51552091502 GALLIPOT INCORPORATED yPENTRAVAN CRE 51552091906 GALLIPOT INCORPORATED yITRACONAZOLE POW 51552092002 GALLIPOT INCORPORATED yTROCHIBASE S MIS 51552092105 GALLIPOT INCORPORATED yTROCHIBASE S MIS 51552092106 GALLIPOT INCORPORATED yPROPANTHELIN POW BROMIDE 51552092202 GALLIPOT INCORPORATED y4 AMINOPYRID POW 51552093904 GALLIPOT INCORPORATED yFUROSEMIDE POW 51552094002 GALLIPOT INCORPORATED yDIPHENYLCYCL POW 51552094301 GALLIPOT INCORPORATED yDIPHENYLCYCL POW 51552094302 GALLIPOT INCORPORATED yENALAPRIL POW MALEATE 51552094404 GALLIPOT INCORPORATED yENALAPRIL POW MALEATE 51552094405 GALLIPOT INCORPORATED yENALAPRIL POW MALEATE 51552094406 GALLIPOT INCORPORATED yPOLYMYXIN B POW SULFATE 51552094609 GALLIPOT INCORPORATED yDIGITOXIN POW 51552095001 GALLIPOT INCORPORATED yGLUCOSAMINE POW ACETYL-D 51552095102 GALLIPOT INCORPORATED yGLUCOSAMINE POW ACETYL-D 51552095104 GALLIPOT INCORPORATED yGLUCOSAMINE POW ACETYL-D 51552095105 GALLIPOT INCORPORATED yGLUCOSAMINE POW ACETYL-D 51552095106 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENZTROPINE POW MESYLATE 51552095201 GALLIPOT INCORPORATED yTRIMETHOPRIM POW 51552095304 GALLIPOT INCORPORATED yMETHYLPRED POW ACETATE 51552095802 GALLIPOT INCORPORATED yMETHYLPRED POW ACETATE 51552095804 GALLIPOT INCORPORATED yMETHYLPRED POW ACETATE 51552095805 GALLIPOT INCORPORATED yMETHYLPRED POW ACETATE 51552095806 GALLIPOT INCORPORATED yRIBO-5-PHOSP POW SODIUM 51552096105 GALLIPOT INCORPORATED yRIBO-5-PHOSP POW SODIUM 51552096107 GALLIPOT INCORPORATED yFLUORESCEIN POW SODIUM 51552096804 GALLIPOT INCORPORATED yFLUORESCEIN POW SODIUM 51552096805 GALLIPOT INCORPORATED yNEOMYCIN POW SULFATE 51552096903 GALLIPOT INCORPORATED yNEOMYCIN POW SULFATE 51552096905 GALLIPOT INCORPORATED yNEOMYCIN POW SULFATE 51552096909 GALLIPOT INCORPORATED yCA-D-PANTOTH POW 51552097107 GALLIPOT INCORPORATED ySELENIUM CHE POW 0.2% 51552097307 GALLIPOT INCORPORATED yZINC AMINO POW CHELATE 51552097507 GALLIPOT INCORPORATED yCHLORELLA POW 51552097607 GALLIPOT INCORPORATED ySTREPTOMYCIN POW SULFATE 51552097805 GALLIPOT INCORPORATED yHYDROXYZINE POW PAMOATE 51552097904 GALLIPOT INCORPORATED yPOLICOSANOL POW 5% 51552098107 GALLIPOT INCORPORATED yDOXEPIN HCL POW 51552098202 GALLIPOT INCORPORATED yDOXEPIN HCL POW 51552098204 GALLIPOT INCORPORATED yDOXEPIN HCL POW 51552098205 GALLIPOT INCORPORATED yCLOMIPRAMINE POW HCL 51552098501 GALLIPOT INCORPORATED yGRAPE SEED POW 95% 51552098607 GALLIPOT INCORPORATED yCOLCHICINE POW 51552099101 GALLIPOT INCORPORATED yACETYL-L-CAR POW HCL 51552099407 GALLIPOT INCORPORATED yCATS CLAW POW 51552099607 GALLIPOT INCORPORATED yQUERCITIN POW 51552099707 GALLIPOT INCORPORATED yWILLOW BARK POW 51552099807 GALLIPOT INCORPORATED yATROPINE POW USP 51552099902 GALLIPOT INCORPORATED yATROPINE POW USP 51552099904 GALLIPOT INCORPORATED yTRIAMTERENE POW 51552100805 GALLIPOT INCORPORATED yNICOTINE POW POLACRIL 51552100902 GALLIPOT INCORPORATED yANTHRALIN POW 51552101003 GALLIPOT INCORPORATED yANTHRALIN POW 51552101004 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ANTHRALIN POW 51552101005 GALLIPOT INCORPORATED yLOPERAMIDE POW HCL 51552101104 GALLIPOT INCORPORATED yHYDROCHLOROT POW 51552101204 GALLIPOT INCORPORATED yTROPICAMIDE POW 51552101602 GALLIPOT INCORPORATED yBHRTBASE CRE CREAM 51552102106 GALLIPOT INCORPORATED yLIPOVAN OIN BASE 51552102203 GALLIPOT INCORPORATED yLIPOVAN OIN BASE 51552102206 GALLIPOT INCORPORATED yDIAZEPAM POW USP 51552102502 GALLIPOT INCORPORATED yDIAZEPAM POW USP 51552102504 GALLIPOT INCORPORATED yDIAZEPAM POW USP 51552102505 GALLIPOT INCORPORATED yGLYCERIN LIQ 51552102606 GALLIPOT INCORPORATED yHYDROXYPROG POW CAPROATE 51552102804 GALLIPOT INCORPORATED yFLUCONAZOLE POW 51552103101 GALLIPOT INCORPORATED yFLUCONAZOLE POW 51552103102 GALLIPOT INCORPORATED yFLUCONAZOLE POW 51552103104 GALLIPOT INCORPORATED yFLUCONAZOLE POW 51552103105 GALLIPOT INCORPORATED yLIPOIC ACID POW 51552103207 GALLIPOT INCORPORATED yVANCOMYCIN POW 51552103601 GALLIPOT INCORPORATED yVANCOMYCIN POW 51552103609 GALLIPOT INCORPORATED yLACTOB ACIDO POW 51552103907 GALLIPOT INCORPORATED yBROMOCRIPTIN POW MESYLATE 51552104002 GALLIPOT INCORPORATED yDAPSONE POW 51552104202 GALLIPOT INCORPORATED yNANDROLONE POW DECANOAT 51552104302 GALLIPOT INCORPORATED ySULFASALAZIN POW USP 51552104405 GALLIPOT INCORPORATED yCYANOCOBALAM CRY 51552104501 GALLIPOT INCORPORATED ySTANOZOLOL POW 51552104902 GALLIPOT INCORPORATED ySTANOZOLOL POW 51552104904 GALLIPOT INCORPORATED ySTANOZOLOL POW 51552104905 GALLIPOT INCORPORATED yOMEPRAZOLE POW USP 51552105002 GALLIPOT INCORPORATED yOMEPRAZOLE POW USP 51552105004 GALLIPOT INCORPORATED yOMEPRAZOLE POW USP 51552105005 GALLIPOT INCORPORATED yCARISOPRODOL POW 51552105204 GALLIPOT INCORPORATED yDIMETHYL SOL SULFOXID 51552105306 GALLIPOT INCORPORATED yMETHOTREXATE POW 51552105401 GALLIPOT INCORPORATED yMETHOTREXATE POW 51552105409 GALLIPOT INCORPORATED yESTRADIOL POW CYP USP 51552105601 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BROMELAIN POW 51552105807 GALLIPOT INCORPORATED yPENTOXIFYL POW 51552105905 GALLIPOT INCORPORATED yPROGESTERONE POW WETTABLE 51552106601 GALLIPOT INCORPORATED yPROGESTERONE POW WETTABLE 51552106604 GALLIPOT INCORPORATED yPROGESTERONE POW WETTABLE 51552106605 GALLIPOT INCORPORATED yPROGESTERONE POW WETTABLE 51552106606 GALLIPOT INCORPORATED yPROGESTERONE POW WETTABLE 51552106607 GALLIPOT INCORPORATED yTETRACYCLINE POW 51552106705 GALLIPOT INCORPORATED yCASCARA AROM EXT 325/5ML 51552106806 GALLIPOT INCORPORATED yOXYTETRACYC POW HCL 51552106902 GALLIPOT INCORPORATED yCAPTOPRIL POW 51552107202 GALLIPOT INCORPORATED yACRIFLAVINE POW NEUTRAL 51552107704 GALLIPOT INCORPORATED yPOT PERCHLOR CRY 51552107805 GALLIPOT INCORPORATED ySYRSPEND SF LIQ 51552107906 GALLIPOT INCORPORATED yCICLOPIROX POW OLAMINE 51552109102 GALLIPOT INCORPORATED yPENICILLAMIN POW 51552109605 GALLIPOT INCORPORATED yCHROMIUM POW PICOLINA 51552109901 GALLIPOT INCORPORATED yAMANTADINE POW HCL 51552110004 GALLIPOT INCORPORATED yCARBIDOPA POW 51552110202 GALLIPOT INCORPORATED ySYRSPEND SF LIQ 51552112306 GALLIPOT INCORPORATED yTACROLIMUS POW 51552112801 GALLIPOT INCORPORATED yTACROLIMUS POW 51552112805 GALLIPOT INCORPORATED yTACROLIMUS POW 51552112806 GALLIPOT INCORPORATED yNETTLES ROOT POW 51552113107 GALLIPOT INCORPORATED yBIFIDOBACTER POW BIFIDUM 51552113307 GALLIPOT INCORPORATED yHAWTHORN BER POW 2% 51552113707 GALLIPOT INCORPORATED ySULFAMETHOX POW 51552114005 GALLIPOT INCORPORATED yNALOXONE HCL POW 51552114901 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552115102 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552115104 GALLIPOT INCORPORATED yTESTOSTERONE POW 51552115105 GALLIPOT INCORPORATED yTHICK-AID LIQ 51552115905 GALLIPOT INCORPORATED yLEVOTHYROXIN POW SODIUM 51552117101 GALLIPOT INCORPORATED yLEVOTHYROXIN POW SODIUM 51552117102 GALLIPOT INCORPORATED ySILDENAFIL POW CITRATE 51552117201 GALLIPOT INCORPORATED ySILDENAFIL POW CITRATE 51552117202 GALLIPOT INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SILDENAFIL POW CITRATE 51552117204 GALLIPOT INCORPORATED ySILDENAFIL POW CITRATE 51552117205 GALLIPOT INCORPORATED yBUTORPHANOL POW TARTRATE 51552119001 GALLIPOT INCORPORATED yALUMINUM HYD POW DR GEL 51552119606 GALLIPOT INCORPORATED yADIPEX-P TAB 37.5MG 57844000901 GATE PHARMACEUTICALS yADIPEX-P CAP 37.5MG 57844001901 GATE PHARMACEUTICALS yORAP TAB 1MG 57844015101 GATE PHARMACEUTICALS yORAP TAB 2MG 57844018701 GATE PHARMACEUTICALS yGALZIN CAP 50MG 57844020852 GATE PHARMACEUTICALS yGALZIN CAP 25MG 57844021552 GATE PHARMACEUTICALS yLOFIBRA CAP 67MG 57844032201 GATE PHARMACEUTICALS yLOFIBRA CAP 134MG 57844032301 GATE PHARMACEUTICALS yLOFIBRA CAP 200MG 57844032401 GATE PHARMACEUTICALS yPURINETHOL TAB 50MG 57844052206 GATE PHARMACEUTICALS yLOFIBRA TAB 54MG 57844069198 GATE PHARMACEUTICALS yLOFIBRA TAB 160MG 57844069298 GATE PHARMACEUTICALS yTEV-TROPIN INJ 5MG 57844071319 GATE PHARMACEUTICALS yTEV-TROPIN INJ 5MG 57844071341 GATE PHARMACEUTICALS yPEDIA RELIEF LIQ CGH/COLD 00113000326 GEISS, DESTIN & DUNN, INC. yPAIN RELIEF DRO INFANTS 00113000805 GEISS, DESTIN & DUNN, INC. yPAIN RELIEF DRO INFANTS 00113000810 GEISS, DESTIN & DUNN, INC. yMULT SYMPTOM TAB COLD RLF 00113001562 GEISS, DESTIN & DUNN, INC. yNAT SENNA LX TAB 8.6MG 00113002178 GEISS, DESTIN & DUNN, INC. yNICOTINE POL GUM 2MG 00113002960 GEISS, DESTIN & DUNN, INC. yALLRGY SINUS TAB HEADACHE 00113003062 GEISS, DESTIN & DUNN, INC. yCOLD/ALLERGY ELX CHILDS 00113003426 GEISS, DESTIN & DUNN, INC. yIBUPROFEN SUS INFANTS 00113005705 GEISS, DESTIN & DUNN, INC. yNON-DROWSY TAB SINUS 00113007762 GEISS, DESTIN & DUNN, INC. yMULTI-SYMPTO CAP COLD/CGH 00113008052 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB COLD/SIN 00113008360 GEISS, DESTIN & DUNN, INC. yLAXATIVE TAB 5MG EC 00113008663 GEISS, DESTIN & DUNN, INC. yCHILD PN REL CHW 80MG 00113009165 GEISS, DESTIN & DUNN, INC. yCHILD PAIN SUS 160/5ML 00113010526 GEISS, DESTIN & DUNN, INC. ySIMETHICONE DRO 40/0.6ML 00113011910 GEISS, DESTIN & DUNN, INC. yTRIACTING LIQ SORE THR 00113012726 GEISS, DESTIN & DUNN, INC. yAPAP SUS CHILD 00113013026 GEISS, DESTIN & DUNN, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAIN RELIEVE CHW 160MG JR 00113013762 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE CHW 160MG 00113014365 GEISS, DESTIN & DUNN, INC. yALLERGY/CONG TAB RELIEF 00113016513 GEISS, DESTIN & DUNN, INC. yALLERGY/CONG TAB RELIEF 00113016552 GEISS, DESTIN & DUNN, INC. yCHLD IBUPROF SUS 100/5ML 00113016626 GEISS, DESTIN & DUNN, INC. yWOMENS LAXAT TAB 5MG EC 00113017465 GEISS, DESTIN & DUNN, INC. yCHILDS APAP SUS 160/5ML 00113017526 GEISS, DESTIN & DUNN, INC. yCAL ANTACID CHW 750MG 00113017980 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB 25-500MG 00113018571 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113018762 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113018771 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113018778 GEISS, DESTIN & DUNN, INC. yMICONAZOLE CRE TUBE/KIT 00113021429 GEISS, DESTIN & DUNN, INC. yTUSSIN COLD CAP COUGH 00113022653 GEISS, DESTIN & DUNN, INC. yTRIACTING LIQ COLD/CGH 00113023826 GEISS, DESTIN & DUNN, INC. yFIBER THERAP TAB 500MG 00113025478 GEISS, DESTIN & DUNN, INC. yASPIRIN CHW 81MG 00113025968 GEISS, DESTIN & DUNN, INC. yCHILDS ALLER LIQ COLD/CGH 00113026326 GEISS, DESTIN & DUNN, INC. yCHILD ASA CHW 81MG 00113027468 GEISS, DESTIN & DUNN, INC. yDAYHIST TAB 1.34MG 00113028251 GEISS, DESTIN & DUNN, INC. yDAYHIST TAB 1.34MG 00113028273 GEISS, DESTIN & DUNN, INC. y12 HOUR COLD TAB 120MG CR 00113028652 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE DRO 80/0.8ML 00113028905 GEISS, DESTIN & DUNN, INC. yNAT FIBER POW 48.57% 00113030127 GEISS, DESTIN & DUNN, INC. yPINK BISMUTH SUS 527/30ML 00113030234 GEISS, DESTIN & DUNN, INC. yPINK BISMUTH SUS 527/30ML 00113030240 GEISS, DESTIN & DUNN, INC. yNATURAL VEG POW 33% 00113030341 GEISS, DESTIN & DUNN, INC. yLONG LASTING SPR 0.05% 00113030410 GEISS, DESTIN & DUNN, INC. yTUSSIN COUGH SYP 100/5ML 00113031026 GEISS, DESTIN & DUNN, INC. yTUSSIN COUGH SYP 100/5ML 00113031034 GEISS, DESTIN & DUNN, INC. yALLERGY RELF TAB 10MG 00113031152 GEISS, DESTIN & DUNN, INC. ySALINE NASAL SPR 0.65% 00113031213 GEISS, DESTIN & DUNN, INC. yINFANT DRO 100MG/ML 00113031305 GEISS, DESTIN & DUNN, INC. yINFANT DRO 100MG/ML 00113031310 GEISS, DESTIN & DUNN, INC. yHEMORRHOIDAL SUP 00113031553 GEISS, DESTIN & DUNN, INC. yHEMORRHOIDAL SUP 00113031562 GEISS, DESTIN & DUNN, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ANTACID PLUS SUS 00113031940 GEISS, DESTIN & DUNN, INC. yGLYCERIN SUP 3GM 00113032071 GEISS, DESTIN & DUNN, INC. yNAT FIBER LX POW 58.6 CIT 00113032719 GEISS, DESTIN & DUNN, INC. ySORE THROAT SPR CHERRY 00113032830 GEISS, DESTIN & DUNN, INC. yMILK OF MAGN SUS MINT 00113033240 GEISS, DESTIN & DUNN, INC. yMAX-ST STRES SUS 690/30ML 00113033734 GEISS, DESTIN & DUNN, INC. yMAX-ST STRES SUS 690/30ML 00113033740 GEISS, DESTIN & DUNN, INC. yTRIACTING SYP 2-12.5/5 00113033934 GEISS, DESTIN & DUNN, INC. yMASANTI II SUS 00113034040 GEISS, DESTIN & DUNN, INC. yDECONGESTANT DRO 0.025% 00113034110 GEISS, DESTIN & DUNN, INC. yNVP REG - SF POW 92% 00113034204 GEISS, DESTIN & DUNN, INC. ySORE THROAT LIQ MEN SPY 00113034330 GEISS, DESTIN & DUNN, INC. yNAT FIBER LX POW 28.3% 00113034715 GEISS, DESTIN & DUNN, INC. yMALDROXAL SUS 00113035640 GEISS, DESTIN & DUNN, INC. yMASANTI SUS ANTACID 00113035740 GEISS, DESTIN & DUNN, INC. yTUSSIN DM SYP 100-10/5 00113035926 GEISS, DESTIN & DUNN, INC. yTUSSIN DM SYP 100-10/5 00113035934 GEISS, DESTIN & DUNN, INC. yNATURAL VEG POW 58.6% 00113036638 GEISS, DESTIN & DUNN, INC. yALL DAY PAIN TAB 220MG 00113036862 GEISS, DESTIN & DUNN, INC. yALL DAY PAIN TAB 220MG 00113036871 GEISS, DESTIN & DUNN, INC. yALL DAY PAIN TAB 220MG 00113036878 GEISS, DESTIN & DUNN, INC. yALL DAY PAIN TAB 220MG 00113036887 GEISS, DESTIN & DUNN, INC. yNATURAL VEG POW 28.3 CIT 00113037009 GEISS, DESTIN & DUNN, INC. yMIGRAINE REL TAB 00113037462 GEISS, DESTIN & DUNN, INC. yMIGRAINE REL TAB 00113037478 GEISS, DESTIN & DUNN, INC. yANTACID/ SUS SIMETH 00113037640 GEISS, DESTIN & DUNN, INC. yANTI-DIARRHE LIQ 1MG/5ML 00113037726 GEISS, DESTIN & DUNN, INC. yDIPHEDRYL ELX 12.5/5ML 00113037926 GEISS, DESTIN & DUNN, INC. yDIPHEDRYL ELX 12.5/5ML 00113037934 GEISS, DESTIN & DUNN, INC. yAPHEDRID SYP 1.25-30 00113038326 GEISS, DESTIN & DUNN, INC. yTUSSIN CF SYP 00113038534 GEISS, DESTIN & DUNN, INC. yCOUGH FORMUL ELX RELIEF D 00113039126 GEISS, DESTIN & DUNN, INC. yCOUGH FORMUL ELX RELIEF D 00113039134 GEISS, DESTIN & DUNN, INC. yMILK OF MAGN SUS 00113039640 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 325MG 00113040378 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB 500MG 00113040552 GEISS, DESTIN & DUNN, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAIN RELIEVE TAB 500MG 00113040572 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB 500MG 00113040590 GEISS, DESTIN & DUNN, INC. yDIPHENHYDRAM TAB 25MG 00113040673 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041178 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041185 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041187 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041190 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041678 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG EC 00113041685 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041687 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG 00113041690 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB EFFERVES 00113042168 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB ALRG/SIN 00113042762 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB ALRG/SIN 00113042767 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG EC 00113042978 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 325MG EC 00113042993 GEISS, DESTIN & DUNN, INC. yHEADACHE REL TAB 00113043071 GEISS, DESTIN & DUNN, INC. yHEADACHE REL TAB 00113043078 GEISS, DESTIN & DUNN, INC. yAPHEDRID TAB 2.5-60MG 00113043462 GEISS, DESTIN & DUNN, INC. yAPHEDRID TAB 2.5-60MG 00113043467 GEISS, DESTIN & DUNN, INC. yAPHEDRID TAB 2.5-60MG 00113043478 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB PM 00113043771 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB 30-500MG 00113043862 GEISS, DESTIN & DUNN, INC. yJR STR PAIN CHW RELIEVER 00113044962 GEISS, DESTIN & DUNN, INC. yPSEUDOEPHED TAB PLUS 00113045062 GEISS, DESTIN & DUNN, INC. yLAXATIVE TAB 25MG 00113045762 GEISS, DESTIN & DUNN, INC. yDIPHEDRYL CAP 25MG 00113046262 GEISS, DESTIN & DUNN, INC. yCHLORPHENIR TAB 4MG 00113046362 GEISS, DESTIN & DUNN, INC. yCHLORPHENIR TAB 4MG 00113046378 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE TAB PM 00113046571 GEISS, DESTIN & DUNN, INC. yACID RELIEF CHW 412-80 00113046647 GEISS, DESTIN & DUNN, INC. yCHILD ASA CHW 81MG 00113046768 GEISS, DESTIN & DUNN, INC. yPINK BISMUTH CHW 262MG 00113046965 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113047071 GEISS, DESTIN & DUNN, INC. yFIBER LAX TAB 625MG 00113047775 GEISS, DESTIN & DUNN, INC. yANTACID CHW 500MG 00113047847 GEISS, DESTIN & DUNN, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIPHEDRYL TAB 25MG 00113047962 GEISS, DESTIN & DUNN, INC. yDIPHEDRYL TAB 25MG 00113047978 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113048452 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113048462 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113048471 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113048478 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113048490 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 500MG 00113048494 GEISS, DESTIN & DUNN, INC. yCALC ANTACID CHW 500MG 00113048547 GEISS, DESTIN & DUNN, INC. ySTOOL SOFTEN CAP 100MG 00113048672 GEISS, DESTIN & DUNN, INC. yPEDIA RELIEF DRO INFANT 00113048705 GEISS, DESTIN & DUNN, INC. yNAPROXEN SOD TAB 220MG 00113049062 GEISS, DESTIN & DUNN, INC. yTUSSIN DM SYP 100-10/5 00113051526 GEISS, DESTIN & DUNN, INC. yTUSSIN DM SYP 100-10/5 00113051534 GEISS, DESTIN & DUNN, INC. ySORE THROAT LIQ SPRAY 00113053230 GEISS, DESTIN & DUNN, INC. yASPIRIN TAB 81MG EC 00113053576 GEISS, DESTIN & DUNN, INC. yFLU/COLD/CG POW MEDICINE 00113053691 GEISS, DESTIN & DUNN, INC. yTUSSIN CAP SEV CONG 00113053753 GEISS, DESTIN & DUNN, INC. yNITE TIME LIQ CHERRY 00113055030 GEISS, DESTIN & DUNN, INC. yNITE TIME LIQ CHERRY 00113055038 GEISS, DESTIN & DUNN, INC. yANTI-DIARRHE TAB 2MG 00113055453 GEISS, DESTIN & DUNN, INC. yANTI-DIARRHE TAB 2MG 00113055489 GEISS, DESTIN & DUNN, INC. yNITE-TIME EF TAB COLD REL 00113055660 GEISS, DESTIN & DUNN, INC. yTUSSIN CF SYP 00113055826 GEISS, DESTIN & DUNN, INC. yTUSSIN CF SYP 00113055834 GEISS, DESTIN & DUNN, INC. yFLU/COUGH/ POW /COLD MS 00113057091 GEISS, DESTIN & DUNN, INC. yHEMORRHOIDAL CRE 00113057224 GEISS, DESTIN & DUNN, INC. yTUSSIN PED LIQ CGH/COLD 00113057526 GEISS, DESTIN & DUNN, INC. yTUSSIN DM LIQ CLEAR 00113057826 GEISS, DESTIN & DUNN, INC. yTUSSIN DM LIQ CLEAR 00113057834 GEISS, DESTIN & DUNN, INC. yPAIN RELIEF/ LIQ FLU CHLD 00113058526 GEISS, DESTIN & DUNN, INC. yTUSSIN COUGH LIQ COLD 00113058926 GEISS, DESTIN & DUNN, INC. yMICONAZOLE 7 CRE 2% 00113059029 GEISS, DESTIN & DUNN, INC. ySEVERE COLD TAB 00113059652 GEISS, DESTIN & DUNN, INC. ySEVERE COLD TAB 00113059653 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113060411 GEISS, DESTIN & DUNN, INC. y

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IBUPROFEN TAB 200MG 00113060452 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113060462 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113060471 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113060478 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113060485 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113060490 GEISS, DESTIN & DUNN, INC. yNITE TIME LIQ 00113060930 GEISS, DESTIN & DUNN, INC. yNITE TIME LIQ 00113060938 GEISS, DESTIN & DUNN, INC. yIBUPROF CHLD SUS 100/5ML 00113062326 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113062862 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113062871 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113062878 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113064752 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113064762 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113064771 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113064778 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113064785 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113064790 GEISS, DESTIN & DUNN, INC. yNASAL FOUR SOL 1% 00113064810 GEISS, DESTIN & DUNN, INC. yIBUPROF CHLD SUS 100/5ML 00113066026 GEISS, DESTIN & DUNN, INC. yNITE TIME LIQ COUGH 00113066830 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113066962 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113066971 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113066978 GEISS, DESTIN & DUNN, INC. yTRIACTING SYP COLD/ALL 00113067026 GEISS, DESTIN & DUNN, INC. ySINUS NASAL SPR 0.05% 00113081710 GEISS, DESTIN & DUNN, INC. yALLERGY RELF TAB 10MG 00113082462 GEISS, DESTIN & DUNN, INC. yCOLD RELIEF TAB EFF 00113087060 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE CAP 500MG 00113087747 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE CAP 500MG 00113087752 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE CAP 500MG 00113087762 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE CAP 500MG 00113087771 GEISS, DESTIN & DUNN, INC. yPAIN RELIEVE CAP 500MG 00113087778 GEISS, DESTIN & DUNN, INC. yIPECAC SYP 00113089410 GEISS, DESTIN & DUNN, INC. yIBUPROF CHLD SUS 100/5ML 00113089726 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113095371 GEISS, DESTIN & DUNN, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ASPIRIN TAB 325MG 00113095978 GEISS, DESTIN & DUNN, INC. yAPAP TAB 500MG 00113097571 GEISS, DESTIN & DUNN, INC. yAPAP TAB 500MG 00113098872 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113099511 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113099571 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113099578 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113099585 GEISS, DESTIN & DUNN, INC. yIBUPROFEN TAB 200MG 00113099590 GEISS, DESTIN & DUNN, INC. yACETAMIN TAB 325MG 51645070301 GEMINI PHARMACEUTICALS, INC. yACETAMIN TAB 325MG 51645070310 GEMINI PHARMACEUTICALS, INC. yACETAMIN TAB 325MG 51645070399 GEMINI PHARMACEUTICALS, INC. yACETAMIN TAB 500MG 51645070501 GEMINI PHARMACEUTICALS, INC. yACETAMIN TAB 500MG 51645070510 GEMINI PHARMACEUTICALS, INC. yACETAMIN TAB 500MG 51645070601 GEMINI PHARMACEUTICALS, INC. yACETAMIN TAB 500MG 51645070610 GEMINI PHARMACEUTICALS, INC. yASPIRIN TAB 81MG 51645071308 GEMINI PHARMACEUTICALS, INC. yASPIRIN TAB 81MG 51645071310 GEMINI PHARMACEUTICALS, INC. yASPIRIN EC TAB 325MG 51645071401 GEMINI PHARMACEUTICALS, INC. yASPIRIN EC TAB 325MG 51645071410 GEMINI PHARMACEUTICALS, INC. yASPIRIN TAB 325MG 51645071601 GEMINI PHARMACEUTICALS, INC. yASPIRIN TAB 325MG 51645071610 GEMINI PHARMACEUTICALS, INC. yCALC ANTACID CHW 500MG 51645073515 GEMINI PHARMACEUTICALS, INC. yDOCUSATE SOD TAB 100MG 51645075001 GEMINI PHARMACEUTICALS, INC. yFERROUS SULF TAB 325MG 51645076001 GEMINI PHARMACEUTICALS, INC. yFERROUS SULF TAB 325MG 51645076010 GEMINI PHARMACEUTICALS, INC. yFERROUS SULF TAB 325MG 51645076110 GEMINI PHARMACEUTICALS, INC. yIBUPROFEN TAB 200MG 51645077501 GEMINI PHARMACEUTICALS, INC. yIBUPROFEN TAB 200MG 51645077509 GEMINI PHARMACEUTICALS, INC. yPSYLLIUM POW 58.6% 51645079513 GEMINI PHARMACEUTICALS, INC. yPSYLLIUM POW 58.6% 51645079613 GEMINI PHARMACEUTICALS, INC. yPRENATAL TAB 51645083601 GEMINI PHARMACEUTICALS, INC. ySENNA PLUS TAB 8.6-50MG 51645085006 GEMINI PHARMACEUTICALS, INC. ySENNA TAB 8.6MG 51645085101 GEMINI PHARMACEUTICALS, INC. ySENNA TAB 8.6MG 51645085110 GEMINI PHARMACEUTICALS, INC. yNUTROPIN INJ 10MG 50242001821 GENENTECH, INC. yNUTROPIN INJ 5MG 50242001902 GENENTECH, INC. y

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NUTROPIN INJ 10MG 50242002020 GENENTECH, INC. yNUTROPIN AQ INJ 10MG/2ML 50242002220 GENENTECH, INC. yTNKASE KIT 50MG 50242003861 GENENTECH, INC. yXOLAIR SOL 150MG 50242004062 GENENTECH, INC. yCATHFLO ACTI INJ VASE 50242004163 GENENTECH, INC. yCATHFLO ACTI INJ VASE 50242004164 GENENTECH, INC. yCATHFLO ACTI INJ 2MG 50242004165 GENENTECH, INC. yNUTROPIN AQ INJ 10MG/2ML 50242004314 GENENTECH, INC. yACTIVASE INJ 50MG 50242004413 GENENTECH, INC. yRITUXAN INJ 100MG 50242005121 GENENTECH, INC. yRITUXAN INJ 500MG 50242005306 GENENTECH, INC. yRAPTIVA KIT 125MG 50242005801 GENENTECH, INC. yRAPTIVA KIT 125MG 50242005804 GENENTECH, INC. yAVASTIN INJ 50242006001 GENENTECH, INC. yAVASTIN INJ 50242006101 GENENTECH, INC. yTARCEVA TAB 25MG 50242006201 GENENTECH, INC. yTARCEVA TAB 100MG 50242006301 GENENTECH, INC. yTARCEVA TAB 150MG 50242006401 GENENTECH, INC. yNUTROPIN INJ 5MG 50242007203 GENENTECH, INC. yLUCENTIS SOL 50242008001 GENENTECH, INC. yACTIVASE INJ 100MG 50242008527 GENENTECH, INC. yPULMOZYME SOL 1MG/ML 50242010039 GENENTECH, INC. yPULMOZYME SOL 1MG/ML 50242010040 GENENTECH, INC. yHERCEPTIN INJ 440MG 50242013468 GENENTECH, INC. yCALCICARB TAB 650MG 52569023106 GENERAMED, INC. yOYSTER SHELL TAB 500MG 52569023206 GENERAMED, INC. yCALCIUM LACT TAB 650MG 52569023310 GENERAMED, INC. yDOCUSATE SOD CAP 100MG 52569061510 GENERAMED, INC. yDOCUSATE SOD CAP 250MG 52569061610 GENERAMED, INC. yASPIRIN TAB 325MG EC 52569062210 GENERAMED, INC. yASPIRIN TAB 81MG EC 52569062410 GENERAMED, INC. yAPAP SOL 160/5ML 52569085077 GENERAMED, INC. yAPAP SOL 160/5ML 52569085080 GENERAMED, INC. yAPAP TAB 325MG 52569085110 GENERAMED, INC. yAPAP TAB 500MG 52569085410 GENERAMED, INC. yTUSSID DM SYP 100-10/5 52569086677 GENERAMED, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TUSSID DM SYP 100-10/5 52569086680 GENERAMED, INC. yBENEFIX INJ 1000UNIT 58394000101 GENETICS INSTITUTE, INC. yBENEFIX INJ 500UNIT 58394000201 GENETICS INSTITUTE, INC. yBENEFIX INJ 250UNIT 58394000301 GENETICS INSTITUTE, INC. yNEUMEGA INJ 5MG 58394000401 GENETICS INSTITUTE, INC. yNEUMEGA INJ 5MG 58394000402 GENETICS INSTITUTE, INC. yREFACTO INJ 1000UNIT 58394000502 GENETICS INSTITUTE, INC. yREFACTO INJ 500UNIT 58394000602 GENETICS INSTITUTE, INC. yREFACTO INJ 250UNIT 58394000702 GENETICS INSTITUTE, INC. yREFACTO KIT 2000UNIT 58394001102 GENETICS INSTITUTE, INC. yATENOLOL TAB 25MG 15330002501 GENPHARM, L.P. yATENOLOL TAB 25MG 15330002510 GENPHARM, L.P. yATENOLOL TAB 50MG 15330002801 GENPHARM, L.P. yATENOLOL TAB 50MG 15330002810 GENPHARM, L.P. yATENOLOL TAB 100MG 15330002901 GENPHARM, L.P. yATENOLOL TAB 100MG 15330002910 GENPHARM, L.P. yRANITIDINE TAB 150MG 15330003005 GENPHARM, L.P. yRANITIDINE TAB 150MG 15330003006 GENPHARM, L.P. yRANITIDINE TAB 300MG 15330003103 GENPHARM, L.P. yRANITIDINE TAB 300MG 15330003125 GENPHARM, L.P. yNICARDIPINE CAP 20MG 15330004101 GENPHARM, L.P. yNICARDIPINE CAP 30MG 15330004201 GENPHARM, L.P. yETIDRONATE TAB DISODIUM 15330009406 GENPHARM, L.P. yETIDRONATE TAB DISODIUM 15330009506 GENPHARM, L.P. yWARFARIN TAB 1MG 15330010001 GENPHARM, L.P. yWARFARIN TAB 2MG 15330010101 GENPHARM, L.P. yWARFARIN TAB 2.5MG 15330010201 GENPHARM, L.P. yZONISAMIDE CAP 25MG 15330010301 GENPHARM, L.P. yZONISAMIDE CAP 50MG 15330010401 GENPHARM, L.P. yZONISAMIDE CAP 100MG 15330010501 GENPHARM, L.P. yWARFARIN TAB 6MG 15330010601 GENPHARM, L.P. yWARFARIN TAB 7.5MG 15330010701 GENPHARM, L.P. yWARFARIN TAB 10MG 15330010801 GENPHARM, L.P. ySOTALOL AF TAB 80MG 15330020801 GENPHARM, L.P. ySOTALOL AF TAB 120MG 15330020901 GENPHARM, L.P. ySOTALOL AF TAB 160MG 15330021001 GENPHARM, L.P. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MELOXICAM TAB 15MG 15330021910 GENPHARM, L.P. yBACLOFEN TAB 10MG 15330024501 GENPHARM, L.P. yBACLOFEN TAB 10MG 15330024505 GENPHARM, L.P. yBACLOFEN TAB 10MG 15330024510 GENPHARM, L.P. yBACLOFEN TAB 20MG 15330024601 GENPHARM, L.P. yBACLOFEN TAB 20MG 15330024605 GENPHARM, L.P. yTIZANIDINE TAB 2MG 15330024715 GENPHARM, L.P. yTIZANIDINE TAB 4MG 15330024810 GENPHARM, L.P. yTIZANIDINE TAB 4MG 15330024815 GENPHARM, L.P. yTRIAZOLAM TAB 0.125MG 15330024901 GENPHARM, L.P. yTRIAZOLAM TAB 0.125MG 15330024905 GENPHARM, L.P. yTRIAZOLAM TAB 0.125MG 15330024981 GENPHARM, L.P. yTRIAZOLAM TAB 0.25MG 15330025001 GENPHARM, L.P. yTRIAZOLAM TAB 0.25MG 15330025005 GENPHARM, L.P. yTRIAZOLAM TAB 0.25MG 15330025081 GENPHARM, L.P. yWARFARIN TAB 3MG 15330026601 GENPHARM, L.P. yWARFARIN TAB 4MG 15330026701 GENPHARM, L.P. yWARFARIN TAB 5MG 15330026801 GENPHARM, L.P. yGANITE INJ 25MG/ML 66657030101 GENTA, INC. yGANITE INJ 25MG/ML 66657030105 GENTA, INC. yRENAGEL TAB 400MG 58468002001 GENZYME CORPORATION yRENAGEL TAB 800MG 58468002101 GENZYME CORPORATION yFABRAZYME INJ 35MG 58468004001 GENZYME CORPORATION yFABRAZYME INJ 5MG 58468004101 GENZYME CORPORATION yALDURAZYME INJ 2.9MG/5M 58468007001 GENZYME CORPORATION yCLOLAR INJ 1MG/ML 58468010001 GENZYME CORPORATION yMYOZYME SOL 50MG 58468015001 GENZYME CORPORATION yCEREDASE INJ 80UNT/ML 58468106001 GENZYME CORPORATION yTHYROGEN INJ 1.1MG 58468184904 GENZYME CORPORATION yCEREZYME INJ 200UNIT 58468198301 GENZYME CORPORATION yCEREZYME INJ 400UNIT 58468466301 GENZYME CORPORATION yTHYMOGLOBULN INJ 25MG 62053053425 GENZYME CORPORATION yHECTOROL CAP 0.5MCG 64894080550 GENZYME CORPORATION yHECTOROL CAP 2.5MCG 64894082550 GENZYME CORPORATION yHECTOROL INJ 4MCG/2ML 64894084050 GENZYME CORPORATION yESGIC TAB 00535001101 GILBERT LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ESGIC CAP 00535001201 GILBERT LABORATORIES yVISTIDE INJ 75MG/ML 61958010101 GILEAD SCIENCES, INC. yDAUNOXOME INJ 2MG/ML 61958030101 GILEAD SCIENCES, INC. yVIREAD TAB 300MG 61958040101 GILEAD SCIENCES, INC. yHEPSERA TAB 10MG 61958050101 GILEAD SCIENCES, INC. yEMTRIVA CAP 200MG 61958060101 GILEAD SCIENCES, INC. yEMTRIVA SOL 10MG/ML 61958060201 GILEAD SCIENCES, INC. yTRUVADA TAB 61958070101 GILEAD SCIENCES, INC. yUREA CRE 40% 59366222601 GLADES PHARMACEUTICALS LLC yUREA CRE 40% 59366222603 GLADES PHARMACEUTICALS LLC yUREA CRE 40% 59366222607 GLADES PHARMACEUTICALS LLC yUREA CRE 50% 59366223605 GLADES PHARMACEUTICALS LLC yUREA CRE 50% 59366223607 GLADES PHARMACEUTICALS LLC yUREA LOT 40% 59366233608 GLADES PHARMACEUTICALS LLC yUREA GEL 40% 59366244602 GLADES PHARMACEUTICALS LLC yERYTHROMYCIN GEL 2% 59366246203 GLADES PHARMACEUTICALS LLC yERYTHROMYCIN GEL 2% 59366246205 GLADES PHARMACEUTICALS LLC yUREA LOT 35% 59366255607 GLADES PHARMACEUTICALS LLC yUREA LOT 35% 59366255609 GLADES PHARMACEUTICALS LLC ySOD SULFACET EMU SULFUR 59366262106 GLADES PHARMACEUTICALS LLC ySOD SULFACET EMU SULFUR 59366262108 GLADES PHARMACEUTICALS LLC yCAPSICUM OLE CRE 0.025% 59366269206 GLADES PHARMACEUTICALS LLC yCAPSICUM OLE CRE 0.075% 59366269306 GLADES PHARMACEUTICALS LLC yWART REMOVER SOL MAX-ST 59366270105 GLADES PHARMACEUTICALS LLC yHYDROCORT/ CRE IODOQUIN 59366270601 GLADES PHARMACEUTICALS LLC yHYDROCORT LOT 1% 59366270704 GLADES PHARMACEUTICALS LLC yHYDROCORT LOT 2.5% 59366270802 GLADES PHARMACEUTICALS LLC yHYDROCORT LOT 2.5% 59366270804 GLADES PHARMACEUTICALS LLC yALUMINUM CL SOL 20% 59366271003 GLADES PHARMACEUTICALS LLC yALUMINUM CL SOL 20% 59366271004 GLADES PHARMACEUTICALS LLC yALUMINUM CL SOL 20% 59366271006 GLADES PHARMACEUTICALS LLC ySOD SUL/SULF SUS 10-5% 59366272405 GLADES PHARMACEUTICALS LLC ySOD SUL/SULF LOT 10%-5% 59366273103 GLADES PHARMACEUTICALS LLC yBENZOYL PER LIQ WASH 2.5 59366273608 GLADES PHARMACEUTICALS LLC yBENZOYL PER LIQ WASH 5% 59366273904 GLADES PHARMACEUTICALS LLC yBENZOYL PER LIQ WASH 5% 59366273905 GLADES PHARMACEUTICALS LLC y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENZOYL PER LIQ WASH 5% 59366273908 GLADES PHARMACEUTICALS LLC ySOD SUL/SULF LOT 10%-5% 59366274003 GLADES PHARMACEUTICALS LLC yBENZOYL LIQ WASH 10% 59366274005 GLADES PHARMACEUTICALS LLC yBENZOYL PER LIQ WASH 10% 59366274105 GLADES PHARMACEUTICALS LLC yBENZOYL PER LIQ WASH 10% 59366274108 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 2.5% 59366274201 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 5% 59366274301 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 5% 59366274303 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 10% 59366274401 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 10% 59366274403 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 5% 59366274501 GLADES PHARMACEUTICALS LLC yBENZOYL PER GEL 10% 59366274601 GLADES PHARMACEUTICALS LLC ySOD SUL/SULF LOT 10%-5% 59366276205 GLADES PHARMACEUTICALS LLC ySOD SUL/SULF LOT 10%-5% 59366276207 GLADES PHARMACEUTICALS LLC yHYDROQUINONE SOL 3% 59366278103 GLADES PHARMACEUTICALS LLC yHYDROQUINONE GEL 4%/SUNS 59366278303 GLADES PHARMACEUTICALS LLC yHYDROQUINONE CRE 4% 59366278503 GLADES PHARMACEUTICALS LLC yHYDROQUINONE CRE 4%/SUNS 59366278703 GLADES PHARMACEUTICALS LLC yHYDROQUINONE CRE 4%/SUNS 59366278903 GLADES PHARMACEUTICALS LLC yCLOBETASOL GEL 0.05% 59366279101 GLADES PHARMACEUTICALS LLC yCLOBETASOL GEL 0.05% 59366279103 GLADES PHARMACEUTICALS LLC yCLOBETASOL GEL 0.05% 59366279106 GLADES PHARMACEUTICALS LLC yDEMECLOCYCL TAB 150MG 59366281902 GLADES PHARMACEUTICALS LLC yDEMECLOCYCL TAB 300MG 59366282904 GLADES PHARMACEUTICALS LLC yCLINDAMYCIN PAD 1% 59366285206 GLADES PHARMACEUTICALS LLC yDESONIDE LOT 0.05% 59366285502 GLADES PHARMACEUTICALS LLC yDESONIDE LOT 0.05% 59366285504 GLADES PHARMACEUTICALS LLC yMETRONIDAZOL CRE 0.75% 59366287605 GLADES PHARMACEUTICALS LLC yERYTHROMYCIN PAD 2% 59366287806 GLADES PHARMACEUTICALS LLC yGRISEOFULVIN SUS 125/5ML 59366290004 GLADES PHARMACEUTICALS LLC yHALOBETASOL OIN 0.05% 59366300001 GLADES PHARMACEUTICALS LLC yHALOBETASOL OIN 0.05% 59366300005 GLADES PHARMACEUTICALS LLC ySEB-PREV LIQ WASH 59366360001 GLADES PHARMACEUTICALS LLC ySEB-PREV LIQ WASH 59366360002 GLADES PHARMACEUTICALS LLC yAMMONIUM LAC CRE 12% 59366400002 GLADES PHARMACEUTICALS LLC yAMMONIUM LAC CRE 12% 59366400003 GLADES PHARMACEUTICALS LLC y

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AMMONIUM LAC LOT 12% 59366410002 GLADES PHARMACEUTICALS LLC yAMMONIUM LAC LOT 12% 59366410004 GLADES PHARMACEUTICALS LLC yCICLOPIROX SUS 0.77% 59366600003 GLADES PHARMACEUTICALS LLC yCICLOPIROX SUS 0.77% 59366600006 GLADES PHARMACEUTICALS LLC yCICLOPIROX CRE 0.77% 59366610001 GLADES PHARMACEUTICALS LLC yCICLOPIROX CRE 0.77% 59366610002 GLADES PHARMACEUTICALS LLC yCICLOPIROX CRE 0.77% 59366610003 GLADES PHARMACEUTICALS LLC yMYRAC TAB 50MG 59366733801 GLADES PHARMACEUTICALS LLC yMYRAC TAB 75MG 59366733901 GLADES PHARMACEUTICALS LLC yMYRAC TAB 100MG 59366734005 GLADES PHARMACEUTICALS LLC yANCEF/D5W INJ 500MG 00007314204 GLAXOSMITHKLINE yANCEF/D5W INJ 1GM 00007314304 GLAXOSMITHKLINE yAVANDARYL TAB 4-1MG 00007315113 GLAXOSMITHKLINE yAVANDARYL TAB 4-2MG 00007315213 GLAXOSMITHKLINE yAVANDARYL TAB 4-4MG 00007315313 GLAXOSMITHKLINE yAVANDAMET TAB 2-1000MG 00007316318 GLAXOSMITHKLINE yAVANDAMET TAB 4-1000MG 00007316418 GLAXOSMITHKLINE yAVANDAMET TAB 1-500MG 00007316618 GLAXOSMITHKLINE yAVANDAMET TAB 2-500MG 00007316718 GLAXOSMITHKLINE yAVANDAMET TAB 4-500MG 00007316818 GLAXOSMITHKLINE yARIXTRA SOL 5.0/0.4 00007323202 GLAXOSMITHKLINE yARIXTRA SOL 5.0/0.4 00007323211 GLAXOSMITHKLINE yARIXTRA SOL 7.5/0.6 00007323402 GLAXOSMITHKLINE yARIXTRA SOL 7.5/0.6 00007323411 GLAXOSMITHKLINE yARIXTRA SOL 10/0.8 00007323602 GLAXOSMITHKLINE yARIXTRA SOL 10/0.8 00007323611 GLAXOSMITHKLINE yDEXEDRINE CAP 5MG CR 00007351220 GLAXOSMITHKLINE yDEXEDRINE CAP 10MG 00007351320 GLAXOSMITHKLINE yDEXEDRINE CAP 10MG 00007351325 GLAXOSMITHKLINE yDEXEDRINE CAP 15MG CR 00007351420 GLAXOSMITHKLINE yDEXEDRINE CAP 15MG CR 00007351425 GLAXOSMITHKLINE yDEXEDRINE TAB 5MG 00007351920 GLAXOSMITHKLINE yDYAZIDE CAP 37.5-25 00007365022 GLAXOSMITHKLINE yDYAZIDE CAP 37.5-25 00007365030 GLAXOSMITHKLINE yESKALITH CAP 300MG 00007400725 GLAXOSMITHKLINE yCOREG TAB 3.125MG 00007413920 GLAXOSMITHKLINE y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COREG TAB 6.25MG 00007414020 GLAXOSMITHKLINE yCOREG TAB 12.5MG 00007414120 GLAXOSMITHKLINE yCOREG TAB 25MG 00007414220 GLAXOSMITHKLINE yHYCAMTIN INJ 4MG 00007420101 GLAXOSMITHKLINE yHYCAMTIN INJ 4MG 00007420105 GLAXOSMITHKLINE yARRANON INJ 5MG/ML 00007440106 GLAXOSMITHKLINE yARGATROBAN INJ 100MG/ML 00007440701 GLAXOSMITHKLINE yPARNATE TAB 10MG 00007447120 GLAXOSMITHKLINE yPARNATE TAB 10MG 00007447130 GLAXOSMITHKLINE yREQUIP TAB 0.25MG 00007489020 GLAXOSMITHKLINE yREQUIP TAB 0.5MG 00007489120 GLAXOSMITHKLINE yREQUIP TAB 1MG 00007489220 GLAXOSMITHKLINE yREQUIP TAB 2MG 00007489320 GLAXOSMITHKLINE yREQUIP TAB 5MG 00007489420 GLAXOSMITHKLINE yREQUIP TAB 3MG 00007489520 GLAXOSMITHKLINE yREQUIP TAB 4MG 00007489620 GLAXOSMITHKLINE yTAZICEF INJ 1GM 00007508216 GLAXOSMITHKLINE yTAZICEF INJ 1GM PBK 00007508311 GLAXOSMITHKLINE yTAZICEF INJ 2GM 00007508411 GLAXOSMITHKLINE yTAZICEF INJ 2GM PBK 00007508511 GLAXOSMITHKLINE yTAZICEF INJ 6GM 00007508611 GLAXOSMITHKLINE yTAZICEF INJ 1GM 00007509016 GLAXOSMITHKLINE yTAZICEF INJ 2GM 00007509111 GLAXOSMITHKLINE yALBENZA TAB 200MG 00007550040 GLAXOSMITHKLINE yBACTROBAN OIN 2% 00029152544 GLAXOSMITHKLINE yBACTROBAN OIN NASAL 2% 00029152611 GLAXOSMITHKLINE yBACTROBAN CRE 2% 00029152722 GLAXOSMITHKLINE yBACTROBAN CRE 2% 00029152725 GLAXOSMITHKLINE yAVANDIA TAB 2MG 00029315818 GLAXOSMITHKLINE yAVANDIA TAB 4MG 00029315913 GLAXOSMITHKLINE yAVANDIA TAB 4MG 00029315920 GLAXOSMITHKLINE yAVANDIA TAB 8MG 00029316013 GLAXOSMITHKLINE yAVANDIA TAB 8MG 00029316020 GLAXOSMITHKLINE yPAXIL CR TAB 12.5MG 00029320613 GLAXOSMITHKLINE yPAXIL CR TAB 25MG 00029320713 GLAXOSMITHKLINE yPAXIL CR TAB 37.5MG 00029320813 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAXIL TAB 10MG 00029321013 GLAXOSMITHKLINE yPAXIL TAB 20MG 00029321113 GLAXOSMITHKLINE yPAXIL TAB 20MG 00029321120 GLAXOSMITHKLINE yPAXIL TAB 20MG 00029321121 GLAXOSMITHKLINE yPAXIL TAB 20MG 00029321159 GLAXOSMITHKLINE yPAXIL TAB 30MG 00029321213 GLAXOSMITHKLINE yPAXIL TAB 40MG 00029321313 GLAXOSMITHKLINE yPAXIL SUS 10MG/5ML 00029321548 GLAXOSMITHKLINE yRELAFEN TAB 500MG 00029485120 GLAXOSMITHKLINE yRELAFEN TAB 750MG 00029485220 GLAXOSMITHKLINE yAMOXIL CAP 250MG 00029600613 GLAXOSMITHKLINE yAMOXIL CAP 500MG 00029600713 GLAXOSMITHKLINE yAMOXIL CAP 500MG 00029600732 GLAXOSMITHKLINE yAMOXIL SUS 125/5ML 00029600818 GLAXOSMITHKLINE yAMOXIL SUS 250/5ML 00029600918 GLAXOSMITHKLINE yAMOXIL SUS 250/5ML 00029600922 GLAXOSMITHKLINE yAMOXIL SUS 250/5ML 00029600923 GLAXOSMITHKLINE yAMOXIL DRO 50MG/ML 00029603839 GLAXOSMITHKLINE yAMOXIL CHW 200MG 00029604412 GLAXOSMITHKLINE yAMOXIL CHW 200MG 00029604420 GLAXOSMITHKLINE yAMOXIL CHW 400MG 00029604512 GLAXOSMITHKLINE yAMOXIL CHW 400MG 00029604520 GLAXOSMITHKLINE yAMOXIL TAB 500MG 00029604612 GLAXOSMITHKLINE yAMOXIL TAB 500MG 00029604620 GLAXOSMITHKLINE yAMOXIL TAB 500MG 00029604625 GLAXOSMITHKLINE yAMOXIL TAB 875MG 00029604720 GLAXOSMITHKLINE yAMOXIL SUS 200/5ML 00029604854 GLAXOSMITHKLINE yAMOXIL SUS 200/5ML 00029604855 GLAXOSMITHKLINE yAMOXIL SUS 200/5ML 00029604859 GLAXOSMITHKLINE yAMOXIL SUS 400/5ML 00029604918 GLAXOSMITHKLINE yAMOXIL SUS 400/5ML 00029604954 GLAXOSMITHKLINE yAMOXIL SUS 400/5ML 00029604955 GLAXOSMITHKLINE yAMOXIL SUS 400/5ML 00029604959 GLAXOSMITHKLINE yAUGMENTIN CHW 200MG 00029607112 GLAXOSMITHKLINE yAUGMENTIN CHW 400MG 00029607212 GLAXOSMITHKLINE yAUGMENTIN CHW 125MG 00029607347 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AUGMENTIN CHW 250MG 00029607447 GLAXOSMITHKLINE yAUGMENTIN TAB 250MG 00029607527 GLAXOSMITHKLINE yAUGMENTIN TAB 250MG 00029607531 GLAXOSMITHKLINE yAUGMENTIN TAB 500MG 00029608012 GLAXOSMITHKLINE yAUGMENTIN TAB 500MG 00029608027 GLAXOSMITHKLINE yAUGMENTIN TAB 500MG 00029608031 GLAXOSMITHKLINE yAUGMENTIN SUS 125/5ML 00029608522 GLAXOSMITHKLINE yAUGMENTIN SUS 125/5ML 00029608523 GLAXOSMITHKLINE yAUGMENTIN SUS 125/5ML 00029608539 GLAXOSMITHKLINE yAUGMENTIN TAB 875MG 00029608612 GLAXOSMITHKLINE yAUGMENTIN TAB 875MG 00029608621 GLAXOSMITHKLINE yAUGMENTIN SUS 200/5ML 00029608729 GLAXOSMITHKLINE yAUGMENTIN SUS 200/5ML 00029608739 GLAXOSMITHKLINE yAUGMENTIN SUS 200/5ML 00029608751 GLAXOSMITHKLINE yAUGMENTIN SUS 250/5ML 00029609022 GLAXOSMITHKLINE yAUGMENTIN SUS 250/5ML 00029609023 GLAXOSMITHKLINE yAUGMENTIN SUS 250/5ML 00029609039 GLAXOSMITHKLINE yAUGMENTIN SUS 400/5ML 00029609229 GLAXOSMITHKLINE yAUGMENTIN SUS 400/5ML 00029609239 GLAXOSMITHKLINE yAUGMENTIN SUS 400/5ML 00029609251 GLAXOSMITHKLINE yAUGMENTIN SUS ES-600 00029609425 GLAXOSMITHKLINE yAUGMENTIN SUS ES-600 00029609440 GLAXOSMITHKLINE yAUGMENTIN SUS ES-600 00029609446 GLAXOSMITHKLINE yAUGMENTIN XR TAB SR 12HR 00029609648 GLAXOSMITHKLINE yAUGMENTIN XR TAB SR 12HR 00029609660 GLAXOSMITHKLINE yTIMENTIN INJ 3.1GM 00029657126 GLAXOSMITHKLINE yTIMENTIN INJ 3.1GM 00029657131 GLAXOSMITHKLINE yTIMENTIN INJ 3.1GM 00029657140 GLAXOSMITHKLINE yTIMENTIN INJ 31GM 00029657921 GLAXOSMITHKLINE yTAGAMET TAB 300MG 00108501320 GLAXOSMITHKLINE yNOVAHISTINE LIQ DH 00135010836 GLAXOSMITHKLINE yNOVAHISTINE LIQ DH 00135010842 GLAXOSMITHKLINE yNOVAHISTINE SOL EXPECT 00135010936 GLAXOSMITHKLINE yNOVAHISTINE SOL EXPECT 00135010942 GLAXOSMITHKLINE yECOTRIN LOW TAB 81MG EC 00135011784 GLAXOSMITHKLINE yNICORETTE ST GUM 2MG 00135015707 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NICORETTE ST GUM 2MG 00135017007 GLAXOSMITHKLINE yNICORETTE ST GUM 4MG 00135017107 GLAXOSMITHKLINE yNICORETTE ST GUM 2MG 00135019707 GLAXOSMITHKLINE yNICORETTE ST GUM 4MG 00135019807 GLAXOSMITHKLINE yCOMMIT LOZ 2MG 00135020801 GLAXOSMITHKLINE yCOMMIT LOZ 2MG 00135020803 GLAXOSMITHKLINE yCOMMIT LOZ 4MG 00135020901 GLAXOSMITHKLINE yCOMMIT LOZ 4MG 00135020903 GLAXOSMITHKLINE yRETROVIR INJ 10MG/ML 00173010793 GLAXOSMITHKLINE yRETROVIR CAP 100MG 00173010855 GLAXOSMITHKLINE yRETROVIR CAP 100MG 00173010856 GLAXOSMITHKLINE yRETROVIR SYP 10MG/ML 00173011318 GLAXOSMITHKLINE yWELLBUTRIN TAB 150MG SR 00173013555 GLAXOSMITHKLINE yWELLBUTRIN TAB 75MG 00173017755 GLAXOSMITHKLINE yWELLBUTRIN TAB 100MG 00173017855 GLAXOSMITHKLINE yDARAPRIM TAB 25MG 00173020155 GLAXOSMITHKLINE yDIGIBIND SOL 00173023044 GLAXOSMITHKLINE yLANOXIN TAB 0.125MG 00173024255 GLAXOSMITHKLINE yLANOXIN TAB 0.125MG 00173024256 GLAXOSMITHKLINE yLANOXIN TAB 0.125MG 00173024275 GLAXOSMITHKLINE yLANOXIN TAB 0.25MG 00173024955 GLAXOSMITHKLINE yLANOXIN TAB 0.25MG 00173024956 GLAXOSMITHKLINE yLANOXIN TAB 0.25MG 00173024975 GLAXOSMITHKLINE yLANOXIN TAB 0.25MG 00173024980 GLAXOSMITHKLINE yLANOXIN INJ 0.25MG/1 00173026010 GLAXOSMITHKLINE yLANOXIN INJ 0.25MG/1 00173026035 GLAXOSMITHKLINE yLANOXIN INJ 0.1MG/ML 00173026210 GLAXOSMITHKLINE yLANOXIN PED ELX 0.05/ML 00173026427 GLAXOSMITHKLINE yLANOXICAPS CAP 0.1MG 00173027255 GLAXOSMITHKLINE yLANOXICAPS CAP 0.2MG 00173027455 GLAXOSMITHKLINE yZANTAC TAB 150MG 00173034414 GLAXOSMITHKLINE yZANTAC TAB 150MG 00173034417 GLAXOSMITHKLINE yZANTAC TAB 150MG 00173034442 GLAXOSMITHKLINE yZANTAC TAB 150MG 00173034447 GLAXOSMITHKLINE yZINACEF INJ 750MG 00173035210 GLAXOSMITHKLINE yZINACEF INJ 750MG 00173035332 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZINACEF INJ 1.5GM 00173035410 GLAXOSMITHKLINE yZINACEF INJ 1.5GM 00173035632 GLAXOSMITHKLINE yZANTAC INJ 25MG/ML 00173036238 GLAXOSMITHKLINE yZANTAC INJ 25MG/ML 00173036300 GLAXOSMITHKLINE yZANTAC INJ 25MG/ML 00173036301 GLAXOSMITHKLINE yTEMOVATE CRE 0.05% 00173037502 GLAXOSMITHKLINE yTEMOVATE CRE 0.05% 00173037572 GLAXOSMITHKLINE yTEMOVATE CRE 0.05% 00173037573 GLAXOSMITHKLINE yTEMOVATE OIN 0.05% 00173037602 GLAXOSMITHKLINE yTEMOVATE OIN 0.05% 00173037672 GLAXOSMITHKLINE yTEMOVATE OIN 0.05% 00173037673 GLAXOSMITHKLINE yFORTAZ INJ 500MG 00173037710 GLAXOSMITHKLINE yFORTAZ INJ 1GM 00173037810 GLAXOSMITHKLINE yFORTAZ INJ 2GM 00173037934 GLAXOSMITHKLINE yFORTAZ INJ 1GM 00173038032 GLAXOSMITHKLINE yFORTAZ INJ 6GM 00173038237 GLAXOSMITHKLINE yZANTAC SYP 15MG/ML 00173038354 GLAXOSMITHKLINE yCEFTIN TAB 250MG 00173038700 GLAXOSMITHKLINE yBECONASE AQ SPR 0.042% 00173038879 GLAXOSMITHKLINE yZANTAC TAB 300MG 00173039306 GLAXOSMITHKLINE yZANTAC TAB 300MG 00173039340 GLAXOSMITHKLINE yCEFTIN TAB 500MG 00173039400 GLAXOSMITHKLINE yCEFTIN TAB 500MG 00173039442 GLAXOSMITHKLINE yZINACEF INJ 7.5 GM 00173040000 GLAXOSMITHKLINE yACLOVATE CRE 0.05% 00173040100 GLAXOSMITHKLINE yACLOVATE CRE 0.05% 00173040101 GLAXOSMITHKLINE yACLOVATE CRE 0.05% 00173040106 GLAXOSMITHKLINE yACLOVATE OIN 0.05% 00173040200 GLAXOSMITHKLINE yACLOVATE OIN 0.05% 00173040201 GLAXOSMITHKLINE yFORTAZ INJ 1GM 00173041200 GLAXOSMITHKLINE yFORTAZ INJ 2GM 00173041300 GLAXOSMITHKLINE yOXISTAT CRE 1% 00173042300 GLAXOSMITHKLINE yOXISTAT CRE 1% 00173042301 GLAXOSMITHKLINE yOXISTAT CRE 1% 00173042304 GLAXOSMITHKLINE yZINACEF/D5W INJ 750MG PB 00173042400 GLAXOSMITHKLINE yZINACEF/H20 INJ 1.5GM PB 00173042500 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZANTAC TAB 150MG EF 00173042702 GLAXOSMITHKLINE yCUTIVATE CRE 0.05% 00173043000 GLAXOSMITHKLINE yCUTIVATE CRE 0.05% 00173043001 GLAXOSMITHKLINE yCUTIVATE CRE 0.05% 00173043002 GLAXOSMITHKLINE yCUTIVATE OIN 0.005% 00173043102 GLAXOSMITHKLINE yTEMOVATE SOL 0.05% 00173043201 GLAXOSMITHKLINE yFORTAZ INJ 1GM 00173043400 GLAXOSMITHKLINE yFORTAZ INJ 2GM 00173043500 GLAXOSMITHKLINE yZINACEF INJ 750MG 00173043600 GLAXOSMITHKLINE yZINACEF INJ 1.5GM 00173043700 GLAXOSMITHKLINE yZANTAC INJ 50/50ML 00173044100 GLAXOSMITHKLINE yZOFRAN INJ 2MG/ML 00173044200 GLAXOSMITHKLINE yZOFRAN INJ 2MG/ML 00173044202 GLAXOSMITHKLINE yZOFRAN TAB 4MG 00173044600 GLAXOSMITHKLINE yZOFRAN TAB 4MG 00173044602 GLAXOSMITHKLINE yZOFRAN TAB 4MG 00173044604 GLAXOSMITHKLINE yZOFRAN TAB 8MG 00173044700 GLAXOSMITHKLINE yZOFRAN TAB 8MG 00173044702 GLAXOSMITHKLINE yZOFRAN TAB 8MG 00173044704 GLAXOSMITHKLINE yOXISTAT LOT 1% 00173044801 GLAXOSMITHKLINE yIMITREX INJ 6MG/0.5 00173044902 GLAXOSMITHKLINE yFLONASE SPR 0.05% 00173045301 GLAXOSMITHKLINE yTEMOVATE E CRE 0.05%EML 00173045403 GLAXOSMITHKLINE yTEMOVATE GEL 0.05% 00173045502 GLAXOSMITHKLINE yTEMOVATE GEL 0.05% 00173045503 GLAXOSMITHKLINE yZOFRAN INJ 32/50ML 00173046100 GLAXOSMITHKLINE yEPIVIR TAB 150MG 00173047001 GLAXOSMITHKLINE yEPIVIR SOL 10MG/ML 00173047100 GLAXOSMITHKLINE yIMITREX KIT RF 00173047800 GLAXOSMITHKLINE yIMITREX KIT 6MG/0.5 00173047900 GLAXOSMITHKLINE yZOFRAN SOL 4MG/5ML 00173048900 GLAXOSMITHKLINE yRETROVIR TAB 300MG 00173050100 GLAXOSMITHKLINE yFLOLAN INJ 0.5MG 00173051700 GLAXOSMITHKLINE ySTERILE DILU SOL FLOLAN 00173051801 GLAXOSMITHKLINE yFLOLAN INJ 1.5MG 00173051900 GLAXOSMITHKLINE ySEREVENT DIS AER 50MCG 00173052000 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SEREVENT DIS AER 50MCG 00173052100 GLAXOSMITHKLINE yIMITREX SPR 20MG/ACT 00173052300 GLAXOSMITHKLINE yIMITREX SPR 5MG/ACT 00173052400 GLAXOSMITHKLINE yLAMICTAL CHW 5MG 00173052600 GLAXOSMITHKLINE yLAMICTAL CHW 25MG 00173052700 GLAXOSMITHKLINE yMEPRON SUS 00173054700 GLAXOSMITHKLINE yZYBAN TAB 150MG SR 00173055601 GLAXOSMITHKLINE yZYBAN TAB 150MG SR 00173055602 GLAXOSMITHKLINE yAMERGE TAB 1MG 00173056100 GLAXOSMITHKLINE yAMERGE TAB 2.5MG 00173056200 GLAXOSMITHKLINE yVALTREX TAB 1GM 00173056502 GLAXOSMITHKLINE yVALTREX TAB 1GM 00173056504 GLAXOSMITHKLINE yZOFRAN ODT TAB 4MG 00173056900 GLAXOSMITHKLINE yZOFRAN ODT TAB 8MG 00173057000 GLAXOSMITHKLINE yZOFRAN ODT TAB 8MG 00173057004 GLAXOSMITHKLINE yCOMBIVIR TAB 00173059500 GLAXOSMITHKLINE yCOMBIVIR TAB 00173059502 GLAXOSMITHKLINE yLAMICTAL TAB 25MG 00173063302 GLAXOSMITHKLINE yLAMICTAL KIT START 35 00173063310 GLAXOSMITHKLINE yLEUKERAN TAB 2MG 00173063535 GLAXOSMITHKLINE yLAMICTAL TAB 100MG 00173064255 GLAXOSMITHKLINE yLAMICTAL TAB 150MG 00173064360 GLAXOSMITHKLINE yLAMICTAL TAB 200MG 00173064460 GLAXOSMITHKLINE yNAVELBINE INJ 10MG/ML 00173065601 GLAXOSMITHKLINE yNAVELBINE INJ 10MG/ML 00173065644 GLAXOSMITHKLINE yZIAGEN TAB 300MG 00173066100 GLAXOSMITHKLINE yZIAGEN TAB 300MG 00173066101 GLAXOSMITHKLINE yEPIVIR HBV TAB 100MG 00173066200 GLAXOSMITHKLINE yEPIVIR HBV SOL 5MG/ML 00173066300 GLAXOSMITHKLINE yZIAGEN SOL 20MG/ML 00173066400 GLAXOSMITHKLINE yMEPRON SUS 00173066518 GLAXOSMITHKLINE yAGENERASE CAP 150MG 00173067200 GLAXOSMITHKLINE yMALARONE TAB 250-100 00173067501 GLAXOSMITHKLINE yMALARONE TAB 250-100 00173067502 GLAXOSMITHKLINE yMALARONE TAB 62.5/25 00173067601 GLAXOSMITHKLINE yAGENERASE CAP 50MG 00173067900 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RELENZA MIS DISKHALE 00173068101 GLAXOSMITHKLINE yVENTOLIN HFA AER 00173068220 GLAXOSMITHKLINE yAGENERASE SOL 15MG/ML 00173068700 GLAXOSMITHKLINE yLOTRONEX TAB 1MG 00173069000 GLAXOSMITHKLINE yLOTRONEX TAB 1MG 00173069005 GLAXOSMITHKLINE yTRIZIVIR TAB 00173069100 GLAXOSMITHKLINE yADVAIR DISKU MIS 100/50 00173069500 GLAXOSMITHKLINE yADVAIR DISKU MIS 100/50 00173069502 GLAXOSMITHKLINE yADVAIR DISKU MIS 250/50 00173069600 GLAXOSMITHKLINE yADVAIR DISKU MIS 250/50 00173069602 GLAXOSMITHKLINE yADVAIR DISKU MIS 500/50 00173069700 GLAXOSMITHKLINE yADVAIR DISKU MIS 500/50 00173069702 GLAXOSMITHKLINE yCUTIVATE LOT 0.05% 00173070800 GLAXOSMITHKLINE yAVODART CAP 0.5MG 00173071200 GLAXOSMITHKLINE yAVODART CAP 0.5MG 00173071204 GLAXOSMITHKLINE yAVODART CAP 0.5MG 00173071215 GLAXOSMITHKLINE yMYLERAN TAB 2MG 00173071325 GLAXOSMITHKLINE yEPIVIR TAB 300MG 00173071400 GLAXOSMITHKLINE yADVAIR HFA AER 45/21 00173071500 GLAXOSMITHKLINE yADVAIR HFA AER 115/21 00173071600 GLAXOSMITHKLINE yADVAIR HFA AER 230/21 00173071700 GLAXOSMITHKLINE yFLOVENT HFA AER 44MCG 00173071800 GLAXOSMITHKLINE yFLOVENT HFA AER 110MCG 00173071900 GLAXOSMITHKLINE yFLOVENT HFA AER 220MCG 00173072000 GLAXOSMITHKLINE yLEXIVA TAB 700MG 00173072100 GLAXOSMITHKLINE yWELLBUTRIN TAB 200MG SR 00173072200 GLAXOSMITHKLINE yWELLBUTRIN TAB XL 150MG 00173073001 GLAXOSMITHKLINE yWELLBUTRIN TAB XL 150MG 00173073002 GLAXOSMITHKLINE yWELLBUTRIN TAB XL 300MG 00173073101 GLAXOSMITHKLINE yZANTAC TAB 25MG EF 00173073400 GLAXOSMITHKLINE yIMITREX TAB 25MG 00173073500 GLAXOSMITHKLINE yIMITREX TAB 50MG 00173073601 GLAXOSMITHKLINE yIMITREX TAB 50MG 00173073602 GLAXOSMITHKLINE yIMITREX TAB 100MG 00173073701 GLAXOSMITHKLINE yLOTRONEX TAB 0.5MG 00173073800 GLAXOSMITHKLINE yIMITREX KIT 4MG/0.5 00173073900 GLAXOSMITHKLINE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IMITREX KIT RF 00173073902 GLAXOSMITHKLINE yCEFTIN SUS 125/5ML 00173074000 GLAXOSMITHKLINE yCEFTIN SUS 250/5ML 00173074100 GLAXOSMITHKLINE yCEFTIN SUS 250/5ML 00173074110 GLAXOSMITHKLINE yEPZICOM TAB 00173074200 GLAXOSMITHKLINE yTABLOID TAB 40MG 00173088025 GLAXOSMITHKLINE yVALTREX TAB 500MG 00173093303 GLAXOSMITHKLINE yVALTREX TAB 500MG 00173093308 GLAXOSMITHKLINE yVALTREX TAB 500MG 00173093356 GLAXOSMITHKLINE yZOVIRAX TAB 800MG 00173094555 GLAXOSMITHKLINE yZOVIRAX TAB 800MG 00173094556 GLAXOSMITHKLINE yWELLBUTRIN TAB 100MG SR 00173094755 GLAXOSMITHKLINE yZOVIRAX TAB 400MG 00173094955 GLAXOSMITHKLINE yZOVIRAX SUS 200/5ML 00173095396 GLAXOSMITHKLINE yZOVIRAX CAP 200MG 00173099155 GLAXOSMITHKLINE yZOVIRAX CAP 200MG 00173099156 GLAXOSMITHKLINE yZOVIRAX OIN 5% 00173099394 GLAXOSMITHKLINE yBC HEADACHE POW 10158000908 GLAXOSMITHKLINE yBC HEADACHE POW 10158000910 GLAXOSMITHKLINE yBC HEADACHE POW 10158000912 GLAXOSMITHKLINE yBC HEADACHE POW 10158000916 GLAXOSMITHKLINE yNYTOL MX-STR TAB 50MG 10158004201 GLAXOSMITHKLINE yNYTOL TAB 25MG 10158004302 GLAXOSMITHKLINE yNYTOL TAB 25MG 10158004304 GLAXOSMITHKLINE yNYTOL TAB 25MG 10158004306 GLAXOSMITHKLINE ySENSODYNE-SC PST ORIGINAL 10158007704 GLAXOSMITHKLINE ySENSODYNE PST MINT 10158008111 GLAXOSMITHKLINE yEFFICOL EMU WHIP 10158008404 GLAXOSMITHKLINE ySTANBACK POW 650MG 11530000202 GLAXOSMITHKLINE ySTANBACK POW 650MG 11530000206 GLAXOSMITHKLINE ySTANBACK POW 650MG 11530000224 GLAXOSMITHKLINE ySTANBACK POW 650MG 11530000250 GLAXOSMITHKLINE yARIXTRA SOL 2.5/0.5 66203230001 GLAXOSMITHKLINE yARIXTRA SOL 2.5/0.5 66203230002 GLAXOSMITHKLINE yFLUCONAZOLE TAB 50MG 68462010130 GLENMARK PHARMACEUTICALS, INC., USA yFLUCONAZOLE TAB 100MG 68462010230 GLENMARK PHARMACEUTICALS, INC., USA y

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FLUCONAZOLE TAB 150MG 68462010340 GLENMARK PHARMACEUTICALS, INC., USA yFLUCONAZOLE TAB 200MG 68462010430 GLENMARK PHARMACEUTICALS, INC., USA yGABAPENTIN TAB 600MG 68462012601 GLENMARK PHARMACEUTICALS, INC., USA yGABAPENTIN TAB 600MG 68462012605 GLENMARK PHARMACEUTICALS, INC., USA yGABAPENTIN TAB 800MG 68462012701 GLENMARK PHARMACEUTICALS, INC., USA yGABAPENTIN TAB 800MG 68462012705 GLENMARK PHARMACEUTICALS, INC., USA yZONISAMIDE CAP 25MG 68462012801 GLENMARK PHARMACEUTICALS, INC., USA yZONISAMIDE CAP 25MG 68462012805 GLENMARK PHARMACEUTICALS, INC., USA yZONISAMIDE CAP 50MG 68462012901 GLENMARK PHARMACEUTICALS, INC., USA yZONISAMIDE CAP 50MG 68462012905 GLENMARK PHARMACEUTICALS, INC., USA yZONISAMIDE CAP 100MG 68462013001 GLENMARK PHARMACEUTICALS, INC., USA yZONISAMIDE CAP 100MG 68462013005 GLENMARK PHARMACEUTICALS, INC., USA yMELOXICAM TAB 7.5MG 68462014001 GLENMARK PHARMACEUTICALS, INC., USA yMELOXICAM TAB 15MG 68462014101 GLENMARK PHARMACEUTICALS, INC., USA yNITROGLYCER SUB 0.3MG 68462014501 GLENMARK PHARMACEUTICALS, INC., USA yNITROGLYCER SUB 0.4MG 68462014601 GLENMARK PHARMACEUTICALS, INC., USA yNITROGLYCER SUB 0.4MG 68462014625 GLENMARK PHARMACEUTICALS, INC., USA yNITROGLYCER SUB 0.4MG 68462014645 GLENMARK PHARMACEUTICALS, INC., USA yNITROGLYCER SUB 0.6MG 68462014701 GLENMARK PHARMACEUTICALS, INC., USA yMETHYLTESTOS TAB ESTRO HS 68462017301 GLENMARK PHARMACEUTICALS, INC., USA yMETHYLTESTOS TAB ESTRO DS 68462017401 GLENMARK PHARMACEUTICALS, INC., USA yNAPROXEN TAB 250MG 68462018801 GLENMARK PHARMACEUTICALS, INC., USA yNAPROXEN TAB 250MG 68462018805 GLENMARK PHARMACEUTICALS, INC., USA yNAPROXEN TAB 375MG 68462018901 GLENMARK PHARMACEUTICALS, INC., USA yNAPROXEN TAB 375MG 68462018905 GLENMARK PHARMACEUTICALS, INC., USA yNAPROXEN TAB 500MG 68462019001 GLENMARK PHARMACEUTICALS, INC., USA yNAPROXEN TAB 500MG 68462019005 GLENMARK PHARMACEUTICALS, INC., USA yCODEINE SULF TAB 60MG 68462019401 GLENMARK PHARMACEUTICALS, INC., USA yMORPHINE SUL TAB 15MG 68462020201 GLENMARK PHARMACEUTICALS, INC., USA yMORPHINE SUL TAB 15MG 68462020205 GLENMARK PHARMACEUTICALS, INC., USA yMORPHINE SUL TAB 30MG 68462020301 GLENMARK PHARMACEUTICALS, INC., USA yMORPHINE SUL TAB 30MG 68462020305 GLENMARK PHARMACEUTICALS, INC., USA yFOSINOPRIL TAB 10MG 68462036710 GLENMARK PHARMACEUTICALS, INC., USA yFOSINOPRIL TAB 10MG 68462036790 GLENMARK PHARMACEUTICALS, INC., USA yFOSINOPRIL TAB 20MG 68462036810 GLENMARK PHARMACEUTICALS, INC., USA yFOSINOPRIL TAB 20MG 68462036890 GLENMARK PHARMACEUTICALS, INC., USA y

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FOSINOPRIL TAB 40MG 68462036910 GLENMARK PHARMACEUTICALS, INC., USA yFOSINOPRIL TAB 40MG 68462036990 GLENMARK PHARMACEUTICALS, INC., USA yFLAVOXATE TAB 100MG 00115181101 GLOBAL PHARMACEUTICAL CORPORATION yRIMANTADINE TAB 100MG 00115191101 GLOBAL PHARMACEUTICAL CORPORATION yORPHENADRINE TAB 100MG ER 00115201101 GLOBAL PHARMACEUTICAL CORPORATION yORPHENADRINE TAB 100MG ER 00115201102 GLOBAL PHARMACEUTICAL CORPORATION yDEMECLOCYCL TAB 150MG 00115211101 GLOBAL PHARMACEUTICAL CORPORATION yDEMECLOCYCL TAB 300MG 00115212214 GLOBAL PHARMACEUTICAL CORPORATION yTERBUTALINE TAB 2.5MG 00115261101 GLOBAL PHARMACEUTICAL CORPORATION yTERBUTALINE TAB 5MG 00115262201 GLOBAL PHARMACEUTICAL CORPORATION ySOTALOL HCL TAB 80MG 00115271101 GLOBAL PHARMACEUTICAL CORPORATION ySOTALOL HCL TAB 120MG 00115272201 GLOBAL PHARMACEUTICAL CORPORATION ySOTALOL HCL TAB 160MG 00115273301 GLOBAL PHARMACEUTICAL CORPORATION yCHLOROQUINE TAB 250MG 00115279006 GLOBAL PHARMACEUTICAL CORPORATION yPYRIDOSTIGM TAB 60MG 00115351101 GLOBAL PHARMACEUTICAL CORPORATION yCARB/LEVO ER TAB 50-200MG 00115391101 GLOBAL PHARMACEUTICAL CORPORATION yCARB/LEVO ER TAB 25/100 00115392201 GLOBAL PHARMACEUTICAL CORPORATION yMIDODRINE TAB 2.5MG 00115421101 GLOBAL PHARMACEUTICAL CORPORATION yMIDODRINE TAB 5MG 00115422201 GLOBAL PHARMACEUTICAL CORPORATION yDANTROLENE CAP 25MG 00115441101 GLOBAL PHARMACEUTICAL CORPORATION yDANTROLENE CAP 50MG 00115442201 GLOBAL PHARMACEUTICAL CORPORATION yDANTROLENE CAP 100MG 00115443301 GLOBAL PHARMACEUTICAL CORPORATION yCOLESTIPOL GRA 5GM 00115521218 GLOBAL PHARMACEUTICAL CORPORATION yCOLESTIPOL GRA 5GM 00115521229 GLOBAL PHARMACEUTICAL CORPORATION yCOLESTIPOL GRA 5GM 00115521302 GLOBAL PHARMACEUTICAL CORPORATION yBUPROPION TAB 200MG SR 00115544513 GLOBAL PHARMACEUTICAL CORPORATION yCHLOROQUINE TAB 500MG 00115701009 GLOBAL PHARMACEUTICAL CORPORATION yMINOCYCLINE CAP 50MG 00115701701 GLOBAL PHARMACEUTICAL CORPORATION yMINOCYCLINE CAP 100MG 00115701806 GLOBAL PHARMACEUTICAL CORPORATION yMINOCYCLINE CAP 100MG 00115701813 GLOBAL PHARMACEUTICAL CORPORATION yLIPRAM-PN16 CAP 00115702301 GLOBAL PHARMACEUTICAL CORPORATION yLIPRAM-CR20 CAP 00115702401 GLOBAL PHARMACEUTICAL CORPORATION yFLUDROCORT TAB 0.1MG 00115703301 GLOBAL PHARMACEUTICAL CORPORATION yLIPRAM 4500 CAP 00115703501 GLOBAL PHARMACEUTICAL CORPORATION yLIPRAM-CR10 CAP 00115703601 GLOBAL PHARMACEUTICAL CORPORATION yMETHITEST TAB 10MG 00115703701 GLOBAL PHARMACEUTICAL CORPORATION y

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LIPRAM-PN10 CAP 00115704001 GLOBAL PHARMACEUTICAL CORPORATION yLIPRAM-UL20 CAP 00115704301 GLOBAL PHARMACEUTICAL CORPORATION yMINOCYCLINE CAP 75MG 00115705401 GLOBAL PHARMACEUTICAL CORPORATION yLIPRAM-PN20 CAP 00115705501 GLOBAL PHARMACEUTICAL CORPORATION yPHENA-S LIQ 58809011201 GM PHARMACEUTICALS, INC. yPHENA-PLUS TAB 58809028101 GM PHARMACEUTICALS, INC. yCARBA-XP LIQ 58809030301 GM PHARMACEUTICALS, INC. yCARISOPRODOL TAB 350MG 58809042401 GM PHARMACEUTICALS, INC. yPHENA-HC LIQ 58809044201 GM PHARMACEUTICALS, INC. yCARBATUSS SYP 58809053601 GM PHARMACEUTICALS, INC. yCARBATAB-12 TAB 58809061501 GM PHARMACEUTICALS, INC. yCARBATUSS-CL LIQ 58809070701 GM PHARMACEUTICALS, INC. yCARBATUSS-12 SUS 58809081801 GM PHARMACEUTICALS, INC. yVANACET TAB 5-500MG 58809083801 GM PHARMACEUTICALS, INC. yPHENA-S 12 SUS 58809091201 GM PHARMACEUTICALS, INC. yVANACON SOL 58809092901 GM PHARMACEUTICALS, INC. yNIACIN TAB 100MG 00182000101 GOLDLINE LABORATORIES, INC. yVITAMIN C TAB 250MG 00182000301 GOLDLINE LABORATORIES, INC. yGENERIX T TAB 00182000601 GOLDLINE LABORATORIES, INC. yACIDOPHILUS CAP /PECTIN 00182001301 GOLDLINE LABORATORIES, INC. yGUIATUSS AC SYP 10-100/5 00182001737 GOLDLINE LABORATORIES, INC. yGUIATUSS AC SYP 10-100/5 00182001740 GOLDLINE LABORATORIES, INC. yCOD LIVER OI CAP 00182002001 GOLDLINE LABORATORIES, INC. yVITAMIN B-12 TAB 500MCG 00182003701 GOLDLINE LABORATORIES, INC. yNIACIN TAB 50MG 00182005301 GOLDLINE LABORATORIES, INC. yVITAMIN C TAB 500MG 00182006801 GOLDLINE LABORATORIES, INC. yVITAMIN C TAB 500MG 00182006802 GOLDLINE LABORATORIES, INC. yVITAMIN C TAB 500MG 00182006810 GOLDLINE LABORATORIES, INC. yVITAMIN C TAB 500MG 00182006889 GOLDLINE LABORATORIES, INC. yVITAMIN E CAP 200UNIT 00182007901 GOLDLINE LABORATORIES, INC. yVITAMIN E CAP 400UNIT 00182008201 GOLDLINE LABORATORIES, INC. yVITAMIN E CAP 400UNIT 00182008210 GOLDLINE LABORATORIES, INC. yVITAMIN E CAP 1000UNIT 00182008301 GOLDLINE LABORATORIES, INC. yVITAMIN B-6 TAB 50MG 00182008601 GOLDLINE LABORATORIES, INC. yVITAMIN B-6 TAB 100MG 00182008701 GOLDLINE LABORATORIES, INC. yTETRACYCLINE CAP 250MG 00182011289 GOLDLINE LABORATORIES, INC. y

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PHENAZOPYRID TAB 100MG 00182013801 GOLDLINE LABORATORIES, INC. yGENEBS TAB 325MG 00182014101 GOLDLINE LABORATORIES, INC. yGENEBS TAB 325MG 00182014110 GOLDLINE LABORATORIES, INC. yD.O.S. CAP 250MG 00182018201 GOLDLINE LABORATORIES, INC. yDIMENHYDRIN TAB 50MG 00182019501 GOLDLINE LABORATORIES, INC. yPREDNISONE TAB 5MG 00182020189 GOLDLINE LABORATORIES, INC. yBACITRACIN OIN 500/GM 00182020830 GOLDLINE LABORATORIES, INC. yBACITRACIN OIN 500/GM 00182020833 GOLDLINE LABORATORIES, INC. yBACITRACIN OIN 500/GM 00182020834 GOLDLINE LABORATORIES, INC. yTRIPLE ANTIB OIN 00182023230 GOLDLINE LABORATORIES, INC. yGUIATUSS SYP 100/5ML 00182025937 GOLDLINE LABORATORIES, INC. yGUIATUSS SYP 100/5ML 00182025940 GOLDLINE LABORATORIES, INC. yD.O.S. CAP 100MG 00182028701 GOLDLINE LABORATORIES, INC. yD.O.S. CAP 100MG 00182028710 GOLDLINE LABORATORIES, INC. yPROPO-N/APAP TAB 100-650 00182031789 GOLDLINE LABORATORIES, INC. yCALCIUM LACT TAB 650MG 00182036201 GOLDLINE LABORATORIES, INC. yGELATIN CAP 650MG 00182038501 GOLDLINE LABORATORIES, INC. yHI B COMPLEX TAB /B12/C 00182039401 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 325MG 00182044401 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 325MG 00182044410 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 325MG 00182044417 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 325MG EC 00182044801 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 325MG EC 00182044810 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 325MG EC 00182044889 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 650MG 00182044901 GOLDLINE LABORATORIES, INC. yCHLORPHENIR TAB 4MG 00182047101 GOLDLINE LABORATORIES, INC. yCHLORPHENIR TAB 4MG 00182047110 GOLDLINE LABORATORIES, INC. yDIPHENHYDRAM CAP 25MG 00182049210 GOLDLINE LABORATORIES, INC. yFOLIC ACID TAB 1MG 00182050710 GOLDLINE LABORATORIES, INC. yFOLIC ACID TAB 1MG 00182050789 GOLDLINE LABORATORIES, INC. yISOSORB DIN TAB 10MG 00182051489 GOLDLINE LABORATORIES, INC. yISOSORB DIN TAB 5MG 00182055089 GOLDLINE LABORATORIES, INC. yHYDRALAZINE TAB 25MG 00182055489 GOLDLINE LABORATORIES, INC. yHYDRALAZINE TAB 50MG 00182055589 GOLDLINE LABORATORIES, INC. yHYDROCHLOROT TAB 50MG 00182055789 GOLDLINE LABORATORIES, INC. yMECLIZINE CHW 25MG 00182057101 GOLDLINE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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TETRACYCLINE CAP 500MG 00182067989 GOLDLINE LABORATORIES, INC. yNITROGLYCER CAP 2.5MG TD 00182070289 GOLDLINE LABORATORIES, INC. yNITROGLYCER CAP 6.5MG TD 00182070389 GOLDLINE LABORATORIES, INC. yBABY VITAMIN DRO 00182074767 GOLDLINE LABORATORIES, INC. yVITAMIN A&D OIN 00182076343 GOLDLINE LABORATORIES, INC. yVITAMIN A&D OIN 00182076345 GOLDLINE LABORATORIES, INC. yPOVIDONE IOD SOL 10% 00182076740 GOLDLINE LABORATORIES, INC. yVITAMIN E CRE 3000UNIT 00182079943 GOLDLINE LABORATORIES, INC. yALAMAG SUS 00182080939 GOLDLINE LABORATORIES, INC. yNIACIN CAP 250MG CR 00182081101 GOLDLINE LABORATORIES, INC. yMILK OF MAGN SUS 00182083339 GOLDLINE LABORATORIES, INC. yMILK OF MAGN SUS 00182083340 GOLDLINE LABORATORIES, INC. yMILK OF MAGN SUS 00182083341 GOLDLINE LABORATORIES, INC. yISOSORB DIN TAB 20MG 00182086889 GOLDLINE LABORATORIES, INC. yPHENAZOPYRID TAB 200MG 00182090401 GOLDLINE LABORATORIES, INC. yHYDRALAZINE TAB 10MG 00182090589 GOLDLINE LABORATORIES, INC. yVIOGEN-C CAP 00182094101 GOLDLINE LABORATORIES, INC. yHYDROCORT CRE 1% 00182095034 GOLDLINE LABORATORIES, INC. yZINC OXIDE OIN 20% 00182095243 GOLDLINE LABORATORIES, INC. yZINC OXIDE OIN 20% 00182095245 GOLDLINE LABORATORIES, INC. yICHTHAMMOL OIN 20% 00182095534 GOLDLINE LABORATORIES, INC. yACETAMIN TAB 325MG 00182100010 GOLDLINE LABORATORIES, INC. yACETAMIN TAB 325MG 00182100019 GOLDLINE LABORATORIES, INC. yDEXCHLORPHEN TAB 6MG TR 00182101501 GOLDLINE LABORATORIES, INC. yVITAMIN B-12 TAB 1000MCG 00182101701 GOLDLINE LABORATORIES, INC. yPHENYLGESIC TAB 00182102701 GOLDLINE LABORATORIES, INC. yPHENYLGESIC TAB 00182102710 GOLDLINE LABORATORIES, INC. yDOXYCYCL HYC CAP 100MG 00182103589 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 200MG 00182103901 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 200MG 00182103902 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 200MG 00182103910 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 200MG 00182103916 GOLDLINE LABORATORIES, INC. yGG/DM CR TAB 600-30MG 00182104201 GOLDLINE LABORATORIES, INC. yASPIRIN TAB /ANTACID 00182105801 GOLDLINE LABORATORIES, INC. yASPIRIN AD TAB /ANTACID 00182106001 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 81MG EC 00182106105 GOLDLINE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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ASPIRIN TAB 81MG EC 00182106107 GOLDLINE LABORATORIES, INC. yVITAMIN E OIL 28000UNT 00182108134 GOLDLINE LABORATORIES, INC. yACETAMIN SUP 120MG 00182166211 GOLDLINE LABORATORIES, INC. yTOLNAFTATE POW 1% 00182166760 GOLDLINE LABORATORIES, INC. yINDOMETHACIN CAP 25MG 00182168189 GOLDLINE LABORATORIES, INC. yINDOMETHACIN CAP 50MG 00182168289 GOLDLINE LABORATORIES, INC. yGENEYES SOL 0.05% OP 00182169233 GOLDLINE LABORATORIES, INC. yBENZTROPINE TAB 1MG 00182170089 GOLDLINE LABORATORIES, INC. yBENZTROPINE TAB 2MG 00182170189 GOLDLINE LABORATORIES, INC. yVITAMIN C CHW 500MG 00182170401 GOLDLINE LABORATORIES, INC. yVALPROIC ACD CAP 250MG 00182175401 GOLDLINE LABORATORIES, INC. yDIOCTO LIQ 150/15ML 00182177440 GOLDLINE LABORATORIES, INC. yLITHIUM CARB CAP 300MG 00182178101 GOLDLINE LABORATORIES, INC. yLITHIUM CARB CAP 300MG 00182178110 GOLDLINE LABORATORIES, INC. yMETOCLOPRAM TAB 10MG 00182178989 GOLDLINE LABORATORIES, INC. ySALSALATE TAB 500MG 00182180289 GOLDLINE LABORATORIES, INC. ySALSALATE TAB 750MG 00182180389 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 400MG 00182180989 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 600MG 00182181089 GOLDLINE LABORATORIES, INC. yPINK BISMUTH SUS 527/30ML 00182181144 GOLDLINE LABORATORIES, INC. yPROPRANOLOL TAB 10MG 00182181289 GOLDLINE LABORATORIES, INC. yPROPRANOLOL TAB 20MG 00182181389 GOLDLINE LABORATORIES, INC. yPROPRANOLOL TAB 40MG 00182181489 GOLDLINE LABORATORIES, INC. yPROPRANOLOL TAB 80MG 00182181589 GOLDLINE LABORATORIES, INC. yGENEBS TAB 500MG 00182183201 GOLDLINE LABORATORIES, INC. yGENEBS TAB 500MG 00182183210 GOLDLINE LABORATORIES, INC. yMEGESTROL AC TAB 40MG 00182186489 GOLDLINE LABORATORIES, INC. yTRIAMT/HCTZ TAB 75-50MG 00182187289 GOLDLINE LABORATORIES, INC. yCHO MAG TRIS TAB 750MG 00182189501 GOLDLINE LABORATORIES, INC. yMETOCLOPRAM TAB 5MG 00182189889 GOLDLINE LABORATORIES, INC. yCHO MAG TRIS TAB 500MG 00182189901 GOLDLINE LABORATORIES, INC. yBUFFERED ASA TAB 325MG 00182190901 GOLDLINE LABORATORIES, INC. yBUFFERED ASA TAB 325MG 00182190910 GOLDLINE LABORATORIES, INC. yCYCLOBENZAPR TAB 10MG 00182191989 GOLDLINE LABORATORIES, INC. yNITROFUR MAC CAP 50MG 00182194489 GOLDLINE LABORATORIES, INC. yNITROFUR MAC CAP 100MG 00182194589 GOLDLINE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARB/LEVO TAB 25-100MG 00182194989 GOLDLINE LABORATORIES, INC. yRELIABLE GEN TAB 5MG EC 00182199201 GOLDLINE LABORATORIES, INC. yRELIABLE GEN TAB 5MG EC 00182199210 GOLDLINE LABORATORIES, INC. yGLIPIZIDE TAB 5MG 00182199489 GOLDLINE LABORATORIES, INC. yGLIPIZIDE TAB 10MG 00182199589 GOLDLINE LABORATORIES, INC. yGENAHIST ELX 12.5/5ML 00182200137 GOLDLINE LABORATORIES, INC. yGENFIBER CAP 520MG 00182201025 GOLDLINE LABORATORIES, INC. yGENACOL MS TAB COLD/FLU 00182202219 GOLDLINE LABORATORIES, INC. yGENAHIST TAB 25MG 00182209116 GOLDLINE LABORATORIES, INC. yGENAHIST CAP 25MG 00182209201 GOLDLINE LABORATORIES, INC. yGENAHIST CAP 25MG 00182209216 GOLDLINE LABORATORIES, INC. yGENAPAP SINU TAB MAX-STR 00182214516 GOLDLINE LABORATORIES, INC. yGENAPAP ELX 160/5ML 00182214637 GOLDLINE LABORATORIES, INC. yGENAPAP CHW 80MG GRP 00182214717 GOLDLINE LABORATORIES, INC. yGENAPAP TAB 500MG ES 00182215201 GOLDLINE LABORATORIES, INC. yGENAPAP TAB 500MG 00182215401 GOLDLINE LABORATORIES, INC. yGENASYME DRO 40/0.6ML 00182219166 GOLDLINE LABORATORIES, INC. yGENATON CHW 00182222001 GOLDLINE LABORATORIES, INC. yGENATUSS DM SYP 100-10/5 00182223637 GOLDLINE LABORATORIES, INC. yGENPRIL TAB 200MG 00182240101 GOLDLINE LABORATORIES, INC. yGENPRIL TAB 200MG 00182240119 GOLDLINE LABORATORIES, INC. yINDAPAMIDE TAB 2.5MG 00182261089 GOLDLINE LABORATORIES, INC. yGUAIFENESIN TAB 200MG 00182261401 GOLDLINE LABORATORIES, INC. yCAPTOPRIL TAB 25MG 00182262389 GOLDLINE LABORATORIES, INC. yCIPROFLOXACN TAB 250MG 00182263101 GOLDLINE LABORATORIES, INC. yGLYBURIDE TAB 2.5MG 00182264689 GOLDLINE LABORATORIES, INC. yGLYBURIDE TAB 5MG 00182264789 GOLDLINE LABORATORIES, INC. yBUT/APAP/CAF TAB 00182265901 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 25MCG 00182270701 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 25MCG 00182270710 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 50MCG 00182270801 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 50MCG 00182270810 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 75MCG 00182270901 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 75MCG 00182270910 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 88MCG 00182271001 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 88MCG 00182271010 GOLDLINE LABORATORIES, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LEVOTHYROXIN TAB 100MCG 00182271101 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 100MCG 00182271110 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 112MCG 00182271201 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 112MCG 00182271210 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 125MCG 00182271301 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 125MCG 00182271310 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 150MCG 00182271401 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 150MCG 00182271410 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 175MCG 00182271501 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 175MCG 00182271510 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 200MCG 00182271601 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 200MCG 00182271610 GOLDLINE LABORATORIES, INC. yLEVOTHYROXIN TAB 300MCG 00182271701 GOLDLINE LABORATORIES, INC. yCIPROFLOXACN TAB 500MG 00182272101 GOLDLINE LABORATORIES, INC. yCIPROFLOXACN TAB 500MG 00182272136 GOLDLINE LABORATORIES, INC. yCIPROFLOXACN TAB 750MG 00182272219 GOLDLINE LABORATORIES, INC. yPRENATAL S TAB 00182403901 GOLDLINE LABORATORIES, INC. yGLUCOSAMINE CAP 500MG 00182404826 GOLDLINE LABORATORIES, INC. yB-COMPLEX/ TAB VIT B-12 00182405901 GOLDLINE LABORATORIES, INC. yBIOTIN TAB 300MCG 00182406001 GOLDLINE LABORATORIES, INC. yB-PLEX TAB 00182406201 GOLDLINE LABORATORIES, INC. yCERTAGEN TAB SENIOR 00182408926 GOLDLINE LABORATORIES, INC. yGLUCOS/CHOND TAB 500/400 00182409507 GOLDLINE LABORATORIES, INC. yVITAMIN C CAP 500MG TD 00182410901 GOLDLINE LABORATORIES, INC. yVITAMIN C TAB 1000MG 00182411001 GOLDLINE LABORATORIES, INC. yCALCARB 600 TAB 00182414005 GOLDLINE LABORATORIES, INC. yCALCARB 600 TAB 00182414026 GOLDLINE LABORATORIES, INC. yCALCARB/D TAB 600 00182414126 GOLDLINE LABORATORIES, INC. yCALCIUM CIT TAB 950MG 00182415101 GOLDLINE LABORATORIES, INC. yCALC/MAGNES TAB 426-246 00182415601 GOLDLINE LABORATORIES, INC. yCERTAGEN SR TAB 00182415826 GOLDLINE LABORATORIES, INC. yCERTAGEN TAB 00182416201 GOLDLINE LABORATORIES, INC. yCERTAGEN TAB 00182416210 GOLDLINE LABORATORIES, INC. yCHOLINOID CAP 00182416601 GOLDLINE LABORATORIES, INC. yFOLIC ACID TAB 400MCG 00182430901 GOLDLINE LABORATORIES, INC. yFRUITY CHEWS CHW NF 00182431401 GOLDLINE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FRUITY CHEWS CHW /IRON 00182431501 GOLDLINE LABORATORIES, INC. yHI-POTEN B- TAB CPLX/C 00182432906 GOLDLINE LABORATORIES, INC. yMAGNESIUM TAB 30MG 00182438501 GOLDLINE LABORATORIES, INC. yNIACIN TAB 250MG 00182440401 GOLDLINE LABORATORIES, INC. yNIACIN TAB 500MG 00182440501 GOLDLINE LABORATORIES, INC. yOPTI-GEN TAB 00182441326 GOLDLINE LABORATORIES, INC. yNIACIN TAB 500MG TD 00182441701 GOLDLINE LABORATORIES, INC. yNIACIN CAP 500MG TD 00182441801 GOLDLINE LABORATORIES, INC. yNIACIN CAP 500MG TD 00182441810 GOLDLINE LABORATORIES, INC. yONE-TAB-DAIL TAB 00182442801 GOLDLINE LABORATORIES, INC. yONE-TAB-DAIL TAB 00182442810 GOLDLINE LABORATORIES, INC. yONE-TAB-DAIL TAB 00182442889 GOLDLINE LABORATORIES, INC. yONE-TAB-DAIL TAB W/MIN 00182443601 GOLDLINE LABORATORIES, INC. yONE-TAB-DAIL TAB W/MIN 00182443610 GOLDLINE LABORATORIES, INC. yOYST-CAL-D TAB 500MG 00182443907 GOLDLINE LABORATORIES, INC. yOYST-CAL-D TAB 500MG 00182443910 GOLDLINE LABORATORIES, INC. yOYST-CAL-D TAB 500MG 00182443926 GOLDLINE LABORATORIES, INC. yOYST-CAL-D TAB 500MG 00182443989 GOLDLINE LABORATORIES, INC. yONE-TAB-DAIL TAB /IRON NF 00182444001 GOLDLINE LABORATORIES, INC. ySTRESS/IRON TAB 00182448126 GOLDLINE LABORATORIES, INC. ySTRESS NF TAB 00182448726 GOLDLINE LABORATORIES, INC. ySTRESS W/ZN TAB NF 00182449126 GOLDLINE LABORATORIES, INC. ySUPER B-100 TAB 00182450526 GOLDLINE LABORATORIES, INC. yTHERAPEUTIC TAB 00182451806 GOLDLINE LABORATORIES, INC. yTHERAPEUTIC TAB 00182451810 GOLDLINE LABORATORIES, INC. yTHERAPEUTIC TAB 00182451889 GOLDLINE LABORATORIES, INC. yTHERAPEUTIC TAB -M 00182451906 GOLDLINE LABORATORIES, INC. yTHERAPEUTIC TAB -M 00182451910 GOLDLINE LABORATORIES, INC. yTHERAPEUTIC TAB -M 00182451989 GOLDLINE LABORATORIES, INC. yCLOTRIMAZOLE CRE 1% VAG 00182503160 GOLDLINE LABORATORIES, INC. yTOLNAFTATE CRE 1% 00182503834 GOLDLINE LABORATORIES, INC. yEYE LUBRICAN OIN OP 00182505631 GOLDLINE LABORATORIES, INC. yARTH PAIN ME CRE 10% 00182505882 GOLDLINE LABORATORIES, INC. yHYDROCORT AC CRE 1% MX-ST 00182506034 GOLDLINE LABORATORIES, INC. yANTI-FUNGAL CRE 2% 00182506434 GOLDLINE LABORATORIES, INC. yDESONIDE CRE 0.05% 00182506651 GOLDLINE LABORATORIES, INC. y

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DESONIDE CRE 0.05% 00182506652 GOLDLINE LABORATORIES, INC. yTRIAMCINOLON OIN 0.5% 00182506851 GOLDLINE LABORATORIES, INC. yMICONAZOLE CRE 2% 00182507460 GOLDLINE LABORATORIES, INC. yMOISTURIN CRE DRY SKIN 00182507945 GOLDLINE LABORATORIES, INC. yDIAPER RASH OIN 40% 00182508757 GOLDLINE LABORATORIES, INC. yMEDICATED PAD 00182508801 GOLDLINE LABORATORIES, INC. yMUSCLE RUB CRE MAX STR 00182509157 GOLDLINE LABORATORIES, INC. yCLOTRIMAZOLE CRE 1% 00182509533 GOLDLINE LABORATORIES, INC. yCLOTRIMAZOLE CRE 1% 00182509534 GOLDLINE LABORATORIES, INC. yANTI-ITCH CRE MAX-STR 00182512134 GOLDLINE LABORATORIES, INC. yTRIPLE ANTIB OIN 00182512234 GOLDLINE LABORATORIES, INC. yPROMPT RLF OIN HEMORR 00182512334 GOLDLINE LABORATORIES, INC. yPROMPT RLF OIN HEMORR 00182512343 GOLDLINE LABORATORIES, INC. yCAPSICUM OLE CRE 0.025% 00182512852 GOLDLINE LABORATORIES, INC. yCAPSICUM OLE CRE 0.075% 00182512952 GOLDLINE LABORATORIES, INC. yAMMONIUM LAC CRE 12% 00182513076 GOLDLINE LABORATORIES, INC. yALAMAG PLUS SUS 00182600439 GOLDLINE LABORATORIES, INC. yANTACID DS SUS 00182616139 GOLDLINE LABORATORIES, INC. yLICE TRTMNT SHA MAX STR 00182616737 GOLDLINE LABORATORIES, INC. yLICE TRTMNT SHA MAX STR 00182616743 GOLDLINE LABORATORIES, INC. yLICE TRTMNT KIT MAX-STR 00182616799 GOLDLINE LABORATORIES, INC. yHYDRAMINE ELX 12.5/5ML 00182616837 GOLDLINE LABORATORIES, INC. yHYDRAMINE ELX 12.5/5ML 00182616840 GOLDLINE LABORATORIES, INC. yPED ELCTRLYT SOL BUBBLGUM 00182620558 GOLDLINE LABORATORIES, INC. yPED ELCTRLYT SOL FRUIT 00182620658 GOLDLINE LABORATORIES, INC. yPED ELCTRLYT SOL UNFLAVRD 00182620758 GOLDLINE LABORATORIES, INC. yACETAMIN SUP 325MG 00182700111 GOLDLINE LABORATORIES, INC. yHEMORRHOIDAL SUP -HC 25MG 00182703811 GOLDLINE LABORATORIES, INC. yEYE WASH SOL OP 00182705137 GOLDLINE LABORATORIES, INC. yTEARGEN II SOL OP 00182708264 GOLDLINE LABORATORIES, INC. yPROCHLORPER SUP 25MG 00182709611 GOLDLINE LABORATORIES, INC. yPROMETHAZINE SUP 12.5MG 00182709911 GOLDLINE LABORATORIES, INC. yPROMETHAZINE SUP 25MG 00182710011 GOLDLINE LABORATORIES, INC. yPROMETHAZINE SUP 50MG 00182710111 GOLDLINE LABORATORIES, INC. yGENFIBER POW 00182724432 GOLDLINE LABORATORIES, INC. yACYCLOVIR TAB 400MG 00182820089 GOLDLINE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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LABETALOL TAB 100MG 00182820289 GOLDLINE LABORATORIES, INC. yLABETALOL TAB 200MG 00182820389 GOLDLINE LABORATORIES, INC. yPROCHLORPER TAB 5MG 00182821089 GOLDLINE LABORATORIES, INC. yPROCHLORPER TAB 10MG 00182821189 GOLDLINE LABORATORIES, INC. ySENNAGEN TAB 8.6MG 00182821589 GOLDLINE LABORATORIES, INC. yASPIRIN TAB 81MG EC 00182821789 GOLDLINE LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 00182822189 GOLDLINE LABORATORIES, INC. yPROMETHAZINE TAB 25MG 00182822289 GOLDLINE LABORATORIES, INC. yDILTIAZEM CAP 120MG ER 00182822589 GOLDLINE LABORATORIES, INC. yDILTIAZEM CAP 180MG ER 00182822689 GOLDLINE LABORATORIES, INC. yDILTIAZEM CAP 240MG ER 00182822789 GOLDLINE LABORATORIES, INC. yCLONAZEPAM TAB 0.5MG 00182822889 GOLDLINE LABORATORIES, INC. yCLONAZEPAM TAB 1MG 00182822989 GOLDLINE LABORATORIES, INC. yCLONAZEPAM TAB 2MG 00182823089 GOLDLINE LABORATORIES, INC. yNIFEDIPINE TAB 30MG ER 00182823289 GOLDLINE LABORATORIES, INC. yNIFEDIPINE TAB 60MG ER 00182823389 GOLDLINE LABORATORIES, INC. yNIFEDIPINE TAB 90MG CR 00182823489 GOLDLINE LABORATORIES, INC. yATENOLOL TAB 25MG 00182823589 GOLDLINE LABORATORIES, INC. yATENOLOL TAB 50MG 00182823689 GOLDLINE LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 00182823789 GOLDLINE LABORATORIES, INC. yLORAZEPAM TAB 1MG 00182823889 GOLDLINE LABORATORIES, INC. yLORAZEPAM TAB 2MG 00182823989 GOLDLINE LABORATORIES, INC. yNAPROXEN TAB 250MG 00182824089 GOLDLINE LABORATORIES, INC. yNAPROXEN TAB 500MG 00182824189 GOLDLINE LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 00182836389 GOLDLINE LABORATORIES, INC. yACETAMIN TAB 325MG 00182844789 GOLDLINE LABORATORIES, INC. yACETAMIN TAB 500MG 00182845389 GOLDLINE LABORATORIES, INC. yBISACODYL TAB 5MG EC 00182853489 GOLDLINE LABORATORIES, INC. yQUININE SULF TAB 260MG 00182861589 GOLDLINE LABORATORIES, INC. ySENNA-S TAB 8.6-50MG 00182864289 GOLDLINE LABORATORIES, INC. ySIMETHICONE CHW 80MG 00182864389 GOLDLINE LABORATORIES, INC. yIBUPROFEN TAB 200MG 00182868889 GOLDLINE LABORATORIES, INC. yPROFILNINE INJ 500UNIT 68516320002 GRIFOLS BIOLOGICALS INC. yPROFILNINE INJ 68516320003 GRIFOLS BIOLOGICALS INC. yALPHANINE SD INJ 250-1500 68516360002 GRIFOLS BIOLOGICALS INC. yALPHANATE INJ 250-500 68516460001 GRIFOLS BIOLOGICALS INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALPHANATE INJ 68516460002 GRIFOLS BIOLOGICALS INC. yALBUTEIN INJ 5% 68516521101 GRIFOLS BIOLOGICALS INC. yALBUTEIN INJ 5% 68516521102 GRIFOLS BIOLOGICALS INC. yALBUTEIN INJ 5% 49669521101 GRIFOLS BIOLOGICALS, INC. yARALAST INJ 400MG 49669580001 GRIFOLS BIOLOGICALS, INC. yARALAST INJ 800MG 49669580002 GRIFOLS BIOLOGICALS, INC. yFARESTON TAB 60MG 11399000501 GTX, INC. yFARESTON TAB 60MG 11399000530 GTX, INC. yERGOMAR SUB 2MG 67754012020 HARVEST PHARMACEUTICALS, INC. yEASPRIN TAB 975MG EC 67754097571 HARVEST PHARMACEUTICALS, INC. yDIABTC TUSSN CAP ALLERGY 61787005212 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC CAP COLD/FLU 61787005312 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABTC TUSSN CAP DM 61787005412 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS CAP DM 61787005512 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETISWEET POW 61787005616 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ DM 61787006204 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ DM 61787006208 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ EX 61787006304 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ EX 61787006316 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ MAX STR 61787006404 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ MAX STR 61787006408 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC TUS LIQ MAX STR 61787006416 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETIC LIQ TUSSIN C 61787014816 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yDIABETI-GEST CHW 420MG 61787066101 HEALTH CARE PRODUCTS DIVISION-HEALTH CA yPROSHIELD AER FOAM/SPR 00064015008 HEALTHPOINT, LTD. yPROSHIELD CRE PLUS 00064030004 HEALTHPOINT, LTD. yPROSHIELD KIT SKN CARE 00064030025 HEALTHPOINT, LTD. yEMBELINE OIN 0.05% 00064041015 HEALTHPOINT, LTD. yEMBELINE OIN 0.05% 00064041030 HEALTHPOINT, LTD. yEMBELINE OIN 0.05% 00064041045 HEALTHPOINT, LTD. yEMBELINE OIN 0.05% 00064041060 HEALTHPOINT, LTD. yEMBELINE CRE 0.05% 00064042015 HEALTHPOINT, LTD. yEMBELINE CRE 0.05% 00064042030 HEALTHPOINT, LTD. yEMBELINE CRE 0.05% 00064042045 HEALTHPOINT, LTD. yEMBELINE CRE 0.05% 00064042060 HEALTHPOINT, LTD. yEMBELINE SOL 0.05% 00064043025 HEALTHPOINT, LTD. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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EMBELINE SOL 0.05% 00064043050 HEALTHPOINT, LTD. yEMBELINE E CRE 0.05% 00064044015 HEALTHPOINT, LTD. yEMBELINE E CRE 0.05% 00064044030 HEALTHPOINT, LTD. yEMBELINE E CRE 0.05% 00064044060 HEALTHPOINT, LTD. yEMBELINE GEL 0.05% 00064048015 HEALTHPOINT, LTD. yEMBELINE GEL 0.05% 00064048030 HEALTHPOINT, LTD. yEMBELINE GEL 0.05% 00064048060 HEALTHPOINT, LTD. yMITRAZOL CRE 2% 00064060002 HEALTHPOINT, LTD. yMITRAZOL POW 2% 00064065001 HEALTHPOINT, LTD. yPROSHIELD SPR CLEANSER 00064070004 HEALTHPOINT, LTD. yPROSHIELD CRE PROTECT 00064085006 HEALTHPOINT, LTD. yACCUZYME OIN 00064100001 HEALTHPOINT, LTD. yACCUZYME OIN 00064100007 HEALTHPOINT, LTD. yEXACTACAIN AER 00064107060 HEALTHPOINT, LTD. yCETACORT LOT 1% 00064200002 HEALTHPOINT, LTD. yDARAGEN SHA 00064202008 HEALTHPOINT, LTD. yDERMOVAN CRE 00064203016 HEALTHPOINT, LTD. yIONAX LIQ 00064204008 HEALTHPOINT, LTD. yIONAX GRA 00064205002 HEALTHPOINT, LTD. yIONAX GRA 00064205004 HEALTHPOINT, LTD. yIONIL SHA 00064206004 HEALTHPOINT, LTD. yIONIL SHA 00064206008 HEALTHPOINT, LTD. yIONIL SHA 00064206016 HEALTHPOINT, LTD. yIONIL SHA 00064206032 HEALTHPOINT, LTD. yIONIL PLUS SHA 2% 00064207008 HEALTHPOINT, LTD. yIONIL-T SHA 00064208004 HEALTHPOINT, LTD. yIONIL-T SHA 00064208008 HEALTHPOINT, LTD. yIONIL-T SHA 00064208016 HEALTHPOINT, LTD. yIONIL-T SHA 00064208032 HEALTHPOINT, LTD. yIONIL-T PLUS SHA 2% 00064209008 HEALTHPOINT, LTD. yIONIL LIQ 00064210012 HEALTHPOINT, LTD. yNUTRAPLUS CRE 10% 00064211003 HEALTHPOINT, LTD. yNUTRAPLUS CRE 10% 00064211016 HEALTHPOINT, LTD. yNUTRAPLUS LOT 10% 00064212008 HEALTHPOINT, LTD. yNUTRAPLUS LOT 10% 00064212016 HEALTHPOINT, LTD. yPSORIGEL GEL 7.5% 00064213004 HEALTHPOINT, LTD. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SEBA-NIL LIQ 00064215008 HEALTHPOINT, LTD. ySEBA-NIL LIQ 00064215016 HEALTHPOINT, LTD. ySEBA-NIL MIS MASK 00064216035 HEALTHPOINT, LTD. ySULFORCIN LIQ 00064217004 HEALTHPOINT, LTD. yVELVACHOL CRE 00064218014 HEALTHPOINT, LTD. yWIBI LOT 00064219008 HEALTHPOINT, LTD. yWIBI LOT 00064219016 HEALTHPOINT, LTD. yNUTRACORT LOT 1% 00064220002 HEALTHPOINT, LTD. yNUTRACORT LOT 1% 00064220004 HEALTHPOINT, LTD. yNUTRACORT LOT 2.5% 00064221002 HEALTHPOINT, LTD. yNUTRACORT LOT 2.5% 00064221004 HEALTHPOINT, LTD. ySEBA-GEL GEL 5% 00064230060 HEALTHPOINT, LTD. ySEBA-GEL GEL 5% 00064230090 HEALTHPOINT, LTD. ySEBA-GEL GEL 10% 00064231060 HEALTHPOINT, LTD. ySEBA-GEL GEL 10% 00064231090 HEALTHPOINT, LTD. yREME T SHA 5% 00064250008 HEALTHPOINT, LTD. yAKNE-MYCIN OIN 2% 00064300025 HEALTHPOINT, LTD. yCLODERM CRE 0.1% 00064310015 HEALTHPOINT, LTD. yCLODERM CRE 0.1% 00064310045 HEALTHPOINT, LTD. yCLODERM CRE 0.1% 00064310090 HEALTHPOINT, LTD. yPANAFIL OIN 00064341007 HEALTHPOINT, LTD. yPANAFIL OIN 00064341030 HEALTHPOINT, LTD. yPANAFIL SPR 00064351033 HEALTHPOINT, LTD. yPANAFIL SE EMU 00064351034 HEALTHPOINT, LTD. yPRUDOXIN CRE 5% 00064360045 HEALTHPOINT, LTD. yXENADERM OIN 00064390030 HEALTHPOINT, LTD. yXENADERM OIN 00064390060 HEALTHPOINT, LTD. yOVACE WASH LIQ 00064400012 HEALTHPOINT, LTD. ySALEX LOT 6% 00064401114 HEALTHPOINT, LTD. yOVACE GEL 10% 00064420030 HEALTHPOINT, LTD. yOVACE GEL 10% 00064420060 HEALTHPOINT, LTD. yOVACE CRE 10% 00064430030 HEALTHPOINT, LTD. yOVACE CRE 10% 00064430060 HEALTHPOINT, LTD. yNITRO-TRANSD DIS 0.2MG/HR 49730011130 HERCON LABORATORIES CORPORATION yNITROGLYCER DIS 0.4MG/HR 49730011230 HERCON LABORATORIES CORPORATION yNITROGLYCERI DIS 0.6MG/HR 49730011330 HERCON LABORATORIES CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ETHAMBUTOL TAB 100MG 23155010001 HERITAGE PHARMACEUTICALS, INC. yETHAMBUTOL TAB 400MG 23155010101 HERITAGE PHARMACEUTICALS, INC. yREDNESS RELI SOL EYE DROP 50383001015 HI-TECH PHARMACAL CO. INC. yEYE WASH SOL 50383001804 HI-TECH PHARMACAL CO. INC. yOFLOXACIN SOL 0.3% 50383002405 HI-TECH PHARMACAL CO. INC. yARTIFICIAL SOL TEARS OP 50383002615 HI-TECH PHARMACAL CO. INC. yARTIFICIAL SOL TEARS OP 50383002630 HI-TECH PHARMACAL CO. INC. yPREDNISOLONE SYP 15MG/5ML 50383004224 HI-TECH PHARMACAL CO. INC. yCIMETIDINE SOL 300/5ML 50383005008 HI-TECH PHARMACAL CO. INC. yDIABET EXPEC SYP 100/5ML 50383006104 HI-TECH PHARMACAL CO. INC. yAPAP/CODEINE SOL 120-12/5 50383007916 HI-TECH PHARMACAL CO. INC. yCO-HISTINE LIQ DH 50383008404 HI-TECH PHARMACAL CO. INC. yCO-HISTINE LIQ DH 50383008416 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP AC 50383008704 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP AC 50383008716 HI-TECH PHARMACAL CO. INC. yAPAP DRO 100MG/ML 50383009515 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP DM 50383009804 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP DM 50383009816 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP DM 50383009828 HI-TECH PHARMACAL CO. INC. yAPAP ELX 80MG/2.5 50383009904 HI-TECH PHARMACAL CO. INC. yAPAP ELX 80MG/2.5 50383009916 HI-TECH PHARMACAL CO. INC. yAPAP ELX 80MG/2.5 50383009928 HI-TECH PHARMACAL CO. INC. yACETAMIN ELX 160/5ML 50383010004 HI-TECH PHARMACAL CO. INC. yACETAMIN ELX 160/5ML 50383010016 HI-TECH PHARMACAL CO. INC. yACETAMIN ELX 160/5ML 50383010028 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP 100/5ML 50383010304 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP 100/5ML 50383010308 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP 100/5ML 50383010316 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP 100/5ML 50383010328 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP DM 50383010404 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP DM 50383010416 HI-TECH PHARMACAL CO. INC. yGUAIATUSSIN SYP DM 50383010428 HI-TECH PHARMACAL CO. INC. yGUAIATUS PED SYP 7.5/5ML 50383010604 HI-TECH PHARMACAL CO. INC. yK-PEC SUS 600/15ML 50383010908 HI-TECH PHARMACAL CO. INC. yK-PEC SUS 600/15ML 50383010912 HI-TECH PHARMACAL CO. INC. yPHENTEX SOL 50383011116 HI-TECH PHARMACAL CO. INC. y

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GUAIATUSS CF SYP 50383011304 HI-TECH PHARMACAL CO. INC. yGUIATUSS PE SYP 30-100/5 50383011404 HI-TECH PHARMACAL CO. INC. yGERI-TONIC LIQ 50383012016 HI-TECH PHARMACAL CO. INC. yK-PEC LIQ 750MG/15 50383013108 HI-TECH PHARMACAL CO. INC. yK-PEC LIQ 750MG/15 50383013112 HI-TECH PHARMACAL CO. INC. yK-PEC LIQ 750MG/15 50383013116 HI-TECH PHARMACAL CO. INC. yEXP COUGH CT SYP 100/5ML 50383013208 HI-TECH PHARMACAL CO. INC. yEXP COUGH CT SYP 100/5ML 50383013216 HI-TECH PHARMACAL CO. INC. yHT-TUSS DM ELX 200-20/5 50383013516 HI-TECH PHARMACAL CO. INC. yVITAMIN C SYP 500/5ML 50383016704 HI-TECH PHARMACAL CO. INC. yVITAMIN C SYP 500/5ML 50383016708 HI-TECH PHARMACAL CO. INC. yVITAMIN C SYP 500/5ML 50383016716 HI-TECH PHARMACAL CO. INC. yLEVOCARNITIN SOL 1GM/10ML 50383017104 HI-TECH PHARMACAL CO. INC. yLEVOCARNITIN TAB 330MG 50383017290 HI-TECH PHARMACAL CO. INC. yPREDNISOLONE SOL 15MG/5ML 50383017708 HI-TECH PHARMACAL CO. INC. yGUAIASORB SYP 100/5ML 50383020804 HI-TECH PHARMACAL CO. INC. yHYGIENIC CLN PAD /ALOE 50383021100 HI-TECH PHARMACAL CO. INC. yHYGIENIC CLN PAD /ALOE 50383021125 HI-TECH PHARMACAL CO. INC. yHYGIENIC PAD PRMOXINE 50383021400 HI-TECH PHARMACAL CO. INC. yCIPROFLOXACN SOL 0.3% OP 50383028210 HI-TECH PHARMACAL CO. INC. yHI-TUSS SYP 50383030104 HI-TECH PHARMACAL CO. INC. yPEDIATRIC LIQ CGH/COLD 50383055104 HI-TECH PHARMACAL CO. INC. yCARBOFED DM SYP 50383057516 HI-TECH PHARMACAL CO. INC. yCARBOFED DM DRO 50383057630 HI-TECH PHARMACAL CO. INC. ySALINE MIST SPR 0.65% 50383057745 HI-TECH PHARMACAL CO. INC. yCHILD ALLERG ELX 12.5/5ML 50383057804 HI-TECH PHARMACAL CO. INC. yCHILD ALLERG ELX 12.5/5ML 50383057816 HI-TECH PHARMACAL CO. INC. yDIPHENHYDRAM SYP 12.5/5ML 50383057904 HI-TECH PHARMACAL CO. INC. yDIPHENHYDRAM SYP 12.5/5ML 50383057908 HI-TECH PHARMACAL CO. INC. yDIPHENHYDRAM SYP 12.5/5ML 50383057916 HI-TECH PHARMACAL CO. INC. yDIPHENHYDRAM SYP 12.5/5ML 50383057928 HI-TECH PHARMACAL CO. INC. yPSEUDOEPHED SYP 50383058004 HI-TECH PHARMACAL CO. INC. yPSEUDOEPHED SYP 50383058016 HI-TECH PHARMACAL CO. INC. yCHILD ALLERG ELX 12.5/5ML 50383058104 HI-TECH PHARMACAL CO. INC. yCHILD ALLERG ELX 12.5/5ML 50383058116 HI-TECH PHARMACAL CO. INC. yNYSTATIN POW 50383058950 HI-TECH PHARMACAL CO. INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BROMTAPP ELX 2-12.5/5 50383059008 HI-TECH PHARMACAL CO. INC. yBROMTAPP ELX 2-12.5/5 50383059104 HI-TECH PHARMACAL CO. INC. yBROMTAPP ELX 2-12.5/5 50383059108 HI-TECH PHARMACAL CO. INC. yBROMTAPP ELX 2-12.5/5 50383059116 HI-TECH PHARMACAL CO. INC. yBROMTAPP DM ELX 50383059204 HI-TECH PHARMACAL CO. INC. yBROMETANE DX SYP 50383059316 HI-TECH PHARMACAL CO. INC. yBROMETANE DX SYP 50383059328 HI-TECH PHARMACAL CO. INC. yBROMTAPP DM ELX 50383059404 HI-TECH PHARMACAL CO. INC. yDAIRY AID LIQ 3300U 50383061153 HI-TECH PHARMACAL CO. INC. yNAUSEA CONTR SOL 50383061604 HI-TECH PHARMACAL CO. INC. yNAUSEA CONTR SOL 50383061616 HI-TECH PHARMACAL CO. INC. yLOPERAMIDE LIQ 1MG/5ML 50383061804 HI-TECH PHARMACAL CO. INC. yPINK BISMUTH SUS 527/30ML 50383062008 HI-TECH PHARMACAL CO. INC. yPINK BISMUTH SUS 527/30ML 50383062016 HI-TECH PHARMACAL CO. INC. yPINK BISMUTH SUS 690/30ML 50383062108 HI-TECH PHARMACAL CO. INC. yPINK BISMUTH SUS 690/30ML 50383062116 HI-TECH PHARMACAL CO. INC. yDALYVITE/FE LIQ 50383062316 HI-TECH PHARMACAL CO. INC. yDALYVITE LIQ 50383062416 HI-TECH PHARMACAL CO. INC. yDALYVITE LIQ 50383062428 HI-TECH PHARMACAL CO. INC. yPOLY-VITAMIN DRO 50383062550 HI-TECH PHARMACAL CO. INC. yTRI-VIT/FE DRO FL 0.25 50383062850 HI-TECH PHARMACAL CO. INC. ySOD FLUORIDE DRO 0.275MG 50383062930 HI-TECH PHARMACAL CO. INC. yPOLY-VITAMIN DRO /IRON 50383063250 HI-TECH PHARMACAL CO. INC. yPOLY-VIT/FE DRO /FL0.5MG 50383063350 HI-TECH PHARMACAL CO. INC. yPOLY-VIT/FE DRO /FL 0.25 50383063450 HI-TECH PHARMACAL CO. INC. yTRI-VITAMIN DRO 50383063550 HI-TECH PHARMACAL CO. INC. yTRI-VIT/FLUO DRO 0.5MG 50383063650 HI-TECH PHARMACAL CO. INC. yTRI-VIT/FLUO DRO 0.25MG 50383063750 HI-TECH PHARMACAL CO. INC. yPOLY-VITAMIN DRO 0.5MG 50383064150 HI-TECH PHARMACAL CO. INC. yPOLY-VIT/FL DRO 0.25MG 50383064250 HI-TECH PHARMACAL CO. INC. ySOD FLUORIDE DRO 0.5MG/ML 50383065650 HI-TECH PHARMACAL CO. INC. yUREA LOT 40% 50383066308 HI-TECH PHARMACAL CO. INC. yUREA CRE 40% 50383066430 HI-TECH PHARMACAL CO. INC. yLIDOC/PRILOC CRE 2.5-2.5% 50383066730 HI-TECH PHARMACAL CO. INC. yVAPORIZING OIN 50383067003 HI-TECH PHARMACAL CO. INC. yOXYMETAZOLIN SPR 0.05% 50383067715 HI-TECH PHARMACAL CO. INC. y

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OXYMETAZOLIN SPR 0.05% 50383067730 HI-TECH PHARMACAL CO. INC. yPSEUDOEPHEDR LIQ 30MG/5ML 50383068004 HI-TECH PHARMACAL CO. INC. yPSEUDOEPHEDR LIQ 30MG/5ML 50383068016 HI-TECH PHARMACAL CO. INC. yTHERA-PLUS LIQ 50383068304 HI-TECH PHARMACAL CO. INC. yUREA GEL 40% 50383069715 HI-TECH PHARMACAL CO. INC. yUREALAC NAIL GEL 50% 50383069815 HI-TECH PHARMACAL CO. INC. yUREALAC LOT 35% 50383069911 HI-TECH PHARMACAL CO. INC. yUREALAC CRE 50% 50383070105 HI-TECH PHARMACAL CO. INC. yCHLORHEX GLU SOL 0.12% 50383072016 HI-TECH PHARMACAL CO. INC. yACHE-EZE GEL ICE 50383072608 HI-TECH PHARMACAL CO. INC. yACHE-EZE GEL ICE 50383072616 HI-TECH PHARMACAL CO. INC. yACHE-EZE GEL ICE 50383072808 HI-TECH PHARMACAL CO. INC. yALBUTEROL SYP 2MG/5ML 50383074016 HI-TECH PHARMACAL CO. INC. yALBUTEROL NEB 0.5% 50383074120 HI-TECH PHARMACAL CO. INC. yALBUTEROL NEB 0.083% 50383074225 HI-TECH PHARMACAL CO. INC. yCARBOFED DM SYP 50383075116 HI-TECH PHARMACAL CO. INC. yCARBOFED DM SYP 50383075128 HI-TECH PHARMACAL CO. INC. yCARBOFED DM DRO 50383075401 HI-TECH PHARMACAL CO. INC. yCARBOFED DM SYP 50383075516 HI-TECH PHARMACAL CO. INC. yCARBOFED DM SYP 50383075528 HI-TECH PHARMACAL CO. INC. yNALPHEN DX DRO PED 50383075601 HI-TECH PHARMACAL CO. INC. yNALPHEN EX DRO PED 50383075701 HI-TECH PHARMACAL CO. INC. yNALPHEN DX SYP PED 50383076004 HI-TECH PHARMACAL CO. INC. yNALPHEN SYP 50383076316 HI-TECH PHARMACAL CO. INC. yNALPHEN SYP 50383076328 HI-TECH PHARMACAL CO. INC. yNALPHEN SYP PED 50383076404 HI-TECH PHARMACAL CO. INC. yNALPHEN SYP PED 50383076416 HI-TECH PHARMACAL CO. INC. yNALPHEN SYP PED 50383076428 HI-TECH PHARMACAL CO. INC. yNALPHEN DRO PED 50383076501 HI-TECH PHARMACAL CO. INC. yANTIBEN SOL OTIC 50383076715 HI-TECH PHARMACAL CO. INC. yAROM CASCARA EXT 325/5ML 50383076816 HI-TECH PHARMACAL CO. INC. yPERI-DOCU SYP 60-30/15 50383076916 HI-TECH PHARMACAL CO. INC. yDOCU SYP 60/15ML 50383077016 HI-TECH PHARMACAL CO. INC. yDOCU LIQ 150/15ML 50383077116 HI-TECH PHARMACAL CO. INC. yIOGAN SOL 50MG/ML 50383077301 HI-TECH PHARMACAL CO. INC. yIOGAN-DM SOL COUGH 50383077404 HI-TECH PHARMACAL CO. INC. y

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IOGAN-DM SOL COUGH 50383077416 HI-TECH PHARMACAL CO. INC. yIOGAN-DM SOL COUGH 50383077428 HI-TECH PHARMACAL CO. INC. yLIDOCAINE SOL 2% VISC 50383077503 HI-TECH PHARMACAL CO. INC. yLIDOCAINE SOL 2% VISC 50383077504 HI-TECH PHARMACAL CO. INC. yIOGAN ELX 60MG/5ML 50383077604 HI-TECH PHARMACAL CO. INC. yIOGAN ELX 60MG/5ML 50383077616 HI-TECH PHARMACAL CO. INC. yLACTULOSE SOL 10GM/15 50383077908 HI-TECH PHARMACAL CO. INC. yLACTULOSE SOL 10GM/15 50383077932 HI-TECH PHARMACAL CO. INC. yEQUALIZE GAS DRO RELIEF 50383078530 HI-TECH PHARMACAL CO. INC. yGOLDEN AGE LIQ VIT/MIN 50383078608 HI-TECH PHARMACAL CO. INC. yVALPROIC ACD SYP 250/5ML 50383079216 HI-TECH PHARMACAL CO. INC. yLACTULOSE SOL 10GM/15 50383079516 HI-TECH PHARMACAL CO. INC. yHYDROXYZ HCL SYP 10MG/5ML 50383079616 HI-TECH PHARMACAL CO. INC. yPROMETHAZINE SYP 6.25/5ML 50383080116 HI-TECH PHARMACAL CO. INC. yPROMETHAZINE SYP DM 50383080316 HI-TECH PHARMACAL CO. INC. yPROMETH/COD SYP 6.25-10 50383080416 HI-TECH PHARMACAL CO. INC. yAMANTADINE SYP 50MG/5ML 50383080716 HI-TECH PHARMACAL CO. INC. yTRI-TANNATE SUS PED 50383080804 HI-TECH PHARMACAL CO. INC. yTRI-TANNATE SUS PED 50383080816 HI-TECH PHARMACAL CO. INC. yQUAD-TUSS SUS TANN/PED 50383080916 HI-TECH PHARMACAL CO. INC. yACYCLOVIR SUS 200/5ML 50383081016 HI-TECH PHARMACAL CO. INC. yTRI-HIST PED SUS 50383081916 HI-TECH PHARMACAL CO. INC. ySMZ-TMP SUS 200-40/5 50383082316 HI-TECH PHARMACAL CO. INC. ySMZ-TMP SUS 200-40/5 50383082416 HI-TECH PHARMACAL CO. INC. yCALAHIST LOT 50383083206 HI-TECH PHARMACAL CO. INC. yCALAHIST LOT CLEAR 50383083406 HI-TECH PHARMACAL CO. INC. yCALAMINE LOT 50383083704 HI-TECH PHARMACAL CO. INC. yPHENYL CHLOR SUS TAN 50383084216 HI-TECH PHARMACAL CO. INC. yCALAHIST LOT 50383084706 HI-TECH PHARMACAL CO. INC. yTANNATE-V-DM SUS 50383085616 HI-TECH PHARMACAL CO. INC. yTANNATE 12 S SUS 50383086304 HI-TECH PHARMACAL CO. INC. yRY-T-12 SUS 30-5/5ML 50383086416 HI-TECH PHARMACAL CO. INC. yTANNATE DMP- SUS DEX 50383086616 HI-TECH PHARMACAL CO. INC. yCOUGH FOR 4M SYP 50383086808 HI-TECH PHARMACAL CO. INC. yNITE-TIME LIQ COUGH 50383087506 HI-TECH PHARMACAL CO. INC. yNITE-TIME LIQ COUGH 50383087510 HI-TECH PHARMACAL CO. INC. y

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CALCIONATE SYP 1.8GM/5 50383092116 HI-TECH PHARMACAL CO. INC. yDERMA-SMOOTH OIL /FS 28105014904 HILL DERMACEUTICALS, INC. yDERMA-SMOOTH OIL /FS 28105015004 HILL DERMACEUTICALS, INC. yDERMOTIC OIL 0.01% 28105016020 HILL DERMACEUTICALS, INC. yDERMA-CAS GEL 28105019801 HILL DERMACEUTICALS, INC. yDIALYVITE TAB 10542001010 HILLESTAD PHARMACEUTICALS yDIALYVITE/ TAB ZINC 10542001210 HILLESTAD PHARMACEUTICALS yDIALYVITE TAB 3000 10542001409 HILLESTAD PHARMACEUTICALS yTICLID TAB 250MG 00004001814 HOFFMANN-LA ROCHE yTICLID TAB 250MG 00004001822 HOFFMANN-LA ROCHE yTICLID TAB 250MG 00004001823 HOFFMANN-LA ROCHE yNAPROSYN SUS 125/5ML 00004002828 HOFFMANN-LA ROCHE yVALCYTE TAB 450MG 00004003822 HOFFMANN-LA ROCHE yKLONOPIN TAB 1MG 00004005801 HOFFMANN-LA ROCHE yKLONOPIN TAB 1MG 00004005832 HOFFMANN-LA ROCHE yKLONOPIN TAB 0.5MG 00004006801 HOFFMANN-LA ROCHE yKLONOPIN TAB 0.5MG 00004006832 HOFFMANN-LA ROCHE yCOPEGUS TAB 200MG 00004008694 HOFFMANN-LA ROCHE yKLONOPIN TAB 2MG 00004009801 HOFFMANN-LA ROCHE yKLONOPIN TAB 2MG 00004009832 HOFFMANN-LA ROCHE yBUMEX TAB 1MG 00004012101 HOFFMANN-LA ROCHE yBUMEX TAB 1MG 00004012111 HOFFMANN-LA ROCHE yBUMEX TAB 1MG 00004012114 HOFFMANN-LA ROCHE yBUMEX TAB 0.5MG 00004012501 HOFFMANN-LA ROCHE yBUMEX TAB 0.5MG 00004012511 HOFFMANN-LA ROCHE yBUMEX TAB 0.5MG 00004012557 HOFFMANN-LA ROCHE yROCALTROL CAP 0.25MCG 00004014301 HOFFMANN-LA ROCHE yROCALTROL CAP 0.25MCG 00004014323 HOFFMANN-LA ROCHE yROCALTROL CAP 0.5MCG 00004014401 HOFFMANN-LA ROCHE yACCUTANE CAP 10MG 00004015503 HOFFMANN-LA ROCHE yACCUTANE CAP 10MG 00004015549 HOFFMANN-LA ROCHE yACCUTANE CAP 40MG 00004015603 HOFFMANN-LA ROCHE yACCUTANE CAP 40MG 00004015649 HOFFMANN-LA ROCHE yFANSIDAR TAB 500/25 00004016103 HOFFMANN-LA ROCHE yBUMEX TAB 2MG 00004016201 HOFFMANN-LA ROCHE yBUMEX TAB 2MG 00004016211 HOFFMANN-LA ROCHE y

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ACCUTANE CAP 20MG 00004016904 HOFFMANN-LA ROCHE yACCUTANE CAP 20MG 00004016949 HOFFMANN-LA ROCHE yLARIAM TAB 250MG 00004017202 HOFFMANN-LA ROCHE yCARDENE SR CAP 30MG 00004018022 HOFFMANN-LA ROCHE yCARDENE SR CAP 30MG 00004018091 HOFFMANN-LA ROCHE yCARDENE SR CAP 45MG 00004018122 HOFFMANN-LA ROCHE yCARDENE SR CAP 45MG 00004018191 HOFFMANN-LA ROCHE yCARDENE SR CAP 60MG 00004018222 HOFFMANN-LA ROCHE yCARDENE CAP 20MG 00004018301 HOFFMANN-LA ROCHE yCARDENE CAP 30MG 00004018401 HOFFMANN-LA ROCHE yBONIVA TAB 2.5MG 00004018523 HOFFMANN-LA ROCHE yBONIVA TAB 150MG 00004018682 HOFFMANN-LA ROCHE yBONIVA KIT 3MG/3ML 00004018809 HOFFMANN-LA ROCHE yHIVID TAB 0.375MG 00004022001 HOFFMANN-LA ROCHE yHIVID TAB 0.75MG 00004022101 HOFFMANN-LA ROCHE yKYTRIL SOL 2MG/10ML 00004023709 HOFFMANN-LA ROCHE yKYTRIL INJ 1MG/ML 00004023909 HOFFMANN-LA ROCHE yKYTRIL INJ 1MG/ML 00004024009 HOFFMANN-LA ROCHE yKYTRIL TAB 1MG 00004024126 HOFFMANN-LA ROCHE yKYTRIL TAB 1MG 00004024133 HOFFMANN-LA ROCHE yKYTRIL INJ 0.1MG/ML 00004024208 HOFFMANN-LA ROCHE yINVIRASE TAB 500MG 00004024451 HOFFMANN-LA ROCHE yINVIRASE CAP 200MG 00004024515 HOFFMANN-LA ROCHE yVESANOID CAP 10 MG 00004025001 HOFFMANN-LA ROCHE yXENICAL CAP 120MG 00004025652 HOFFMANN-LA ROCHE yCELLCEPT CAP 250MG 00004025901 HOFFMANN-LA ROCHE yCELLCEPT CAP 250MG 00004025905 HOFFMANN-LA ROCHE yCELLCEPT CAP 250MG 00004025943 HOFFMANN-LA ROCHE yCELLCEPT TAB 500MG 00004026001 HOFFMANN-LA ROCHE yCELLCEPT TAB 500MG 00004026043 HOFFMANN-LA ROCHE yCELLCEPT SUS 200MG/ML 00004026129 HOFFMANN-LA ROCHE yDEMADEX TAB 5MG 00004026201 HOFFMANN-LA ROCHE yDEMADEX TAB 5MG 00004026249 HOFFMANN-LA ROCHE yDEMADEX TAB 10MG 00004026301 HOFFMANN-LA ROCHE yDEMADEX TAB 10MG 00004026349 HOFFMANN-LA ROCHE yDEMADEX TAB 20MG 00004026401 HOFFMANN-LA ROCHE y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEMADEX TAB 20MG 00004026449 HOFFMANN-LA ROCHE yDEMADEX TAB 100MG 00004026501 HOFFMANN-LA ROCHE yDEMADEX TAB 100MG 00004026549 HOFFMANN-LA ROCHE yDEMADEX INJ 20MG/2ML 00004026706 HOFFMANN-LA ROCHE yDEMADEX INJ 50MG/5ML 00004026806 HOFFMANN-LA ROCHE yKLONOPIN WAF TAB 0.125MG 00004027922 HOFFMANN-LA ROCHE yKLONOPIN WAF TAB 0.25MG 00004028022 HOFFMANN-LA ROCHE yKLONOPIN WAF TAB 0.5MG 00004028122 HOFFMANN-LA ROCHE yKLONOPIN WAF TAB 1MG 00004028222 HOFFMANN-LA ROCHE yKLONOPIN WAF TAB 2MG 00004028322 HOFFMANN-LA ROCHE yCELLCEPT IV INJ 500MG 00004029809 HOFFMANN-LA ROCHE yPEGASYS INJ 180MCG/M 00004035009 HOFFMANN-LA ROCHE yPEGASYS KIT 00004035239 HOFFMANN-LA ROCHE yFUZEON KIT 00004038039 HOFFMANN-LA ROCHE yZENAPAX INJ 25MG/5ML 00004050109 HOFFMANN-LA ROCHE yTAMIFLU CAP 75MG 00004080085 HOFFMANN-LA ROCHE yTAMIFLU SUS 12MG/ML 00004081095 HOFFMANN-LA ROCHE yGANTRIS PED SUS 500/5ML 00004100328 HOFFMANN-LA ROCHE yXELODA TAB 150MG 00004110020 HOFFMANN-LA ROCHE yXELODA TAB 500MG 00004110150 HOFFMANN-LA ROCHE yROCEPHIN INJ 250MG 00004196201 HOFFMANN-LA ROCHE yROCEPHIN INJ 250MG 00004196202 HOFFMANN-LA ROCHE yROCEPHIN INJ 500MG 00004196301 HOFFMANN-LA ROCHE yROCEPHIN INJ 500MG 00004196302 HOFFMANN-LA ROCHE yROCEPHIN INJ 1GM 00004196401 HOFFMANN-LA ROCHE yROCEPHIN INJ 1GM 00004196404 HOFFMANN-LA ROCHE yROCEPHIN INJ 1GM 00004196405 HOFFMANN-LA ROCHE yROCEPHIN INJ 2GM 00004196501 HOFFMANN-LA ROCHE yROCEPHIN INJ 2GM 00004196503 HOFFMANN-LA ROCHE yROCEPHIN INJ 2GM 00004196505 HOFFMANN-LA ROCHE yROCEPHIN INJ 10GM 00004197101 HOFFMANN-LA ROCHE yROFERON-A KIT 3MU/0.5 00004201507 HOFFMANN-LA ROCHE yROFERON-A KIT 3MU/0.5 00004201509 HOFFMANN-LA ROCHE yROFERON-A KIT 6MU/0.5 00004201607 HOFFMANN-LA ROCHE yROFERON-A KIT 6MU/0.5 00004201609 HOFFMANN-LA ROCHE yROFERON-A KIT 9MU/0.5 00004201707 HOFFMANN-LA ROCHE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ROFERON-A KIT 9MU/0.5 00004201709 HOFFMANN-LA ROCHE yTASMAR TAB 100MG 00004592001 HOFFMANN-LA ROCHE yTASMAR TAB 200MG 00004592101 HOFFMANN-LA ROCHE yANAPROX TAB 275MG 00004620201 HOFFMANN-LA ROCHE yANAPROX DS TAB 550MG 00004620301 HOFFMANN-LA ROCHE yANAPROX DS TAB 550MG 00004620314 HOFFMANN-LA ROCHE yNAPROSYN TAB 250MG 00004631301 HOFFMANN-LA ROCHE yNAPROSYN TAB 375MG 00004631401 HOFFMANN-LA ROCHE yNAPROSYN TAB 500MG 00004631601 HOFFMANN-LA ROCHE yEC-NAPROSYN TAB 375MG 00004641501 HOFFMANN-LA ROCHE yEC-NAPROSYN TAB 500MG 00004641601 HOFFMANN-LA ROCHE yROMAZICON INJ 0.1MG/ML 00004691106 HOFFMANN-LA ROCHE yROMAZICON INJ 0.1MG/ML 00004691206 HOFFMANN-LA ROCHE yCYTOVENE INJ 500MG 00004694003 HOFFMANN-LA ROCHE yROCALTROL SOL 1MCG/ML 00004911500 HOFFMANN-LA ROCHE yACID JELLY GEL VAG/APPL 60267012585 HOPE PHARMACEUTICALS yAMINO ACID CRE CERVICAL 60267023414 HOPE PHARMACEUTICALS ySCOPACE TAB 0.4MG 60267030100 HOPE PHARMACEUTICALS yMETHYLENE BL INJ 1% 60267040044 HOPE PHARMACEUTICALS yMETHYLENE BL INJ 1% 60267050055 HOPE PHARMACEUTICALS yVERSICLEAR LOT 60267053104 HOPE PHARMACEUTICALS ySAL-TROPINE TAB 0.4MG 60267074230 HOPE PHARMACEUTICALS yAMINOBEZ POT CAP 500MG 60267095325 HOPE PHARMACEUTICALS yNOVAMINE INJ 15% 00409046805 HOSPIRA, INC. yCARBOCAINE INJ 1% 00409103630 HOSPIRA, INC. yCARBOCAINE INJ 1.5% 00409104130 HOSPIRA, INC. yCARBOCAINE INJ 2% 00409106720 HOSPIRA, INC. yCODEINE PHOS INJ 30MG/2ML 00409109732 HOSPIRA, INC. yCODEINE PHOS INJ 60MG/2ML 00409110232 HOSPIRA, INC. yCARBOPLATIN INJ 50MG/5ML 00409112910 HOSPIRA, INC. yCARBOPLATIN INJ 150/15ML 00409112911 HOSPIRA, INC. yCARBOPLATIN INJ 450/45ML 00409112912 HOSPIRA, INC. ySOD CHLORIDE INJ 23.4% 00409113002 HOSPIRA, INC. yMORPHINE SUL INJ 50MG/ML 00409113403 HOSPIRA, INC. yMORPHINE SUL INJ 50MG/ML 00409113405 HOSPIRA, INC. yMORPHINE SUL INJ 25MG/ML 00409113502 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SOD CHLORIDE INJ 23.4% 00409114102 HOSPIRA, INC. yVERAPAMIL INJ 2.5MG/ML 00409114401 HOSPIRA, INC. yVERAPAMIL INJ 2.5MG/ML 00409114402 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409115112 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409115170 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409115178 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409115212 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409115270 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409115278 HOSPIRA, INC. yBUPIVACAINE INJ 0.25% 00409115801 HOSPIRA, INC. yBUPIVACAINE INJ 0.25% 00409115802 HOSPIRA, INC. yBUPIVACAINE INJ 0.25% 00409115901 HOSPIRA, INC. yBUPIVACAINE INJ 0.25% 00409115902 HOSPIRA, INC. yBUPIVACAINE INJ 0.25% 00409116001 HOSPIRA, INC. yBUPIVACAINE INJ 0.5% 00409116101 HOSPIRA, INC. yBUPIVACAINE INJ 0.5% 00409116201 HOSPIRA, INC. yBUPIVACAINE INJ 0.5% 00409116202 HOSPIRA, INC. yBUPIVACAINE INJ 0.5% 00409116301 HOSPIRA, INC. yBUPIVACAINE INJ 0.75% 00409116401 HOSPIRA, INC. yBUPIVACAINE INJ 0.75% 00409116501 HOSPIRA, INC. yBUPIVACAINE INJ 0.75% 00409116502 HOSPIRA, INC. yDILTIAZEM INJ 5MG/ML 00409117101 HOSPIRA, INC. yDILTIAZEM INJ 5MG/ML 00409117102 HOSPIRA, INC. yDILTIAZEM INJ 5MG/ML 00409117161 HOSPIRA, INC. yDILTIAZEM INJ 5MG/ML 00409117162 HOSPIRA, INC. yDEMEROL INJ 25MG/ML 00409117630 HOSPIRA, INC. yDEMEROL INJ 50MG/ML 00409117830 HOSPIRA, INC. yDEMEROL INJ 75MG/ML 00409117930 HOSPIRA, INC. yDEMEROL INJ 100MG/ML 00409118069 HOSPIRA, INC. yDEMEROL INJ 50MG/ML 00409118130 HOSPIRA, INC. yDROPERIDOL INJ 2.5MG/ML 00409118701 HOSPIRA, INC. yDEMEROL INJ 100MG/ML 00409120120 HOSPIRA, INC. yDEMEROL INJ 50MG/ML 00409120301 HOSPIRA, INC. yGENTAMICIN INJ 40MG/ML 00409120703 HOSPIRA, INC. yLIDO/EPI INJ 1.5% 00409120901 HOSPIRA, INC. yNALOXONE INJ 0.4MG/ML 00409121201 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NALOXONE INJ 0.4MG/ML 00409121501 HOSPIRA, INC. yNALOXONE INJ 0.4MG/ML 00409121901 HOSPIRA, INC. yDEMEROL INJ 50MG/ML 00409125301 HOSPIRA, INC. yDEMEROL INJ 75MG/1.5 00409125401 HOSPIRA, INC. yDEMEROL INJ 50MG/ML 00409125502 HOSPIRA, INC. yDEMEROL INJ 100MG/ML 00409125601 HOSPIRA, INC. yMORPHINE SUL INJ 4MG/ML 00409125830 HOSPIRA, INC. yMORPHINE SUL INJ 8MG/ML 00409126069 HOSPIRA, INC. yMORPHINE SUL INJ 10MG/ML 00409126130 HOSPIRA, INC. yMORPHINE SUL INJ 15MG/ML 00409126431 HOSPIRA, INC. yDIAZEPAM INJ 5MG/ML 00409127332 HOSPIRA, INC. yFUROSEMIDE INJ 10MG/ML 00409127532 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409127632 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409128031 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409128032 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409128033 HOSPIRA, INC. yHEPARIN LOCK INJ 10UNT/ML 00409128035 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409128131 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409128132 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409128133 HOSPIRA, INC. yHEPARIN LOCK INJ 100/ML 00409128135 HOSPIRA, INC. yHYDROMORPHON INJ 1MG/ML 00409128331 HOSPIRA, INC. yHYDROMORPHON INJ 4MG/ML 00409130431 HOSPIRA, INC. yHYDROMORPHON INJ 2MG/ML 00409131230 HOSPIRA, INC. yHEPARIN SOD INJ 10000/ML 00409131632 HOSPIRA, INC. yHEPARIN SOD INJ 10000/ML 00409131666 HOSPIRA, INC. yPHENYTOIN INJ 50MG/ML 00409131701 HOSPIRA, INC. yPHENYTOIN INJ 50MG/ML 00409131702 HOSPIRA, INC. yLIDOCAINE INJ 20MG/ML 00409132305 HOSPIRA, INC. yHEPARIN SOD INJ 5000/ML 00409140231 HOSPIRA, INC. yISUPREL INJ 0.2MG/ML 00409141001 HOSPIRA, INC. yISUPREL INJ 0.2MG/ML 00409141005 HOSPIRA, INC. yBUMETANIDE INJ 0.25/ML 00409141204 HOSPIRA, INC. yBUMETANIDE INJ 0.25/ML 00409141210 HOSPIRA, INC. yLEVOPHED INJ 1MG/ML 00409144304 HOSPIRA, INC. yNALBUPHINE INJ 10MG/ML 00409146301 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NALBUPHINE INJ 10MG/ML 00409146401 HOSPIRA, INC. yNALBUPHINE INJ 20MG/ML 00409146501 HOSPIRA, INC. yNALBUPHINE INJ 20MG/ML 00409146701 HOSPIRA, INC. yNITROGLY/D5W INJ 50MG 00409148202 HOSPIRA, INC. yNITROGLY/D5W INJ 00409148302 HOSPIRA, INC. yNITROGLY/D5W INJ 00409148303 HOSPIRA, INC. yNITROGLY/D5W INJ 100MG 00409148402 HOSPIRA, INC. yNITROGLY/D5W INJ 200MG 00409148403 HOSPIRA, INC. yALCOHOL/D5W INJ 5% 00409150005 HOSPIRA, INC. yDEXTRAN 70 INJ NACL 0.9 00409150503 HOSPIRA, INC. yDEXTROSE INJ 2.5% 00409150805 HOSPIRA, INC. yPOT CHLORIDE INJ 2MEQ/ML 00409151302 HOSPIRA, INC. yDEXTROSE INJ 5% 00409152201 HOSPIRA, INC. yDEXTROSE INJ 5% 00409152202 HOSPIRA, INC. yDEXTROSE INJ 5% 00409152203 HOSPIRA, INC. yDEXTROSE INJ 5% 00409152301 HOSPIRA, INC. yDEXTROSE INJ 5% 00409152311 HOSPIRA, INC. yD10W/NACL INJ 0.9% 00409153405 HOSPIRA, INC. yDEXTROSE INJ 20% 00409153503 HOSPIRA, INC. yLORAZEPAM INJ 4MG/ML 00409153931 HOSPIRA, INC. yHEXTEND SOL 6% 00409155554 HOSPIRA, INC. yMARCAINE INJ 0.25% 00409155910 HOSPIRA, INC. yMARCAINE INJ 0.25% 00409155930 HOSPIRA, INC. yMARCAINE INJ 0.5% 00409156010 HOSPIRA, INC. yMARCAINE INJ 0.5% 00409156029 HOSPIRA, INC. yMARCAINE INJ 0.75% 00409158210 HOSPIRA, INC. yMARCAINE INJ 0.75% 00409158229 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409158301 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409158302 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409158411 HOSPIRA, INC. ySOD CHLORIDE INJ 5% 00409158603 HOSPIRA, INC. yMARCAINE INJ 0.25% 00409158750 HOSPIRA, INC. ySTERIL WATER INJ 00409159002 HOSPIRA, INC. ySTERIL WATER INJ 00409159005 HOSPIRA, INC. yTHAM INJ 30MEQ 00409159304 HOSPIRA, INC. ySOD BICARB INJ 5% 00409159403 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MARCAINE INJ 0.5% 00409161050 HOSPIRA, INC. yBUTORPHANOL INJ 1MG/ML 00409162301 HOSPIRA, INC. yBUTORPHANOL INJ 1MG/ML 00409162349 HOSPIRA, INC. yBUTORPHANOL INJ 2MG/ML 00409162601 HOSPIRA, INC. yBUTORPHANOL INJ 2MG/ML 00409162602 HOSPIRA, INC. yBUTORPHANOL INJ 2MG/ML 00409162649 HOSPIRA, INC. yBUTORPHANOL INJ 2MG/ML 00409162651 HOSPIRA, INC. yATROPINE SUL INJ 0.1MG/ML 00409163010 HOSPIRA, INC. yCALCIUM CL INJ 10% 00409163110 HOSPIRA, INC. yVECURONIUM INJ 10MG 00409163201 HOSPIRA, INC. yVECURONIUM INJ 10MG 00409163249 HOSPIRA, INC. yVECURONIUM INJ 20MG 00409163401 HOSPIRA, INC. yVECURONIUM INJ 20MG 00409163449 HOSPIRA, INC. yPRECEDEX INJ 100MCG 00409163802 HOSPIRA, INC. yFUROSEMIDE INJ 10MG/ML 00409163910 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.25 00409174610 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.25 00409174630 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.5% 00409174903 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.5% 00409174910 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.5% 00409174929 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.25 00409175250 HOSPIRA, INC. yMAGNESIUM SU INJ 50% 00409175410 HOSPIRA, INC. yMARCAINE/ INJ EPI 0.5% 00409175550 HOSPIRA, INC. yMARCAINE INJ SPINAL 00409176102 HOSPIRA, INC. yMORPHINE SUL INJ 2MG/ML 00409176230 HOSPIRA, INC. yDEXTROSE INJ 25% 00409177510 HOSPIRA, INC. yMETOPROLOL INJ 1MG/ML 00409177835 HOSPIRA, INC. yNALOXONE INJ 0.4MG/ML 00409178269 HOSPIRA, INC. yNEO-SYNEPHRI INJ 10MG/ML 00409180001 HOSPIRA, INC. yNOVOCAIN INJ 1% 00409180802 HOSPIRA, INC. yNOVOCAIN INJ 10% 00409181002 HOSPIRA, INC. yPHENYTOIN INJ 50MG/ML 00409184432 HOSPIRA, INC. yPONTOCAINE INJ 1% 00409184602 HOSPIRA, INC. yPONTOCAINE INJ 20MG 00409184906 HOSPIRA, INC. yPONTOCAINE SOL 2% 00409186601 HOSPIRA, INC. yPONTOCAINE SOL 2% 00409186602 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROCAINAMIDE INJ 100MG/ML 00409190201 HOSPIRA, INC. yPROCAINAMIDE INJ 500MG/ML 00409190301 HOSPIRA, INC. yTALWIN INJ 30MG/ML 00409192010 HOSPIRA, INC. yTALWIN INJ 30MG/ML 00409194101 HOSPIRA, INC. yTRIMETHOBENZ INJ 100MG/ML 00409195232 HOSPIRA, INC. yAMIKACIN INJ 100/2ML 00409195501 HOSPIRA, INC. yAMIKACIN INJ 500/2ML 00409195601 HOSPIRA, INC. yAMIKACIN INJ 1GM/4ML 00409195701 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9%BACT 00409196604 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9%BACT 00409196605 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9%BACT 00409196607 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9%BACT 00409196612 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9%BACT 00409196614 HOSPIRA, INC. yANTICOAG CPD SOL 00409196703 HOSPIRA, INC. yLORAZEPAM INJ 2MG/ML 00409198501 HOSPIRA, INC. yLORAZEPAM INJ 2MG/ML 00409198510 HOSPIRA, INC. yLORAZEPAM INJ 2MG/ML 00409198530 HOSPIRA, INC. yBUPRENORPHIN INJ 0.324/ML 00409201232 HOSPIRA, INC. yDOBUTAMINE INJ 250MG 00409202520 HOSPIRA, INC. yDOBUTAMINE INJ 500MG 00409202554 HOSPIRA, INC. yMORPHINE SUL INJ 1MG/ML 00409202902 HOSPIRA, INC. yDIPYRIDAMOLE INJ 5MG/ML 00409204302 HOSPIRA, INC. yCARBOCAINE INJ 2% 00409204750 HOSPIRA, INC. yKETAMINE INJ 100MG/ML 00409205105 HOSPIRA, INC. yKETAMINE INJ 50MG/ML 00409205310 HOSPIRA, INC. yLIDOCAINE INJ 2% 00409206605 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409210202 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409210205 HOSPIRA, INC. yENALAPRILAT INJ 1.25/ML 00409212201 HOSPIRA, INC. yENALAPRILAT INJ 1.25/ML 00409212202 HOSPIRA, INC. yENALAPRILAT INJ 1.25/ML 00409212213 HOSPIRA, INC. yENALAPRILAT INJ 1.25/ML 00409212288 HOSPIRA, INC. yMAGNESIUM SU INJ 50% 00409216802 HOSPIRA, INC. yMAGNESIUM SU INJ 50% 00409216803 HOSPIRA, INC. yDIGOXIN INJ 0.25MG/1 00409216931 HOSPIRA, INC. yHYDROMORPHON INJ 10MG/ML 00409217201 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROMORPHON INJ 50MG/5ML 00409217205 HOSPIRA, INC. yMETOCLOPRAM INJ 5MG/ML 00409217332 HOSPIRA, INC. yDESMOPRESSIN INJ 4MCG/ML 00409226501 HOSPIRA, INC. yALFENTANIL INJ 500/ML 00409226602 HOSPIRA, INC. yALFENTANIL INJ 500/ML 00409226605 HOSPIRA, INC. yALFENTANIL INJ 500/ML 00409226649 HOSPIRA, INC. yALFENTANIL INJ 500/ML 00409226651 HOSPIRA, INC. yLABETALOL INJ 5MG/ML 00409226720 HOSPIRA, INC. yLABETALOL INJ 5MG/ML 00409226754 HOSPIRA, INC. yMETOPROLOL INJ 1MG/ML 00409228505 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409228731 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409228761 HOSPIRA, INC. yKETOROLAC INJ 15MG/ML 00409228831 HOSPIRA, INC. yDIPHENHYDRAM INJ 50MG/ML 00409229031 HOSPIRA, INC. yCORLOPAM INJ 10MG/ML 00409230401 HOSPIRA, INC. yCORLOPAM INJ 10MG/ML 00409230402 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409230502 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409230505 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409230549 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409230550 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409230561 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409230562 HOSPIRA, INC. yMIDAZOLAM INJ 2MG/2ML 00409230662 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409230760 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409230801 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409230802 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409230849 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409230850 HOSPIRA, INC. yPROMETHAZINE INJ 25MG/ML 00409231231 HOSPIRA, INC. yDEFEROXAMINE INJ 500MG 00409233610 HOSPIRA, INC. yDEFEROXAMIN INJ 2GM 00409233725 HOSPIRA, INC. yLABETALOL INJ 5MG/ML 00409233934 HOSPIRA, INC. yLUMINAL INJ 60MG/ML 00409234331 HOSPIRA, INC. yDOBUTAMINE INJ 250MG 00409234401 HOSPIRA, INC. yDOBUTAMINE INJ 250MG 00409234402 HOSPIRA, INC. yDOBUTAMINE INJ 250MG 00409234488 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DOBUTAM/D5W INJ 1MG/ML 00409234632 HOSPIRA, INC. yDOBUTAM/D5W INJ 1MG/ML 00409234634 HOSPIRA, INC. yDOBUTAM/D5W INJ 2MG/ML 00409234732 HOSPIRA, INC. yDOBUTAM/D5W INJ 2MG/ML 00409234733 HOSPIRA, INC. yLUMINAL INJ 130MG/ML 00409234931 HOSPIRA, INC. yHYDROMORPHON INJ 4MG/ML 00409254001 HOSPIRA, INC. yHYDROMORPHON INJ 1MG/ML 00409255201 HOSPIRA, INC. yHEPARIN SOD INJ 2000/ML 00409258102 HOSPIRA, INC. yHEPARIN SOD INJ 25000/ML 00409258402 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409258705 HOSPIRA, INC. yMIDAZOLAM INJ 1MG/ML 00409258753 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409259603 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409259605 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409259652 HOSPIRA, INC. yMIDAZOLAM INJ 5MG/ML 00409259653 HOSPIRA, INC. yAMP-SULBACTA INJ 1.5GM 00409268901 HOSPIRA, INC. yMILRINONE INJ 1MG/ML 00409277502 HOSPIRA, INC. yMILRINONE INJ DW5 00409277602 HOSPIRA, INC. yMILRINONE INJ DW5 00409277623 HOSPIRA, INC. yAMP-SULBACTA INJ 3GM 00409298703 HOSPIRA, INC. yNITROPRESS SOL 25MG/ML 00409302401 HOSPIRA, INC. yEPHEDRINE SU INJ 50MG/ML 00409307331 HOSPIRA, INC. yCENOLATE INJ 500MG/ML 00409311831 HOSPIRA, INC. yLIDO/EPI INJ 0.5% 00409317701 HOSPIRA, INC. yLIDO/EPI 1%- INJ 1:100000 00409317801 HOSPIRA, INC. yLIDO/EPI 1%- INJ 1:100000 00409317802 HOSPIRA, INC. yLIDO/EPI 1%- INJ 1:100000 00409317803 HOSPIRA, INC. yLIDO/EPI INJ 1.5% 00409318101 HOSPIRA, INC. yLIDO/EPI INJ 2% 00409318201 HOSPIRA, INC. yLIDO/EPI INJ 2% 00409318202 HOSPIRA, INC. yLIDO/EPI INJ 2% 00409318203 HOSPIRA, INC. yLIDO/EPI INJ 2% 00409318301 HOSPIRA, INC. yDIAZEPAM INJ 5MG/ML 00409321302 HOSPIRA, INC. yA-METHAPRED INJ 40MG 00409321705 HOSPIRA, INC. yA-METHAPRED INJ 125MG 00409321805 HOSPIRA, INC. yTPN ELECTROL INJ II 00409323601 HOSPIRA, INC. y

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TOBRAMYCIN INJ 10MG/ML 00409325503 HOSPIRA, INC. yISOFLURANE SOL 00409329201 HOSPIRA, INC. yISOFLURANE SOL 00409329202 HOSPIRA, INC. yISOFLURANE SOL 00409329249 HOSPIRA, INC. yISOFLURANE SOL 00409329251 HOSPIRA, INC. yPOT ACETATE INJ 2MEQ/ML 00409329406 HOSPIRA, INC. yPOT ACETATE INJ 2MEQ/ML 00409329451 HOSPIRA, INC. yTPN ELECTROL INJ 00409329606 HOSPIRA, INC. yTPN ELECTROL INJ II 00409329706 HOSPIRA, INC. ySOD ACETATE INJ 2MEQ/ML 00409329905 HOSPIRA, INC. ySOD ACETATE INJ 2MEQ/ML 00409329906 HOSPIRA, INC. yACETYLCYST SOL 10% 00409330703 HOSPIRA, INC. yACETYLCYST SOL 20% 00409330803 HOSPIRA, INC. yPENTOTHAL INJ 500MG 00409332901 HOSPIRA, INC. yHYDROMORPHON INJ 2MG/ML 00409335601 HOSPIRA, INC. yHYDROMORPHON INJ 2MG/ML 00409336501 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338031 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338032 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338035 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338049 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338050 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338051 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338221 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338222 HOSPIRA, INC. ySUFENTANIL INJ 50MCG/ML 00409338225 HOSPIRA, INC. yCENOLATE INJ 500MG/ML 00409339732 HOSPIRA, INC. yGENTAMICIN INJ 10MG/ML 00409340001 HOSPIRA, INC. yGENTAMICIN INJ 10MG/ML 00409340101 HOSPIRA, INC. yGENTAMICIN INJ 10MG/ML 00409340201 HOSPIRA, INC. yMETOCLOPRAM INJ 5MG/ML 00409341301 HOSPIRA, INC. yMETOCLOPRAM INJ 5MG/ML 00409341401 HOSPIRA, INC. yTORBA/NACL INJ 60/0.9 00409346913 HOSPIRA, INC. yTOBRA/NACL INJ 80/0.9 00409347023 HOSPIRA, INC. ySOD BICARB INJ 7.5% 00409348616 HOSPIRA, INC. ySOD BICARB INJ 8.4% 00409349516 HOSPIRA, INC. yTOBRAMYCIN INJ 10MG/ML 00409357701 HOSPIRA, INC. y

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TOBRAMYCIN INJ 80MG/2ML 00409357801 HOSPIRA, INC. yTOBRAMYCIN INJ 40MG/ML 00409359002 HOSPIRA, INC. yBUPIVACAINE INJ SPINAL 00409361301 HOSPIRA, INC. yDOBUTAM/D5W INJ 4MG/ML 00409372432 HOSPIRA, INC. yKETOROLAC INJ 15MG/ML 00409379301 HOSPIRA, INC. yKETOROLAC INJ 15MG/ML 00409379349 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409379501 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409379549 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409379561 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409379601 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409379649 HOSPIRA, INC. yKETOROLAC INJ 30MG/ML 00409379661 HOSPIRA, INC. yMORPHINE SUL INJ 0.5MG/ML 00409381412 HOSPIRA, INC. yMORPHINE SUL INJ 1MG/ML 00409381512 HOSPIRA, INC. yFOSCARNET INJ 24MG/ML 00409386302 HOSPIRA, INC. yFOSCARNET INJ 24MG/ML 00409386305 HOSPIRA, INC. yPOT CHLORIDE INJ 2MEQ/ML 00409390703 HOSPIRA, INC. yBALANCED SAL SOL OP 00409391103 HOSPIRA, INC. yBACTER WATER INJ 00409397703 HOSPIRA, INC. yVERAPAMIL INJ 2.5MG/ML 00409401101 HOSPIRA, INC. ySTERIL WATER INJ 00409402702 HOSPIRA, INC. ySTERIL WATER INJ 00409402903 HOSPIRA, INC. yMANNITOL INJ 25% 00409403101 HOSPIRA, INC. ySTERIL WATER INJ 00409404402 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409405001 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409405101 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409405201 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409405303 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409405403 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409405503 HOSPIRA, INC. yLIDOCAINE INJ 1.5% 00409405601 HOSPIRA, INC. yMORPHINE SUL INJ 0.5MG/ML 00409405712 HOSPIRA, INC. yMORPHINE SUL INJ 1MG/ML 00409405812 HOSPIRA, INC. yDEXTROSE INJ 10% 00409408902 HOSPIRA, INC. yZINC TRACE INJ 1MG/ML 00409409001 HOSPIRA, INC. yMANGANESE CL INJ 0.1MG/ML 00409409101 HOSPIRA, INC. y

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CUPRIC CHLOR INJ 0.4MG/ML 00409409201 HOSPIRA, INC. yCHROMIUM CL INJ 4MCG/ML 00409409301 HOSPIRA, INC. yDOPAMINE/D5W INJ 1.6MG/ML 00409414202 HOSPIRA, INC. yAMINOSYN INJ 3.5% 00409415905 HOSPIRA, INC. yAMINOSYN II INJ 7% 00409416003 HOSPIRA, INC. yAMINOSYN II INJ 8.5% 00409416203 HOSPIRA, INC. yAMINOSYN II INJ 8.5% 00409416205 HOSPIRA, INC. yAMINOSYN II INJ 10% 00409416403 HOSPIRA, INC. yAMINOSYN II INJ 10% 00409416405 HOSPIRA, INC. yAMINOSYN-RF INJ 5.2% 00409416603 HOSPIRA, INC. yAMINOSYN-HBC INJ 7% 00409416803 HOSPIRA, INC. yCHLOROPROC INJ 2% 00409416901 HOSPIRA, INC. yCHLOROPROC INJ 3% 00409417001 HOSPIRA, INC. yAMINOSYN II INJ 8.5/LYTE 00409417103 HOSPIRA, INC. yAMINOSYN-PF INJ 7% 00409417803 HOSPIRA, INC. yAMINOSYN-PF INJ 10% 00409417905 HOSPIRA, INC. yAMINOSYN INJ 5% 00409418103 HOSPIRA, INC. yAMINOSYN INJ 5% 00409418105 HOSPIRA, INC. yAMINOSYN INJ 7% 00409418403 HOSPIRA, INC. yAMINOSYN INJ 8.5% 00409418703 HOSPIRA, INC. yAMINOSYN INJ 10% 00409419103 HOSPIRA, INC. yAMINOSYN INJ 10% 00409419105 HOSPIRA, INC. yAMINOSYN INJ 10% 00409419205 HOSPIRA, INC. yAMINOSYN M INJ 3.5% 00409419605 HOSPIRA, INC. yCLINDAMYCIN INJ 150MG/ML 00409419701 HOSPIRA, INC. yAMINOSYN 7% INJ /LYTES 00409420003 HOSPIRA, INC. yPOT PHOSPHAT INJ 3MM/ML 00409420101 HOSPIRA, INC. yAMINOSYN INJ 8.5/LYTE 00409420303 HOSPIRA, INC. yAMINOSYN INJ 8.5/LYTE 00409420305 HOSPIRA, INC. ySOD CHLORIDE INJ 2.5/ML 00409421902 HOSPIRA, INC. yDOPAMINE INJ 80MG/ML 00409426501 HOSPIRA, INC. yLIDOCAINE INJ 1% 00409427001 HOSPIRA, INC. yBUPIVACAINE INJ 0.25% 00409427201 HOSPIRA, INC. yBUPIVACAINE INJ 0.5% 00409427301 HOSPIRA, INC. yBUPIVACAINE INJ 0.75% 00409427401 HOSPIRA, INC. yLIDOCAINE INJ 0.5% 00409427501 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIDOCAINE INJ 1% 00409427601 HOSPIRA, INC. yLIDOCAINE INJ 1% 00409427602 HOSPIRA, INC. yLIDOCAINE INJ 2% 00409427701 HOSPIRA, INC. yLIDOCAINE INJ 2% 00409427702 HOSPIRA, INC. yLIDOCAINE INJ 0.5% 00409427801 HOSPIRA, INC. yLIDOCAINE INJ 1% 00409427902 HOSPIRA, INC. yLIDOCAINE INJ 2% 00409428201 HOSPIRA, INC. yLIDOCAINE INJ 2% 00409428202 HOSPIRA, INC. yLIDOCAINE INJ 4% 00409428301 HOSPIRA, INC. yVANCOMYCIN INJ 500MG 00409433201 HOSPIRA, INC. yVANCOMYCIN INJ 500MG 00409433249 HOSPIRA, INC. yAMINOCAPR AC INJ 250MG/ML 00409434673 HOSPIRA, INC. yAMIODARONE INJ 50MG/ML 00409434835 HOSPIRA, INC. yDILTIAZEM INJ 100MG 00409435003 HOSPIRA, INC. yTRACE METALS INJ 00409459210 HOSPIRA, INC. yTRACE METALS INJ 00409459250 HOSPIRA, INC. yPANCURONIUM INJ 1MG/ML 00409464601 HOSPIRA, INC. yFLUCONAZOLE/ INJ DEX 200 00409468423 HOSPIRA, INC. yFLUCONAZOLE/ INJ NACL 400 00409468802 HOSPIRA, INC. yFLUCONAZOLE/ INJ NACL 200 00409468823 HOSPIRA, INC. yFLUCONAZOLE/ INJ NACL 200 00409468827 HOSPIRA, INC. yFLUCONAZOLE/ INJ NACL 200 00409468828 HOSPIRA, INC. yFLUCONAZOLE/ INJ NACL 400 00409468833 HOSPIRA, INC. yFLUCONAZOLE/ INJ NACL 400 00409468834 HOSPIRA, INC. yPROPOFOL INJ 10MG/ML 00409469924 HOSPIRA, INC. yPROPOFOL INJ 10MG/ML 00409469930 HOSPIRA, INC. yPROPOFOL INJ 10MG/ML 00409469933 HOSPIRA, INC. yLIDO/DEXTROS INJ 5-7.5% 00409471201 HOSPIRA, INC. yLIDOCAINE INJ 1% 00409471302 HOSPIRA, INC. yLIDOCAINE INJ 1% 00409471332 HOSPIRA, INC. yONDANSETRON INJ 2MG/ML 00409475501 HOSPIRA, INC. yONDANSETRON INJ 2MG/ML 00409475561 HOSPIRA, INC. yONDANSETRON INJ 2MG/ML 00409475901 HOSPIRA, INC. yCIPROFLOXACN INJ 200MG 00409476586 HOSPIRA, INC. yLIDOCAINE INJ 1.5% 00409477601 HOSPIRA, INC. yCIPROFLOXACN INJ 400MG 00409477886 HOSPIRA, INC. y

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A-HYDROCORT INJ 100MG 00409485605 HOSPIRA, INC. yD10W/NACL INJ 0.225% 00409486202 HOSPIRA, INC. yD10W/NACL INJ 0.225% 00409486203 HOSPIRA, INC. ySTERIL WATER INJ 00409488710 HOSPIRA, INC. ySTERIL WATER INJ 00409488720 HOSPIRA, INC. ySTERIL WATER INJ 00409488750 HOSPIRA, INC. ySTERIL WATER INJ 00409488799 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409488810 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409488812 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409488820 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409488850 HOSPIRA, INC. ySOD BICARB INJ 8.4% 00409490034 HOSPIRA, INC. yEPINEPHRINE INJ 0.1MG/ML 00409490118 HOSPIRA, INC. yDEXTROSE INJ 50% 00409490234 HOSPIRA, INC. yLIDOCAINE INJ 20MG/ML 00409490334 HOSPIRA, INC. yLIDOCAINE INJ 10MG/ML 00409490434 HOSPIRA, INC. yATROPINE SUL INJ 0.1MG/ML 00409491034 HOSPIRA, INC. yATROPINE SUL INJ 0.1MG/ML 00409491134 HOSPIRA, INC. ySOD BICARB INJ 7.5% 00409491634 HOSPIRA, INC. yEPINEPHRINE INJ 0.1MG/ML 00409492134 HOSPIRA, INC. yCALCIUM CL INJ 10% 00409492834 HOSPIRA, INC. yTAZICEF INJ 1GM 00409508216 HOSPIRA, INC. yTAZICEF INJ 2GM 00409508411 HOSPIRA, INC. yTAZICEF INJ 6GM 00409508611 HOSPIRA, INC. yTAZICEF INJ 6GM 00409508651 HOSPIRA, INC. yTAZICEF INJ 1GM 00409509216 HOSPIRA, INC. yTAZICEF INJ 1GM 00409509252 HOSPIRA, INC. yTAZICEF INJ 2GM 00409509311 HOSPIRA, INC. yTAZICEF INJ 2GM 00409509351 HOSPIRA, INC. ySOD BICARB INJ 4.2% 00409553434 HOSPIRA, INC. yA-METHAPRED INJ 40MG 00409568401 HOSPIRA, INC. yA-METHAPRED INJ 125MG 00409568502 HOSPIRA, INC. yTPN ELECTROL INJ 00409577901 HOSPIRA, INC. yDOPAMINE INJ 40MG/ML 00409582001 HOSPIRA, INC. yAMINOPHYLLIN INJ 25MG/ML 00409592101 HOSPIRA, INC. yAMINOPHYLLIN INJ 25MG/ML 00409592201 HOSPIRA, INC. y

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MEPERIDINE INJ 10MG/ML 00409603004 HOSPIRA, INC. yAMMONIUM CHL INJ 5MEQ/ML 00409604301 HOSPIRA, INC. yMORPHINE/D5W INJ 1MG/ML 00409606202 HOSPIRA, INC. yMORPHINE/D5W INJ 1MG/ML 00409606211 HOSPIRA, INC. yFUROSEMIDE INJ 10MG/ML 00409610202 HOSPIRA, INC. yFUROSEMIDE INJ 10MG/ML 00409610204 HOSPIRA, INC. yFUROSEMIDE INJ 10MG/ML 00409610210 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409613803 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409613822 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409613903 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409613922 HOSPIRA, INC. yRINGER'S IRR SOL 00409614009 HOSPIRA, INC. yPHYSIOSOL SOL IRRIGAT 00409614103 HOSPIRA, INC. yPHYSIOSOL SOL IRRIGAT 00409614109 HOSPIRA, INC. yPHYSIOSOL SOL IRRIGAT 00409614122 HOSPIRA, INC. yACETIC ACID SOL 0.25%IRR 00409614309 HOSPIRA, INC. yACETIC ACID SOL 0.25%IRR 00409614322 HOSPIRA, INC. yMORPHINE SUL INJ 25MG/ML 00409617714 HOSPIRA, INC. yMORPHINE SUL INJ 25MG/ML 00409617914 HOSPIRA, INC. yPENTOTHAL INJ 1GM 00409643501 HOSPIRA, INC. yERYTHROCIN INJ 500MG 00409647644 HOSPIRA, INC. yERYTHROCIN INJ 1000MG 00409647844 HOSPIRA, INC. yERYTHROM LAC INJ 500MG 00409648201 HOSPIRA, INC. yVANCOMYCIN INJ 5GM 00409650901 HOSPIRA, INC. yVANCOMYCIN INJ 5GM 00409650949 HOSPIRA, INC. yVANCOMYCIN INJ 1000MG 00409653301 HOSPIRA, INC. yVANCOMYCIN INJ 1000MG 00409653349 HOSPIRA, INC. yVANCOMYCIN INJ 500MG 00409653401 HOSPIRA, INC. yVANCOMYCIN INJ 500MG 00409653449 HOSPIRA, INC. yVANCOMYCIN INJ 1000MG 00409653501 HOSPIRA, INC. yVANCOMYCIN INJ 1000MG 00409653549 HOSPIRA, INC. yNEUT INJ 4% 00409660902 HOSPIRA, INC. ySOD BICARB INJ 8.4% 00409662502 HOSPIRA, INC. yQUELICIN INJ 20MG/ML 00409662902 HOSPIRA, INC. yQUELICIN INJ 20MG/ML 00409662961 HOSPIRA, INC. yPOT CHLORIDE INJ 2MEQ/ML 00409663501 HOSPIRA, INC. y

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POT CHLORIDE INJ 2MEQ/ML 00409663601 HOSPIRA, INC. ySOD BICARB INJ 8.4% 00409663734 HOSPIRA, INC. yDEXTROSE INJ 50% 00409664802 HOSPIRA, INC. yPOT CHLORIDE INJ 2MEQ/ML 00409665106 HOSPIRA, INC. yPOT CHLORIDE INJ 2MEQ/ML 00409665305 HOSPIRA, INC. ySOD CHLORIDE INJ 2.5/ML 00409665773 HOSPIRA, INC. ySOD CHLORIDE INJ 2.5/ML 00409666075 HOSPIRA, INC. ySOD LACTATE INJ 5MEQ/ML 00409666402 HOSPIRA, INC. yAMIDATE INJ 2MG/ML 00409669501 HOSPIRA, INC. yAMIDATE INJ 2MG/ML 00409669502 HOSPIRA, INC. yMG SO4/D5W INJ 10MG/ML 00409672723 HOSPIRA, INC. yMAGNESIUM SU INJ 40MG/ML 00409672903 HOSPIRA, INC. yMAGNESIUM SU INJ 40MG/ML 00409672909 HOSPIRA, INC. yMAGNESIUM SU INJ 40MG/ML 00409672923 HOSPIRA, INC. yMAGNESIUM SU INJ 80MG/ML 00409673013 HOSPIRA, INC. yLORAZEPAM INJ 2MG/ML 00409677802 HOSPIRA, INC. yLORAZEPAM INJ 2MG/ML 00409677862 HOSPIRA, INC. yLORAZEPAM INJ 4MG/ML 00409677902 HOSPIRA, INC. yLORAZEPAM INJ 2MG/ML 00409678002 HOSPIRA, INC. yLORAZEPAM INJ 4MG/ML 00409678102 HOSPIRA, INC. yQUELICIN INJ -1000 00409697010 HOSPIRA, INC. yPHYSIOSOL SOL IRRIGAT 00409701205 HOSPIRA, INC. yPOT CHLORIDE INJ 10MEQ 00409707426 HOSPIRA, INC. yPOT CHLORIDE INJ 10MEQ 00409707514 HOSPIRA, INC. yPOT CHLORIDE INJ 20MEQ 00409707526 HOSPIRA, INC. yPOT CHLORIDE INJ 30MEQ 00409707626 HOSPIRA, INC. yPOT CHLORIDE INJ 20MEQ 00409707714 HOSPIRA, INC. yPOT CHLORIDE INJ 40MEQ 00409707726 HOSPIRA, INC. yDEXTROSE INJ 5% 00409710002 HOSPIRA, INC. yDEXTROSE INJ 5% 00409710066 HOSPIRA, INC. yDEXTROSE INJ 5% 00409710067 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409710102 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409710166 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409710167 HOSPIRA, INC. yKCL/D5W/NACL INJ 0.15/0.9 00409710709 HOSPIRA, INC. yKCL/D5W/NACL INJ 0.3/0.9% 00409710909 HOSPIRA, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KCL/D5W/LR INJ 0.15% 00409711109 HOSPIRA, INC. yKCL/D5W/LR INJ 0.3% 00409711309 HOSPIRA, INC. yKCL/NACL INJ 0.15-0.9 00409711509 HOSPIRA, INC. yKCL/NACL INJ 0.3-0.9 00409711609 HOSPIRA, INC. ySTERIL WATER INJ 00409711807 HOSPIRA, INC. yDEXTROSE INJ 50% 00409711907 HOSPIRA, INC. yDEXTROSE INJ 70% 00409712007 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409713202 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409713266 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409713267 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409713809 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409713836 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409713909 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409713936 HOSPIRA, INC. yEPINEPHRINE INJ 1MG/ML 00409724101 HOSPIRA, INC. yHETASTARCH INJ 6%/NACL 00409724803 HOSPIRA, INC. yHETASTARCH INJ 6%/NACL 00409724849 HOSPIRA, INC. yPOT PHOSPHAT INJ 3MM/ML 00409729501 HOSPIRA, INC. yPOT PHOSPHAT INJ 3MM/ML 00409729601 HOSPIRA, INC. ySOD ACETATE INJ 2MEQ/ML 00409729973 HOSPIRA, INC. yCEFTRIAXONE INJ 1GM 00409733201 HOSPIRA, INC. yCEFTRIAXONE INJ 1GM 00409733304 HOSPIRA, INC. yCEFTRIAXONE INJ 1GM 00409733349 HOSPIRA, INC. yCEFTRIAXONE INJ 10GM 00409733410 HOSPIRA, INC. yCEFTRIAXONE INJ 2GM 00409733503 HOSPIRA, INC. yCEFTRIAXONE INJ 2GM 00409733604 HOSPIRA, INC. yCEFTRIAXONE INJ 2GM 00409733649 HOSPIRA, INC. yCEFTRIAXONE INJ 250MG 00409733701 HOSPIRA, INC. yCEFTRIAXONE INJ 500MG 00409733801 HOSPIRA, INC. yIONOSOL-B/ INJ D5W 00409737103 HOSPIRA, INC. yIONOSOL-B/ INJ D5W 00409737109 HOSPIRA, INC. yIONOSOL-MB INJ /D5W 00409737203 HOSPIRA, INC. yIONOSOL-MB INJ /D5W 00409737209 HOSPIRA, INC. yIONOSOL-MB INJ /D5W 00409737262 HOSPIRA, INC. yIONOSOL-T INJ /D5W 00409737303 HOSPIRA, INC. yIONOSOL-T INJ /D5W 00409737309 HOSPIRA, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMINOPHYLLIN INJ 25MG/ML 00409738501 HOSPIRA, INC. yAMINOPHYLLIN INJ 25MG/ML 00409738601 HOSPIRA, INC. ySOD PHOSPHAT INJ 3MM/ML 00409739172 HOSPIRA, INC. yLMD 10%/D5W INJ 00409741803 HOSPIRA, INC. yLMD 10%/NACL INJ 0.9% 00409741903 HOSPIRA, INC. yCIMETIDINE INJ 150MG/ML 00409744401 HOSPIRA, INC. yCIMETIDINE INJ 150MG/ML 00409744501 HOSPIRA, INC. yCIMETID/NACL INJ 300/50ML 00409744716 HOSPIRA, INC. yDEXTROSE INJ 50% 00409751716 HOSPIRA, INC. yHEP SOD/NACL INJ 2UNIT/ML 00409762003 HOSPIRA, INC. yHEP SOD/NACL INJ 2UNIT/ML 00409762059 HOSPIRA, INC. yHEP SOD/NACL INJ 25000UNT 00409765062 HOSPIRA, INC. yHEP SOD/NACL INJ 25000UNT 00409765103 HOSPIRA, INC. yHEP SOD/NACL INJ 12500UNT 00409765162 HOSPIRA, INC. yTHEOPHYL/D5W INJ 0.8MG/ML 00409766503 HOSPIRA, INC. yTHEOPHYL/D5W INJ 0.8MG/ML 00409766509 HOSPIRA, INC. yTHEOPHYL/D5W INJ 1.6MG/ML 00409766603 HOSPIRA, INC. yTHEOPHYL/D5W INJ 1.6MG/ML 00409766662 HOSPIRA, INC. yTHEOPHYL/D5W INJ 2MG/ML 00409766823 HOSPIRA, INC. yNORMOSOL-R INJ PH 7.4 00409767003 HOSPIRA, INC. yNORMOSOL-R INJ PH 7.4 00409767009 HOSPIRA, INC. yTHEOPHYL/D5W INJ 4MG/ML 00409767713 HOSPIRA, INC. yAMINOSYN II INJ 3.5/D25 00409770029 HOSPIRA, INC. yAMINOSYN II INJ 3.5/D5 00409770129 HOSPIRA, INC. yAMINOSYN II INJ 4.25/D25 00409770229 HOSPIRA, INC. yTHEOPHYL/D5W INJ 3.2MG/ML 00409770562 HOSPIRA, INC. yMANNITOL INJ 5% 00409771209 HOSPIRA, INC. yMANNITOL INJ 10% 00409771309 HOSPIRA, INC. yMANNITOL INJ 15% 00409771403 HOSPIRA, INC. yMANNITOL INJ 20% 00409771502 HOSPIRA, INC. yMANNITOL INJ 20% 00409771503 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409773020 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409773036 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409773037 HOSPIRA, INC. yAMINOSYN IIM INJ 3.5%/D5W 00409774029 HOSPIRA, INC. yAMINOSYN 2-M INJ 4.25/D10 00409774229 HOSPIRA, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMINOSYN II INJ 5/D25 00409774429 HOSPIRA, INC. yAMINOSYN II INJ 4.25/D10 00409775129 HOSPIRA, INC. yAMINOSYN II INJ 4.25/D20 00409775229 HOSPIRA, INC. yAMINOSYN/D20 INJ II 4.25% 00409775329 HOSPIRA, INC. yAMINOSYN/D25 INJ II 3.5% 00409775629 HOSPIRA, INC. yAMINOSYN/D25 INJ II 4.25% 00409775729 HOSPIRA, INC. yHEP SOD/D5W INJ 20000UNT 00409776003 HOSPIRA, INC. yHEP SOD/D5W INJ 25000UNT 00409776103 HOSPIRA, INC. yHEP SOD/D5W INJ 100/ML 00409779323 HOSPIRA, INC. yHEP SOD/D5W INJ 100/ML 00409779362 HOSPIRA, INC. yHEP SOD/D5W INJ 50UNT/ML 00409779462 HOSPIRA, INC. yDOPAMINE/D5W INJ 0.8MG/ML 00409780822 HOSPIRA, INC. yDOPAMINE/D5W INJ 0.8MG/ML 00409780824 HOSPIRA, INC. yDOPAMINE/D5W INJ 1.6MG/ML 00409780922 HOSPIRA, INC. yDOPAMINE/D5W INJ 1.6MG/ML 00409780924 HOSPIRA, INC. yDOPAMINE/D5W INJ 3.2MG/ML 00409781022 HOSPIRA, INC. yMETRON/NACL INJ 500MG 00409781124 HOSPIRA, INC. yMETRON/NACL INJ 500MG 00409781137 HOSPIRA, INC. yLACTATED RIN SOL IRRIGAT 00409782808 HOSPIRA, INC. yGENTAM/NACL INJ 60MG PB 00409787913 HOSPIRA, INC. yGENTAM/NACL INJ 1.4MG/ML 00409788113 HOSPIRA, INC. yGENTAM/NACL INJ 80MG 00409788313 HOSPIRA, INC. yGENTAM/NACL INJ 80MG PB 00409788423 HOSPIRA, INC. yGENTAM/NACL INJ 0.9MG/ML 00409788623 HOSPIRA, INC. yGENTAM/NACL INJ 100MG 00409788923 HOSPIRA, INC. yKCL/D5W/NACL INJ 0.15/0.2 00409790103 HOSPIRA, INC. yKCL/D5W/NACL INJ 0.15/0.2 00409790109 HOSPIRA, INC. yKCL/D5W/NACL INJ .15-.45% 00409790203 HOSPIRA, INC. yKCL/D5W/NACL INJ .15-.45% 00409790209 HOSPIRA, INC. yKCL/D5W/NACL INJ .224/.45 00409790309 HOSPIRA, INC. yKCL/D5W/NACL INJ 0.3/0.45 00409790409 HOSPIRA, INC. yKCL/D5W INJ 0.15% 00409790509 HOSPIRA, INC. yKCL/D5W INJ 0.3% 00409790609 HOSPIRA, INC. yDEXTROSE INJ 70% 00409791819 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792202 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792203 HOSPIRA, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXTROSE INJ 5% 00409792209 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792230 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792248 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792253 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792255 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792261 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792313 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792320 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792323 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792336 HOSPIRA, INC. yDEXTROSE INJ 5% 00409792337 HOSPIRA, INC. yD5W/NACL INJ 0.225% 00409792402 HOSPIRA, INC. yD5W/NACL INJ 0.225% 00409792403 HOSPIRA, INC. yD5W/NACL INJ 0.225% 00409792409 HOSPIRA, INC. yD5W/NACL INJ 0.3% 00409792502 HOSPIRA, INC. yD5W/NACL INJ 0.3% 00409792503 HOSPIRA, INC. yD5W/NACL INJ 0.3% 00409792509 HOSPIRA, INC. yD5W/NACL INJ 0.45% 00409792602 HOSPIRA, INC. yD5W/NACL INJ 0.45% 00409792603 HOSPIRA, INC. yD5W/NACL INJ 0.45% 00409792609 HOSPIRA, INC. yD5W/NACL INJ 0.45% 00409792630 HOSPIRA, INC. yD5W/NACL INJ 0.45% 00409792648 HOSPIRA, INC. yD5W/LR INJ 00409792903 HOSPIRA, INC. yD5W/LR INJ 00409792909 HOSPIRA, INC. yDEXTROSE INJ 10% 00409793002 HOSPIRA, INC. yDEXTROSE INJ 10% 00409793003 HOSPIRA, INC. yDEXTROSE INJ 10% 00409793009 HOSPIRA, INC. yLIDOCAIN/D5W INJ 4MG/ML 00409793124 HOSPIRA, INC. yLIDOCAIN/D5W INJ 4MG/ML 00409793132 HOSPIRA, INC. yD5W/RINGER'S INJ 00409793309 HOSPIRA, INC. yDEXTROSE INJ 20% 00409793519 HOSPIRA, INC. yDEXTROSE INJ 50% 00409793619 HOSPIRA, INC. yDEXTROSE INJ 50% 00409793629 HOSPIRA, INC. yDEXTROSE INJ 40% 00409793719 HOSPIRA, INC. yDEXTROSE INJ 10% 00409793819 HOSPIRA, INC. yLIDOCAIN/D5W INJ 8MG/ML 00409793932 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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D5W/NACL INJ 0.9% 00409794102 HOSPIRA, INC. yD5W/NACL INJ 0.9% 00409794103 HOSPIRA, INC. yD5W/NACL INJ 0.9% 00409794109 HOSPIRA, INC. yLACTATED RIN INJ 00409795302 HOSPIRA, INC. yLACTATED RIN INJ 00409795303 HOSPIRA, INC. yLACTATED RIN INJ 00409795309 HOSPIRA, INC. yLACTATED RIN INJ 00409795330 HOSPIRA, INC. yLACTATED RIN INJ 00409795348 HOSPIRA, INC. yNORMOSOL -M INJ /D5W 00409796503 HOSPIRA, INC. yNORMOSOL -M INJ /D5W 00409796509 HOSPIRA, INC. yNORMOSOL -R INJ 00409796703 HOSPIRA, INC. yNORMOSOL -R INJ 00409796709 HOSPIRA, INC. yNORMOSOL -R INJ /D5W 00409796809 HOSPIRA, INC. yPLEGISOL SOL 00409796905 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409797205 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409797207 HOSPIRA, INC. ySODIUM CHLOR SOL 0.9% IRR 00409797208 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409797305 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409797307 HOSPIRA, INC. ySTERIL WATER SOL IRRIG 00409797308 HOSPIRA, INC. yGLYCINE SOL 1.5% IRR 00409797408 HOSPIRA, INC. ySOD CHLORIDE SOL 0.45%IRR 00409797507 HOSPIRA, INC. ySORBITOL-MAN SOL 00409798108 HOSPIRA, INC. yRINGERS INJ 00409798209 HOSPIRA, INC. yRINGERS INJ 00409798224 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798302 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798303 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798309 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798330 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798348 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798353 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798355 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798361 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798413 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798420 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798423 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SOD CHLORIDE INJ 0.9% 00409798436 HOSPIRA, INC. ySOD CHLORIDE INJ 0.9% 00409798437 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409798502 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409798503 HOSPIRA, INC. ySOD CHLORIDE INJ 0.45% 00409798509 HOSPIRA, INC. ySTERIL WATER INJ 00409799009 HOSPIRA, INC. yKCL/D5W/NACL INJ .224/0.2 00409799109 HOSPIRA, INC. yKCL/D5W/NACL INJ 0.3/0.2% 00409799209 HOSPIRA, INC. yKCL/D5W/NACL INJ .075/.45 00409799309 HOSPIRA, INC. yKCL/D5W INJ 0.224% 00409799609 HOSPIRA, INC. yKCL/D5W/NACL INJ .075/.2% 00409799709 HOSPIRA, INC. yKCL/D5W/NACL INJ .15/.33% 00409799803 HOSPIRA, INC. yKCL/D5W/NACL INJ .15/.33% 00409799809 HOSPIRA, INC. yDEXTROSE INJ 30% 00409800415 HOSPIRA, INC. yAMIDATE INJ 2MG/ML 00409806029 HOSPIRA, INC. yAMIDATE INJ 2MG/ML 00409806101 HOSPIRA, INC. yAMIDATE INJ 2MG/ML 00409806201 HOSPIRA, INC. yPOT ACETATE INJ 2MEQ/ML 00409818301 HOSPIRA, INC. yCYSTEINE HCL INJ 50MG/ML 00409897510 HOSPIRA, INC. yBUPIVACAINE/ INJ EPI 0.25 00409904201 HOSPIRA, INC. yBUPIVACAINE/ INJ EPI 0.25 00409904202 HOSPIRA, INC. yBUPIVACAINE/ INJ EPI 0.25 00409904301 HOSPIRA, INC. yBUPIVACAINE/ INJ EPI 0.5% 00409904501 HOSPIRA, INC. yBUPIVACAINE/ INJ EPI 0.5% 00409904502 HOSPIRA, INC. yBUPIVACAINE/ INJ EPI 0.5% 00409904601 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909332 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909335 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909336 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909338 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909422 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909425 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909428 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909431 HOSPIRA, INC. yFENTANYL CIT INJ 0.05MG/1 00409909461 HOSPIRA, INC. yDOPAMINE INJ 40MG/ML 00409910420 HOSPIRA, INC. yLIDOCAINE INJ 1% 00409913705 HOSPIRA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VITAMIN K1 INJ 1MG/0.5 00409915701 HOSPIRA, INC. yVITAMIN K1 INJ 10MG/ML 00409915801 HOSPIRA, INC. yATROPINE SUL INJ 0.1MG/ML 00409962905 HOSPIRA, INC. yATROPINE SUL INJ 0.05MG/1 00409963005 HOSPIRA, INC. yFUROSEMIDE INJ 10MG/ML 00409963104 HOSPIRA, INC. yVERAPAMIL INJ 2.5MG/ML 00409963305 HOSPIRA, INC. yLIPOSYN II INJ 10% 00409978601 HOSPIRA, INC. yLIPOSYN II INJ 10% 00409978603 HOSPIRA, INC. yLIPOSYN II INJ 20% 00409978901 HOSPIRA, INC. yLIPOSYN II INJ 20% 00409978903 HOSPIRA, INC. yLIPOSYN III INJ 10% 00409979001 HOSPIRA, INC. yLIPOSYN III INJ 10% 00409979003 HOSPIRA, INC. yLIPOSYN III INJ 20% 00409979101 HOSPIRA, INC. yLIPOSYN III INJ 20% 00409979103 HOSPIRA, INC. yTYZEKA TAB 600MG 24108010101 IDENIX PHARMACEUTICALS yERBITUX INJ 100MG 66733094823 IMCLONE SYSTEMS, INCORPORATED yALBUMIN HUM INJ 25% 61953000201 INSTITUTO GRIFOLS yALBUMIN HUM INJ 25% 61953000202 INSTITUTO GRIFOLS yFLEBOGAMMA INJ 5% 61953000301 INSTITUTO GRIFOLS yFLEBOGAMMA INJ 5% 61953000302 INSTITUTO GRIFOLS yFLEBOGAMMA INJ 5% 61953000303 INSTITUTO GRIFOLS yFLEBOGAMMA INJ 5% 61953000304 INSTITUTO GRIFOLS ySTUART PREN TAB 64731079501 INTEGRITY PHARMACEUTICAL CORPORATION yFINACEA GEL 15% 10922082502 INTENDIS, INC. yACTIMMUNE INJ 2MU/0.5 64116001101 INTERMUNE, INC. yACTIMMUNE INJ 2MU/0.5 64116001112 INTERMUNE, INC. yAMPHOTEC INJ 100MG 64116002101 INTERMUNE, INC. yAMPHOTEC INJ 50MG 64116002501 INTERMUNE, INC. yINFERGEN INJ 15MCG 64116003101 INTERMUNE, INC. yINFERGEN INJ 15MCG 64116003106 INTERMUNE, INC. yINFERGEN INJ 9MCG 64116003901 INTERMUNE, INC. yINFERGEN INJ 9MCG 64116003906 INTERMUNE, INC. yDEXTROSE INJ 50% 00548100100 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 7.5% 00548100200 INTERNATIONAL MEDICATION SYSTEMS LTD yCALCIUM CL INJ 10% 00548100400 INTERNATIONAL MEDICATION SYSTEMS LTD yEPINEPHRINE INJ 0.1MG/ML 00548101400 INTERNATIONAL MEDICATION SYSTEMS LTD y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXTROSE INJ 25% 00548101500 INTERNATIONAL MEDICATION SYSTEMS LTD yEPINEPHRINE INJ 0.1MG/ML 00548101600 INTERNATIONAL MEDICATION SYSTEMS LTD yMAGNESIUM SU INJ 50% 00548103400 INTERNATIONAL MEDICATION SYSTEMS LTD yATROPINE SUL INJ 0.1MG/ML 00548103900 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 8.4% 00548105200 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 1% 00548107800 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 1% 00548107900 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 1% 00548108000 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 1% 00548108100 INTERNATIONAL MEDICATION SYSTEMS LTD yPHYTONADIONE INJ 1MG/0.5 00548114000 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 20MG/ML 00548119000 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 10MG/ML 00548119200 INTERNATIONAL MEDICATION SYSTEMS LTD yPHYTONADIONE INJ 2MG/ML 00548124000 INTERNATIONAL MEDICATION SYSTEMS LTD yDIPHENHYDRAM INJ 50MG/ML 00548139000 INTERNATIONAL MEDICATION SYSTEMS LTD yFUROSEMIDE INJ 10MG/ML 00548143100 INTERNATIONAL MEDICATION SYSTEMS LTD yNALOXONE INJ 0.4MG/ML 00548146600 INTERNATIONAL MEDICATION SYSTEMS LTD yNALOXONE INJ 1MG/ML 00548146900 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 1MG/ML 00548191125 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 1MG/ML 00548193110 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 1MG/ML 00548193310 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 1MG/ML 00548193700 INTERNATIONAL MEDICATION SYSTEMS LTD yDEXTROSE INJ 50% 00548200100 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 7.5% 00548200200 INTERNATIONAL MEDICATION SYSTEMS LTD yCALCIUM CL INJ 10% 00548200400 INTERNATIONAL MEDICATION SYSTEMS LTD yEPINEPHRINE INJ 0.1MG/ML 00548201600 INTERNATIONAL MEDICATION SYSTEMS LTD yATROPINE SUL INJ 0.1MG/ML 00548203900 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 8.4% 00548205200 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 20MG/ML 00548219000 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 1MG/ML 00548290125 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE GEL 2% 00548301100 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE GEL 2% 00548301200 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE GEL 2% 00548301300 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE GEL 2% 00548301500 INTERNATIONAL MEDICATION SYSTEMS LTD yDEXTROSE INJ 50% 00548330100 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 7.5% 00548330200 INTERNATIONAL MEDICATION SYSTEMS LTD yCALCIUM CL INJ 10% 00548330400 INTERNATIONAL MEDICATION SYSTEMS LTD y

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DEXTROSE INJ 25% 00548331500 INTERNATIONAL MEDICATION SYSTEMS LTD yEPINEPHRINE INJ 0.1MG/ML 00548331600 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 4.2% 00548333100 INTERNATIONAL MEDICATION SYSTEMS LTD yATROPINE SUL INJ 0.1MG/ML 00548333800 INTERNATIONAL MEDICATION SYSTEMS LTD yATROPINE SUL INJ 0.1MG/ML 00548333900 INTERNATIONAL MEDICATION SYSTEMS LTD ySOD BICARB INJ 8.4% 00548335200 INTERNATIONAL MEDICATION SYSTEMS LTD yNALOXONE INJ 0.4MG/ML 00548336600 INTERNATIONAL MEDICATION SYSTEMS LTD yNALOXONE INJ 1MG/ML 00548336900 INTERNATIONAL MEDICATION SYSTEMS LTD yAMIODARONE INJ 50MG/ML 00548338000 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE INJ 20MG/ML 00548339000 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 1MG/ML 00548339110 INTERNATIONAL MEDICATION SYSTEMS LTD yCORTROSYN INJ 0.25MG 00548590000 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 50MG/ML 00548604025 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 25MG/ML 00548604225 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 25MG/ML 00548604325 INTERNATIONAL MEDICATION SYSTEMS LTD yMORPHINE SUL INJ 25MG/ML 00548604525 INTERNATIONAL MEDICATION SYSTEMS LTD yLIDOCAINE SOL 4% 00548630000 INTERNATIONAL MEDICATION SYSTEMS LTD yEPINEPHRINE INJ 1MG/ML 00548906100 INTERNATIONAL MEDICATION SYSTEMS LTD yAMPHADASE INJ 150/ML 00548909000 INTERNATIONAL MEDICATION SYSTEMS LTD yIBUPROFEN TAB 400MG 53746013101 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013105 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013118 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013124 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013127 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013150 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013160 INTERPHARM, INC yIBUPROFEN TAB 400MG 53746013190 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013201 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013205 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013218 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013224 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013227 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013230 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013250 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013260 INTERPHARM, INC yIBUPROFEN TAB 600MG 53746013290 INTERPHARM, INC y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IBUPROFEN TAB 200MG 53746013501 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013502 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013505 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013510 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013524 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013550 INTERPHARM, INC yIBUPROFEN TAB 800MG 53746013701 INTERPHARM, INC yIBUPROFEN TAB 800MG 53746013705 INTERPHARM, INC yIBUPROFEN TAB 800MG 53746013724 INTERPHARM, INC yIBUPROFEN TAB 800MG 53746013750 INTERPHARM, INC yIBUPROFEN TAB 800MG 53746013790 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013801 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746013810 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746014001 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746014002 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746014005 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746014010 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746014024 INTERPHARM, INC yIBUPROFEN TAB 200MG 53746014050 INTERPHARM, INC yNAPROXEN TAB 250MG 53746018801 INTERPHARM, INC yNAPROXEN TAB 250MG 53746018805 INTERPHARM, INC yNAPROXEN TAB 250MG 53746018850 INTERPHARM, INC yNAPROXEN TAB 375MG 53746018901 INTERPHARM, INC yNAPROXEN TAB 375MG 53746018905 INTERPHARM, INC yNAPROXEN TAB 375MG 53746018950 INTERPHARM, INC yNAPROXEN TAB 500MG 53746019001 INTERPHARM, INC yNAPROXEN TAB 500MG 53746019005 INTERPHARM, INC yNAPROXEN TAB 500MG 53746019050 INTERPHARM, INC yTHEOPHYLLINE TAB 300MG ER 00258358101 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 300MG ER 00258358105 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 300MG ER 00258358110 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 200MG ER 00258358301 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 200MG ER 00258358305 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 200MG ER 00258358310 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 100MG ER 00258358401 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 100MG ER 00258358405 INWOOD LABORATORIES INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARBAMAZEPIN TAB 200MG 00258358710 INWOOD LABORATORIES INC yISOSORB DIN TAB 40MG ER 00258361301 INWOOD LABORATORIES INC yTHEOPHYLLINE TAB 450MG ER 00258361401 INWOOD LABORATORIES INC yTHEOPHYLLINE CAP 300MG ER 00258362501 INWOOD LABORATORIES INC yTHEOPHYLLINE CAP 200MG ER 00258363401 INWOOD LABORATORIES INC yTHEOPHYLLINE CAP 125MG ER 00258363801 INWOOD LABORATORIES INC yBENZONATATE CAP 100MG 00258365401 INWOOD LABORATORIES INC yBENZONATATE CAP 100MG 00258365405 INWOOD LABORATORIES INC yHYDROCO/APAP TAB 10-650MG 00258365801 INWOOD LABORATORIES INC yHYDROCO/APAP TAB 10-650MG 00258365805 INWOOD LABORATORIES INC yDILTIAZEM CAP 120MG/24 00258368790 INWOOD LABORATORIES INC yDILTIAZEM CAP 180MG/24 00258368890 INWOOD LABORATORIES INC yDILTIAZEM CAP 240MG/24 00258368990 INWOOD LABORATORIES INC yDILTIAZEM CAP 300MG/24 00258369090 INWOOD LABORATORIES INC yDILTIAZEM CAP 360MG/24 00258369190 INWOOD LABORATORIES INC yDILTIAZEM CAP 420MG/24 00258369290 INWOOD LABORATORIES INC yCITALOPRAM TAB 10MG 00258369501 INWOOD LABORATORIES INC yCITALOPRAM TAB 20MG 00258369601 INWOOD LABORATORIES INC yCITALOPRAM TAB 20MG 00258369610 INWOOD LABORATORIES INC yCITALOPRAM TAB 40MG 00258369701 INWOOD LABORATORIES INC yCITALOPRAM TAB 40MG 00258369710 INWOOD LABORATORIES INC yRIMANTADINE TAB 100MG 00258371101 INWOOD LABORATORIES INC yVITRASE INJ 6200UNIT 67425000102 ISTA PHARMACEUTICALS yVITRASE INJ 200/ML 67425000210 ISTA PHARMACEUTICALS yISTALOL SOL 0.5% OP 67425000312 ISTA PHARMACEUTICALS yISTALOL SOL 0.5% OP 67425000350 ISTA PHARMACEUTICALS yXIBROM SOL 0.09% 67425000412 ISTA PHARMACEUTICALS yXIBROM SOL 0.09% 67425000450 ISTA PHARMACEUTICALS yNASAREL SPR 29MCG 59310003725 IVAX LABS INC. yQVAR AER 40MCG 59310017540 IVAX LABS INC. yQVAR AER 80MCG 59310017780 IVAX LABS INC. yPROAIR HFA AER 59310057920 IVAX LABS INC. yPHENY SOD CAP PROMPT 00172205760 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 00172208360 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 00172208380 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 50MG 00172208960 IVAX PHARMACEUTICALS, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCHLOROT TAB 50MG 00172208980 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 50MG 00172208985 IVAX PHARMACEUTICALS, INC. yNITROFUR MAC CAP 50MG 00172213060 IVAX PHARMACEUTICALS, INC. yNITROFUR MAC CAP 50MG 00172213080 IVAX PHARMACEUTICALS, INC. yNITROFUR MAC CAP 100MG 00172213160 IVAX PHARMACEUTICALS, INC. yNITROFUR MAC CAP 100MG 00172213170 IVAX PHARMACEUTICALS, INC. yMORPHINE SUL TAB 15MG CR 00172216260 IVAX PHARMACEUTICALS, INC. yMORPHINE SUL TAB 30MG CR 00172216360 IVAX PHARMACEUTICALS, INC. yMORPHINE SUL TAB 60MG CR 00172216460 IVAX PHARMACEUTICALS, INC. yMORPHINE SUL TAB 100MG CR 00172216560 IVAX PHARMACEUTICALS, INC. yMORPHINE SUL TAB 200MG CR 00172216660 IVAX PHARMACEUTICALS, INC. yPROPOXY HCL CAP 65MG 00172218660 IVAX PHARMACEUTICALS, INC. yPROPOXY HCL CAP 65MG 00172218680 IVAX PHARMACEUTICALS, INC. yPROBENECID TAB 500MG 00172219060 IVAX PHARMACEUTICALS, INC. yPROBEN/COLCH TAB 500-0.5 00172219360 IVAX PHARMACEUTICALS, INC. ySULFISOXAZOL TAB 0.5GM 00172221860 IVAX PHARMACEUTICALS, INC. yPROCAINAMIDE CAP 250MG 00172234560 IVAX PHARMACEUTICALS, INC. yPROCAINAMIDE CAP 500MG 00172234760 IVAX PHARMACEUTICALS, INC. yTETRACYCLINE CAP 500MG 00172240760 IVAX PHARMACEUTICALS, INC. yTETRACYCLINE CAP 500MG 00172240780 IVAX PHARMACEUTICALS, INC. yTETRACYCLINE CAP 250MG 00172241660 IVAX PHARMACEUTICALS, INC. yTETRACYCLINE CAP 250MG 00172241680 IVAX PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00172290860 IVAX PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00172290880 IVAX PHARMACEUTICALS, INC. yHYDROXYZ PAM CAP 50MG 00172290960 IVAX PHARMACEUTICALS, INC. yHYDROXYZ PAM CAP 25MG 00172291160 IVAX PHARMACEUTICALS, INC. yHYDROXYZ PAM CAP 25MG 00172291170 IVAX PHARMACEUTICALS, INC. yCYPROHEPTAD TAB 4MG 00172292960 IVAX PHARMACEUTICALS, INC. yCYPROHEPTAD TAB 4MG 00172292980 IVAX PHARMACEUTICALS, INC. yMETHYLDOPA TAB 250MG 00172293160 IVAX PHARMACEUTICALS, INC. yMETHYLDOPA TAB 250MG 00172293180 IVAX PHARMACEUTICALS, INC. yMETHYLDOPA TAB 500MG 00172293260 IVAX PHARMACEUTICALS, INC. yMETHYLDOPA TAB 500MG 00172293270 IVAX PHARMACEUTICALS, INC. yTRIAMT/HCTZ CAP 50-25MG 00172295060 IVAX PHARMACEUTICALS, INC. yTRIAMT/HCTZ CAP 50-25MG 00172295080 IVAX PHARMACEUTICALS, INC. yERGOLOID MES SUB 1MG SL 00172295960 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METRONIDAZOL TAB 250MG 00172297160 IVAX PHARMACEUTICALS, INC. yTOLAZAMIDE TAB 100MG 00172297860 IVAX PHARMACEUTICALS, INC. yTOLAZAMIDE TAB 250MG 00172297960 IVAX PHARMACEUTICALS, INC. yTOLAZAMIDE TAB 250MG 00172297980 IVAX PHARMACEUTICALS, INC. yTOLAZAMIDE TAB 500MG 00172298060 IVAX PHARMACEUTICALS, INC. yDOXYCYCL HYC CAP 50MG 00172298448 IVAX PHARMACEUTICALS, INC. yDOXYCYCL HYC CAP 100MG 00172298548 IVAX PHARMACEUTICALS, INC. yDOXYCYCL HYC CAP 100MG 00172298570 IVAX PHARMACEUTICALS, INC. yQUININE SULF TAB 260MG 00172300160 IVAX PHARMACEUTICALS, INC. yQUININE SULF TAB 260MG 00172300170 IVAX PHARMACEUTICALS, INC. yMETRONIDAZOL TAB 500MG 00172300760 IVAX PHARMACEUTICALS, INC. yDOXYCYCL HYC TAB 100MG 00172362648 IVAX PHARMACEUTICALS, INC. yDOXYCYCL HYC TAB 100MG 00172362670 IVAX PHARMACEUTICALS, INC. yIBUPROFEN TAB 800MG 00172364870 IVAX PHARMACEUTICALS, INC. yGLIPIZIDE TAB 5MG 00172364960 IVAX PHARMACEUTICALS, INC. yGLIPIZIDE TAB 5MG 00172364970 IVAX PHARMACEUTICALS, INC. yGLIPIZIDE TAB 10MG 00172365060 IVAX PHARMACEUTICALS, INC. yGLIPIZIDE TAB 10MG 00172365070 IVAX PHARMACEUTICALS, INC. yPERPHENAZINE TAB 2MG 00172366760 IVAX PHARMACEUTICALS, INC. yPERPHENAZINE TAB 4MG 00172366860 IVAX PHARMACEUTICALS, INC. yPERPHENAZINE TAB 8MG 00172366960 IVAX PHARMACEUTICALS, INC. yPERPHENAZINE TAB 16MG 00172367060 IVAX PHARMACEUTICALS, INC. yDOXAZOSIN TAB 1MG 00172368560 IVAX PHARMACEUTICALS, INC. yDOXAZOSIN TAB 2MG 00172368670 IVAX PHARMACEUTICALS, INC. yDOXAZOSIN TAB 8MG 00172368860 IVAX PHARMACEUTICALS, INC. yDOXAZOSIN TAB 8MG 00172368870 IVAX PHARMACEUTICALS, INC. yPROCHLORPER TAB 5MG 00172369060 IVAX PHARMACEUTICALS, INC. yPROCHLORPER TAB 10MG 00172369160 IVAX PHARMACEUTICALS, INC. yONXOL INJ 300/50ML 00172375377 IVAX PHARMACEUTICALS, INC. yONXOL INJ 300/50ML 00172375396 IVAX PHARMACEUTICALS, INC. yONXOL INJ 30MG/5ML 00172375473 IVAX PHARMACEUTICALS, INC. yONXOL INJ 30MG/5ML 00172375494 IVAX PHARMACEUTICALS, INC. yONXOL INJ 6MG/ML 00172375531 IVAX PHARMACEUTICALS, INC. yONXOL INJ 150/25ML 00172375675 IVAX PHARMACEUTICALS, INC. yONXOL INJ 150/25ML 00172375695 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 2.5MG 00172375710 IVAX PHARMACEUTICALS, INC. y

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LISINOPRIL TAB 2.5MG 00172375760 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 2.5MG 00172375770 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 00172375810 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 00172375860 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 00172375870 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 00172375880 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 00172375910 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 00172375960 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 00172375970 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 00172375980 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 00172376010 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 00172376060 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 00172376070 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 00172376080 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 00172376110 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 00172376160 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 00172376170 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 00172376210 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 00172376260 IVAX PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 00172376270 IVAX PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00172392560 IVAX PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00172392570 IVAX PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00172392660 IVAX PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00172392670 IVAX PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00172392760 IVAX PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00172392770 IVAX PHARMACEUTICALS, INC. yDIPHEN/ATROP TAB 2.5MG 00172396660 IVAX PHARMACEUTICALS, INC. yDIPHEN/ATROP TAB 2.5MG 00172396680 IVAX PHARMACEUTICALS, INC. yASA/CODEINE TAB 325-30MG 00172398460 IVAX PHARMACEUTICALS, INC. yASA/CODEINE TAB 325-60MG 00172398560 IVAX PHARMACEUTICALS, INC. yINDOMETHACIN CAP 25MG 00172402960 IVAX PHARMACEUTICALS, INC. yINDOMETHACIN CAP 25MG 00172402980 IVAX PHARMACEUTICALS, INC. yINDOMETHACIN CAP 50MG 00172403060 IVAX PHARMACEUTICALS, INC. yINDOMETHACIN CAP 50MG 00172403070 IVAX PHARMACEUTICALS, INC. yESTAZOLAM TAB 1MG 00172403660 IVAX PHARMACEUTICALS, INC. yESTAZOLAM TAB 2MG 00172403760 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CEFADROXIL CAP 500MG 00172405843 IVAX PHARMACEUTICALS, INC. yCEFADROXIL CAP 500MG 00172405848 IVAX PHARMACEUTICALS, INC. yCEFADROXIL CAP 500MG 00172405860 IVAX PHARMACEUTICALS, INC. yCEFADROXIL CAP 500MG 00172405870 IVAX PHARMACEUTICALS, INC. yCEFADROXIL TAB 1000MG 00172405943 IVAX PHARMACEUTICALS, INC. yCEFADROXIL TAB 1000MG 00172405948 IVAX PHARMACEUTICALS, INC. yCEFADROXIL TAB 1000MG 00172405960 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 1MG 00172406760 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 1MG 00172406765 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 1MG 00172406780 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 2MG 00172406860 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 2MG 00172406865 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 2MG 00172406880 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 5MG 00172406960 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 5MG 00172406965 IVAX PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 5MG 00172406970 IVAX PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 00172407360 IVAX PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 00172407370 IVAX PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 00172407460 IVAX PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 00172407470 IVAX PHARMACEUTICALS, INC. yBACLOFEN TAB 10MG 00172409660 IVAX PHARMACEUTICALS, INC. yBACLOFEN TAB 10MG 00172409680 IVAX PHARMACEUTICALS, INC. yBACLOFEN TAB 20MG 00172409760 IVAX PHARMACEUTICALS, INC. yBACLOFEN TAB 20MG 00172409780 IVAX PHARMACEUTICALS, INC. yNABUMETONE TAB 500MG 00172409810 IVAX PHARMACEUTICALS, INC. yNABUMETONE TAB 500MG 00172409860 IVAX PHARMACEUTICALS, INC. yNABUMETONE TAB 500MG 00172409870 IVAX PHARMACEUTICALS, INC. yNABUMETONE TAB 750MG 00172409910 IVAX PHARMACEUTICALS, INC. yNABUMETONE TAB 750MG 00172409960 IVAX PHARMACEUTICALS, INC. yNABUMETONE TAB 750MG 00172409970 IVAX PHARMACEUTICALS, INC. yFENOPROFEN TAB 600MG 00172414160 IVAX PHARMACEUTICALS, INC. yQUININE SULF CAP 200MG 00172417160 IVAX PHARMACEUTICALS, INC. yQUININE SULF CAP 325MG 00172417260 IVAX PHARMACEUTICALS, INC. yQUININE SULF CAP 325MG 00172417280 IVAX PHARMACEUTICALS, INC. yCEFACLOR ER TAB 500MG 00172419460 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 00172419510 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRIL TAB 2.5MG 00172419560 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 00172419580 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 00172419593 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 00172419610 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 00172419660 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 00172419680 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 00172419693 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 00172419710 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 00172419760 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 00172419780 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 00172419793 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 00172419810 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 00172419860 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 00172419880 IVAX PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 00172419893 IVAX PHARMACEUTICALS, INC. yPINDOLOL TAB 5MG 00172421760 IVAX PHARMACEUTICALS, INC. yPINDOLOL TAB 10MG 00172421860 IVAX PHARMACEUTICALS, INC. yGUANABENZ TAB 4MG 00172422660 IVAX PHARMACEUTICALS, INC. yGUANABENZ TAB 8MG 00172422760 IVAX PHARMACEUTICALS, INC. yBUMETANIDE TAB 0.5MG 00172423260 IVAX PHARMACEUTICALS, INC. yBUMETANIDE TAB 1MG 00172423360 IVAX PHARMACEUTICALS, INC. yBUMETANIDE TAB 1MG 00172423380 IVAX PHARMACEUTICALS, INC. yBUMETANIDE TAB 2MG 00172423460 IVAX PHARMACEUTICALS, INC. yBUMETANIDE TAB 2MG 00172423480 IVAX PHARMACEUTICALS, INC. yNADOLOL TAB 20MG 00172423560 IVAX PHARMACEUTICALS, INC. yNADOLOL TAB 20MG 00172423570 IVAX PHARMACEUTICALS, INC. yNADOLOL TAB 40MG 00172423660 IVAX PHARMACEUTICALS, INC. yNADOLOL TAB 80MG 00172423760 IVAX PHARMACEUTICALS, INC. yNADOLOL TAB 120MG 00172423860 IVAX PHARMACEUTICALS, INC. yNADOLOL TAB 160MG 00172423960 IVAX PHARMACEUTICALS, INC. yINDAPAMIDE TAB 2.5MG 00172425960 IVAX PHARMACEUTICALS, INC. yINDAPAMIDE TAB 2.5MG 00172425980 IVAX PHARMACEUTICALS, INC. yINDAPAMIDE TAB 1.25MG 00172426260 IVAX PHARMACEUTICALS, INC. yINDAPAMIDE TAB 1.25MG 00172426280 IVAX PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 00172426660 IVAX PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 00172426670 IVAX PHARMACEUTICALS, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACYCLOVIR TAB 400MG 00172426760 IVAX PHARMACEUTICALS, INC. yACYCLOVIR TAB 400MG 00172426770 IVAX PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 00172426860 IVAX PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 00172426870 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 240MG ER 00172428010 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 240MG ER 00172428060 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 240MG ER 00172428070 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 120MG ER 00172428510 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 120MG ER 00172428560 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 180MG ER 00172428610 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 180MG ER 00172428660 IVAX PHARMACEUTICALS, INC. yVERAPAMIL TAB 180MG ER 00172428670 IVAX PHARMACEUTICALS, INC. yNICARDIPINE CAP 20MG 00172428860 IVAX PHARMACEUTICALS, INC. yNICARDIPINE CAP 30MG 00172428960 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 12.5 00172430310 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 12.5 00172430346 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 12.5 00172430360 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 850MG 00172433010 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 850MG 00172433060 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 850MG 00172433080 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG 00172433110 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG 00172433160 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG 00172433170 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG 00172433180 IVAX PHARMACEUTICALS, INC. yNEFAZODONE TAB 150MG 00172433349 IVAX PHARMACEUTICALS, INC. yNEFAZODONE TAB 200MG 00172433410 IVAX PHARMACEUTICALS, INC. yNEFAZODONE TAB 200MG 00172433449 IVAX PHARMACEUTICALS, INC. yNEFAZODONE TAB 250MG 00172433510 IVAX PHARMACEUTICALS, INC. yNEFAZODONE TAB 250MG 00172433549 IVAX PHARMACEUTICALS, INC. yTERAZOSIN CAP 5MG 00172433860 IVAX PHARMACEUTICALS, INC. yNEFAZODONE TAB 50MG 00172434310 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 00172434610 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 00172434646 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 00172434660 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 00172434670 IVAX PHARMACEUTICALS, INC. yOXAPROZIN TAB 600MG 00172434810 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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OXAPROZIN TAB 600MG 00172434860 IVAX PHARMACEUTICALS, INC. yOXAPROZIN TAB 600MG 00172434870 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 00172435610 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 00172435660 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 00172435670 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 00172435680 IVAX PHARMACEUTICALS, INC. yRANITIDINE TAB 150MG 00172435710 IVAX PHARMACEUTICALS, INC. yRANITIDINE TAB 150MG 00172435749 IVAX PHARMACEUTICALS, INC. yRANITIDINE TAB 150MG 00172435770 IVAX PHARMACEUTICALS, INC. yRANITIDINE TAB 300MG 00172435846 IVAX PHARMACEUTICALS, INC. yRANITIDINE TAB 300MG 00172435860 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 25MG 00172435910 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 25MG 00172435960 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 25MG 00172435970 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 100MG 00172436010 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 100MG 00172436060 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 100MG 00172436070 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 00172436310 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 00172436360 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 00172436370 IVAX PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 00172436380 IVAX PHARMACEUTICALS, INC. yLABETALOL TAB 100MG 00172436460 IVAX PHARMACEUTICALS, INC. yLABETALOL TAB 100MG 00172436470 IVAX PHARMACEUTICALS, INC. yLABETALOL TAB 200MG 00172436560 IVAX PHARMACEUTICALS, INC. yLABETALOL TAB 200MG 00172436570 IVAX PHARMACEUTICALS, INC. yLABETALOL TAB 300MG 00172436660 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 100MG 00172438110 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 100MG 00172438160 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 100MG 00172438170 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 100MG 00172438184 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 300MG 00172438210 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 300MG 00172438260 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 300MG 00172438270 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 300MG 00172438288 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 400MG 00172438310 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 400MG 00172438360 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GABAPENTIN CAP 400MG 00172438370 IVAX PHARMACEUTICALS, INC. yGABAPENTIN CAP 400MG 00172438378 IVAX PHARMACEUTICALS, INC. yFLUVOXAMINE TAB 25MG 00172438960 IVAX PHARMACEUTICALS, INC. yALBUTEROL AER 90MCG 00172439018 IVAX PHARMACEUTICALS, INC. yFLUVOXAMINE TAB 50MG 00172439160 IVAX PHARMACEUTICALS, INC. yFLUVOXAMINE TAB 100MG 00172439260 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 50MG 00172440410 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 50MG 00172440460 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 50MG 00172440470 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 200MG 00172440510 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 200MG 00172440560 IVAX PHARMACEUTICALS, INC. yCLOZAPINE TAB 200MG 00172440570 IVAX PHARMACEUTICALS, INC. yMISOPROSTOL TAB 100MCG 00172443049 IVAX PHARMACEUTICALS, INC. yMISOPROSTOL TAB 100MCG 00172443059 IVAX PHARMACEUTICALS, INC. yMISOPROSTOL TAB 200MCG 00172443149 IVAX PHARMACEUTICALS, INC. yMISOPROSTOL TAB 200MCG 00172443160 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 1000MG 00172443210 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 1000MG 00172443260 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 1000MG 00172443270 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 1000MG 00172443280 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 00172443510 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 00172443560 IVAX PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 00172443570 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 100MG 00172444060 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 100MG 00172444070 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 300MG 00172444160 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 300MG 00172444170 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 400MG 00172444260 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 400MG 00172444270 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 600MG 00172444310 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 600MG 00172444360 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 600MG 00172444370 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 600MG 00172444380 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 800MG 00172444410 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 800MG 00172444460 IVAX PHARMACEUTICALS, INC. yGABAPENTIN TAB 800MG 00172444470 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUOXETINE TAB 10MG 00172451060 IVAX PHARMACEUTICALS, INC. yFLUOXETINE TAB 10MG 00172451070 IVAX PHARMACEUTICALS, INC. yFLUOXETINE TAB 10MG 00172451080 IVAX PHARMACEUTICALS, INC. yPERGOLIDE TAB 0.05MG 00172452060 IVAX PHARMACEUTICALS, INC. yPERGOLIDE TAB 0.25MG 00172452160 IVAX PHARMACEUTICALS, INC. yPERGOLIDE TAB 1MG 00172452260 IVAX PHARMACEUTICALS, INC. yDOXYCYCLINE TAB 20MG 00172462660 IVAX PHARMACEUTICALS, INC. yDOXYCYCLINE TAB 20MG 00172462670 IVAX PHARMACEUTICALS, INC. yCITALOPRAM TAB 40MG 00172474210 IVAX PHARMACEUTICALS, INC. yCITALOPRAM TAB 40MG 00172474260 IVAX PHARMACEUTICALS, INC. yCITALOPRAM TAB 40MG 00172474270 IVAX PHARMACEUTICALS, INC. yCITALOPRAM TAB 40MG 00172474285 IVAX PHARMACEUTICALS, INC. yCEFACLOR CAP 250MG 00172477060 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 125/5ML 00172477222 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 125/5ML 00172477223 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 187/5ML 00172477321 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 250/5ML 00172477422 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 250/5ML 00172477423 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 375/5ML 00172477520 IVAX PHARMACEUTICALS, INC. yCEFACLOR SUS 375/5ML 00172477521 IVAX PHARMACEUTICALS, INC. yOXAZEPAM CAP 10MG 00172480460 IVAX PHARMACEUTICALS, INC. yOXAZEPAM CAP 10MG 00172480470 IVAX PHARMACEUTICALS, INC. yOXAZEPAM CAP 15MG 00172480560 IVAX PHARMACEUTICALS, INC. yOXAZEPAM CAP 15MG 00172480570 IVAX PHARMACEUTICALS, INC. yOXAZEPAM CAP 30MG 00172480660 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00172487010 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00172487060 IVAX PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00172487080 IVAX PHARMACEUTICALS, INC. yFLUTAMIDE CAP 125MG 00172496058 IVAX PHARMACEUTICALS, INC. yFLUTAMIDE CAP 125MG 00172496070 IVAX PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00172498060 IVAX PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00172498070 IVAX PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00172498080 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-25MG 00172503210 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-25MG 00172503260 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-25MG 00172503270 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOP/HCTZ TAB 10-12.5 00172503310 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 10-12.5 00172503360 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 10-12.5 00172503370 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-12.5 00172503410 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-12.5 00172503460 IVAX PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-12.5 00172503470 IVAX PHARMACEUTICALS, INC. yANAGRELIDE CAP 1MG 00172524060 IVAX PHARMACEUTICALS, INC. yANAGRELIDE CAP 0.5MG 00172524160 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 250MG 00172531110 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 250MG 00172531160 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 500MG 00172531210 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 500MG 00172531260 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 500MG 00172531270 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 750MG 00172531310 IVAX PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 750MG 00172531360 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 5MG 00172535060 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 5MG 00172535070 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 00172535110 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 00172535160 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 00172535170 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 00172535180 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 00172535210 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 00172535260 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 00172535270 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 00172535280 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 00172535310 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 00172535360 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 00172535370 IVAX PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 00172535380 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 5-6.25 00172536060 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 10-12.5 00172536160 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 10-12.5 00172536170 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-12.5 00172536260 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-12.5 00172536270 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-25MG 00172536360 IVAX PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-25MG 00172536370 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUCONAZOLE TAB 50MG 00172541010 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 50MG 00172541046 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 50MG 00172541060 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 100MG 00172541110 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 100MG 00172541146 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 100MG 00172541160 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 150MG 00172541211 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 200MG 00172541310 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 200MG 00172541346 IVAX PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 200MG 00172541360 IVAX PHARMACEUTICALS, INC. yCLARITHROMYC TAB 250MG 00172544549 IVAX PHARMACEUTICALS, INC. yCLARITHROMYC TAB 250MG 00172544570 IVAX PHARMACEUTICALS, INC. yCLARITHROMYC TAB 500MG 00172544649 IVAX PHARMACEUTICALS, INC. yCLARITHROMYC TAB 500MG 00172544670 IVAX PHARMACEUTICALS, INC. yNIZATIDINE CAP 150MG 00172562310 IVAX PHARMACEUTICALS, INC. yNIZATIDINE CAP 150MG 00172562360 IVAX PHARMACEUTICALS, INC. yNIZATIDINE CAP 150MG 00172562370 IVAX PHARMACEUTICALS, INC. yNIZATIDINE CAP 300MG 00172562460 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 00172565649 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 00172565658 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 00172565670 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 00172565680 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00172565746 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00172565755 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00172565760 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00172565770 IVAX PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00172565780 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 00172566310 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 00172566360 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 00172566370 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 00172566410 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 00172566460 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 00172566470 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 00172566560 IVAX PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 00172566570 IVAX PHARMACEUTICALS, INC. ySERTRALINE TAB 25MG 00172567210 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SERTRALINE TAB 25MG 00172567280 IVAX PHARMACEUTICALS, INC. ySERTRALINE TAB 50MG 00172567310 IVAX PHARMACEUTICALS, INC. ySERTRALINE TAB 100MG 00172567410 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 15MG 00172567510 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 15MG 00172567546 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 15MG 00172567570 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 30MG 00172567610 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 30MG 00172567646 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 30MG 00172567670 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 45MG 00172569510 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 45MG 00172569546 IVAX PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 45MG 00172569570 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 1.25/250 00172571010 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 1.25/250 00172571060 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 1.25/250 00172571070 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 1.25/250 00172571084 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 5/500MG 00172571210 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 5/500MG 00172571260 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 5/500MG 00172571270 IVAX PHARMACEUTICALS, INC. yGLYB/METFORM TAB 5/500MG 00172571288 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00172572810 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00172572860 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00172572864 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00172572870 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00172572880 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 40MG 00172572910 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 40MG 00172572960 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 40MG 00172572970 IVAX PHARMACEUTICALS, INC. yFAMOTIDINE TAB 40MG 00172572993 IVAX PHARMACEUTICALS, INC. yTIZANIDINE TAB 2MG 00172573529 IVAX PHARMACEUTICALS, INC. yTIZANIDINE TAB 2MG 00172573570 IVAX PHARMACEUTICALS, INC. yTIZANIDINE TAB 4MG 00172573629 IVAX PHARMACEUTICALS, INC. yTIZANIDINE TAB 4MG 00172573670 IVAX PHARMACEUTICALS, INC. yCILOSTAZOL TAB 100MG 00172584110 IVAX PHARMACEUTICALS, INC. yCILOSTAZOL TAB 100MG 00172584149 IVAX PHARMACEUTICALS, INC. yCILOSTAZOL TAB 100MG 00172584170 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

330 of 774

OXYCODONE TAB 10MG CR 00172635460 IVAX PHARMACEUTICALS, INC. yOXYCODONE TAB 20MG CR 00172635560 IVAX PHARMACEUTICALS, INC. yOXYCODONE TAB 40MG CR 00172635660 IVAX PHARMACEUTICALS, INC. yOXYCODONE TAB 80MG CR 00172635760 IVAX PHARMACEUTICALS, INC. yALBUTEROL NEB 0.083% 00172640544 IVAX PHARMACEUTICALS, INC. yALBUTEROL NEB 0.083% 00172640549 IVAX PHARMACEUTICALS, INC. yCROMOLYN SOD NEB 20MG/2ML 00172640649 IVAX PHARMACEUTICALS, INC. yCROMOLYN SOD NEB 20MG/2ML 00172640659 IVAX PHARMACEUTICALS, INC. yIPRATROPIUM SOL INHAL 00172640744 IVAX PHARMACEUTICALS, INC. yIPRATROPIUM SOL INHAL 00172640749 IVAX PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 00172651510 IVAX PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 00172651560 IVAX PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 00172651570 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 00172711760 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 00172711770 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 00172717149 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 00172717160 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 00172717170 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 00172717180 IVAX PHARMACEUTICALS, INC. yCYCLOSPORINE CAP MOD 25MG 00172731046 IVAX PHARMACEUTICALS, INC. yCYCLOSPORINE CAP MOD 50MG 00172731146 IVAX PHARMACEUTICALS, INC. yCYCLOSPORINE CAP MD 100MG 00172731246 IVAX PHARMACEUTICALS, INC. yCYCLOSPORINE SOL MODIFIED 00172731320 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV CHW 200MG 00172740128 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV CHW 400MG 00172740228 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 500MG 00172740310 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 500MG 00172740342 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 00172740520 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 00172740521 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 00172740522 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 00172740620 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 00172740621 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 00172740622 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 600/5ML 00172740814 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 600/5ML 00172740822 IVAX PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 600/5ML 00172740826 IVAX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMOXICILLIN TAB 875MG 00172741142 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN TAB 875MG 00172741160 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN TAB 875MG 00172741170 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN CAP 500MG 00172741470 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN CHW 400MG 00172741642 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN CHW 400MG 00172741660 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 125/5ML 00172741723 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 00172741821 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 00172741823 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 200/5ML 00172741921 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 400/5ML 00172742020 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 400/5ML 00172742021 IVAX PHARMACEUTICALS, INC. yAMOXICILLIN SUS 400/5ML 00172742022 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 00172771146 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 00172771160 IVAX PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 00172771165 IVAX PHARMACEUTICALS, INC. yEQ HEARTBURN TAB RELIEF 00172850049 IVAX PHARMACEUTICALS, INC. yEQ TUSSIN CAP CLD/CONG 00172855311 IVAX PHARMACEUTICALS, INC. yDAPSONE TAB 100MG 49938010101 JACOBUS PHARMACEUTICALS CO INC. yDAPSONE TAB 25MG 49938010201 JACOBUS PHARMACEUTICALS CO INC. yPASER GRA 4GM 49938010704 JACOBUS PHARMACEUTICALS CO INC. yDURAGESIC DIS 25MCG/HR 50458003305 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yDURAGESIC DIS 50MCG/HR 50458003405 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yDURAGESIC DIS 75MCG/HR 50458003505 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yDURAGESIC DIS 100MCG/H 50458003605 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yDURAGESIC DIS 12(12.5) 50458003705 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yNIZORAL TAB 200MG 50458022010 JANSSEN PHARMACEUTICA PRODUCTS, L.P. ySPORANOX CAP 100MG 50458029001 JANSSEN PHARMACEUTICA PRODUCTS, L.P. ySPORANOX CAP 100MG 50458029004 JANSSEN PHARMACEUTICA PRODUCTS, L.P. ySPORANOX CAP PULSEPAK 50458029028 JANSSEN PHARMACEUTICA PRODUCTS, L.P. ySPORANOX SOL 10MG/ML 50458029515 JANSSEN PHARMACEUTICA PRODUCTS, L.P. ySPORANOX KIT 250MG 50458029801 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 1MG 50458030001 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 1MG 50458030006 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 1MG 50458030050 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 0.25MG 50458030101 JANSSEN PHARMACEUTICA PRODUCTS, L.P. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RISPERDAL TAB 0.25MG 50458030104 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 0.25MG 50458030150 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 0.5MG 50458030201 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 0.5MG 50458030206 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 0.5MG 50458030250 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL SOL 1MG/ML 50458030503 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL INJ 25MG 50458030611 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL INJ 37.5MG 50458030711 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL INJ 50MG 50458030811 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 1MG 50458031528 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 1MG 50458031530 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 2MG 50458032001 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 2MG 50458032006 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 2MG 50458032050 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 2MG 50458032528 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 3MG 50458033001 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 3MG 50458033006 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 3MG 50458033050 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 3MG 50458033528 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 4MG 50458035001 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL TAB 4MG 50458035006 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 4MG 50458035528 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE ER CAP 8MG 50458038730 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE ER CAP 16MG 50458038830 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE ER CAP 24MG 50458038930 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yREMINYL TAB 4MG 50458039060 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yREMINYL TAB 8MG 50458039160 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yREMINYL TAB 12MG 50458039260 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 0.5MG 50458039528 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRISPERDAL M TAB 0.5MG 50458039530 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE TAB 4MG 50458039660 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE TAB 8MG 50458039760 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE TAB 12MG 50458039860 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yREMINYL SOL 4MG/ML 50458039910 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yRAZADYNE SOL 4MG/ML 50458049010 JANSSEN PHARMACEUTICA PRODUCTS, L.P. yJ-MAX TAB 64661001001 JAYMAC PHARMACEUTICALS, LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

333 of 774

J-MAX SYP 64661001116 JAYMAC PHARMACEUTICALS, LLC yJ-TAN SUS 64661002016 JAYMAC PHARMACEUTICALS, LLC yJ-TAN D SUS 64661002216 JAYMAC PHARMACEUTICALS, LLC yJAY-PHYL SYP 64661081416 JAYMAC PHARMACEUTICALS, LLC yPEXEVA TAB 10MG 68968201001 JDS PHARMACEUTICALS, LLC yPEXEVA TAB 20MG 68968202001 JDS PHARMACEUTICALS, LLC yLITHOBID TAB 300MG CR 68968449201 JDS PHARMACEUTICALS, LLC yPREVACARE CRE PER/PRO 56091052002 JOHNSON & JOHNSON MEDICAL yPREVACARE OIN XTR PRO 56091053002 JOHNSON & JOHNSON MEDICAL yPREVACARE SPR SKIN CAR 56091055008 JOHNSON & JOHNSON MEDICAL yPEPCID CHW COMPLETE 16837029102 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029105 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029108 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029115 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029121 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029125 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029150 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029152 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029153 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837029165 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA GAS CHW 125MG 16837045524 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS 16837061012 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS 16837061024 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS 16837061055 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA GAS CAP 125MG MS 16837061124 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS CH CREME 16837062112 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS CH CREME 16837062124 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA DS SUS 16837062212 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA DS SUS 16837062412 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS MINT 16837062912 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837063003 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837063005 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837063006 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS ULTIMATE 16837064312 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS ULTIMATE 16837064412 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA DS SUS 16837065212 JOHNSON AND JOHNSON MERCK CONSUMER PHAR y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

334 of 774

MYLANTA DS SUS 16837065224 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA CHW 400MG 16837081024 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS SUPREME 16837082512 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS SUPREME 16837082524 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA SUS SUPREME 16837082536 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA ULTR CHW MINT 16837084909 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA ULTR CHW MINT 16837084935 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA ULTR CHW MINT 16837084970 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA TAB 16837085024 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA TAB 16837085050 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 20MG 16837085505 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 20MG 16837085508 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 20MG 16837085525 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 20MG 16837085550 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 20MG 16837085565 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 20MG 16837085575 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837085606 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837085660 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837085661 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837085690 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA GAS CHW 80MG 16837085810 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yALTERNAGEL SUS 600/5ML 16837086012 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA GAS CHW 125MG 16837086124 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLANTA ULTR CHW CHERRY 16837086970 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087206 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087212 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087218 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087230 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087231 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087260 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087290 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC TAB 10MG 16837087292 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC CHW 10MG 16837087306 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC CHW 10MG 16837087330 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID AC CHW 10MG 16837087361 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837088805 JOHNSON AND JOHNSON MERCK CONSUMER PHAR y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

335 of 774

PEPCID CHW COMPLETE 16837088811 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837088815 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837088825 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837088838 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837088850 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yPEPCID CHW COMPLETE 16837088875 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837091103 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837091105 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837091107 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yMYLICON DRO 40/0.6ML 16837091113 JOHNSON AND JOHNSON MERCK CONSUMER PHAR yENDAGEN-HD SYP 5-2-1.67 52604020006 JONES PHARMA, INCORPORATED yOTOCAIN SOL 20% OTIC 52604021805 JONES PHARMA, INCORPORATED yVANEX-HD SYP 5-2-1.67 52604030006 JONES PHARMA, INCORPORATED yLEVOXYL TAB 25MCG 52604502501 JONES PHARMA, INCORPORATED yLEVOXYL TAB 25MCG 52604502502 JONES PHARMA, INCORPORATED yLEVOXYL TAB 50MCG 52604505001 JONES PHARMA, INCORPORATED yLEVOXYL TAB 50MCG 52604505002 JONES PHARMA, INCORPORATED yLEVOXYL TAB 75MCG 52604507501 JONES PHARMA, INCORPORATED yLEVOXYL TAB 75MCG 52604507502 JONES PHARMA, INCORPORATED yLEVOXYL TAB 88MCG 52604508801 JONES PHARMA, INCORPORATED yLEVOXYL TAB 88MCG 52604508802 JONES PHARMA, INCORPORATED yLEVOXYL TAB 100MCG 52604510001 JONES PHARMA, INCORPORATED yLEVOXYL TAB 100MCG 52604510002 JONES PHARMA, INCORPORATED yLEVOXYL TAB 112MCG 52604511201 JONES PHARMA, INCORPORATED yLEVOXYL TAB 112MCG 52604511202 JONES PHARMA, INCORPORATED yLEVOXYL TAB 125MCG 52604512501 JONES PHARMA, INCORPORATED yLEVOXYL TAB 125MCG 52604512502 JONES PHARMA, INCORPORATED yLEVOXYL TAB 137MCG 52604513701 JONES PHARMA, INCORPORATED yLEVOXYL TAB 137MCG 52604513702 JONES PHARMA, INCORPORATED yLEVOXYL TAB 150MCG 52604515001 JONES PHARMA, INCORPORATED yLEVOXYL TAB 150MCG 52604515002 JONES PHARMA, INCORPORATED yLEVOXYL TAB 175MCG 52604517501 JONES PHARMA, INCORPORATED yLEVOXYL TAB 175MCG 52604517502 JONES PHARMA, INCORPORATED yLEVOXYL TAB 200MCG 52604520001 JONES PHARMA, INCORPORATED yLEVOXYL TAB 200MCG 52604520002 JONES PHARMA, INCORPORATED yTRIOSTAT INJ 10MCG/ML 52604521006 JONES PHARMA, INCORPORATED y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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THROMBIN-JMI SOL 5000UNIT 52604710201 JONES PHARMA, INCORPORATED yTHROMBIN-JMI KIT 20000UNT 52604710502 JONES PHARMA, INCORPORATED yTHROMBIN-JMI SOL 20000UNT 52604710503 JONES PHARMA, INCORPORATED yTHROMBIN-JMI KIT 20000UNT 52604735502 JONES PHARMA, INCORPORATED yACLARO EMU 68712000301 JSJ PHARMACEUTICALS yUMECTA EMU 68712000401 JSJ PHARMACEUTICALS yUMECTA EMU 68712000403 JSJ PHARMACEUTICALS yUMECTA SUS 40% 68712000501 JSJ PHARMACEUTICALS yKURIC CRE 2% 68712000601 JSJ PHARMACEUTICALS yKURIC CRE 2% 68712000603 JSJ PHARMACEUTICALS yBIONECT CRE 0.2% 68712000702 JSJ PHARMACEUTICALS yBIONECT GEL 0.2% 68712000802 JSJ PHARMACEUTICALS yUMECTA NAIL SUS 40% 68712001001 JSJ PHARMACEUTICALS yTEXACORT SOL 2.5% 68712001101 JSJ PHARMACEUTICALS yINOVA PAD 4% 68712001301 JSJ PHARMACEUTICALS yINOVA 4/1 PAD ACNE CON 68712001401 JSJ PHARMACEUTICALS yMETHYLPRED PAK 4MG 59746000103 JUBILANT PHARMA, INC. (formerly Trigen) yMETHYLPRED PAK 4MG 59746000106 JUBILANT PHARMA, INC. (formerly Trigen) yMETHYLPRED PAK 4MG 59746000109 JUBILANT PHARMA, INC. (formerly Trigen) yFOLIC ACID TAB 1MG 59746001210 JUBILANT PHARMA, INC. (formerly Trigen) yPROCHLORPER TAB 5MG 59746011306 JUBILANT PHARMA, INC. (formerly Trigen) yPROCHLORPER TAB 5MG 59746011310 JUBILANT PHARMA, INC. (formerly Trigen) yPROCHLORPER TAB 10MG 59746011506 JUBILANT PHARMA, INC. (formerly Trigen) yPROCHLORPER TAB 10MG 59746011510 JUBILANT PHARMA, INC. (formerly Trigen) yPREDNISONE TAB 1MG 59746017106 JUBILANT PHARMA, INC. (formerly Trigen) yPREDNISONE TAB 1MG 59746017110 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 1MG 59746038306 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 1MG 59746038309 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 1MG 59746038310 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 2MG 59746038406 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 2MG 59746038409 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 2MG 59746038410 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 5MG 59746038506 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 5MG 59746038509 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 5MG 59746038510 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 10MG 59746038606 JUBILANT PHARMA, INC. (formerly Trigen) y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TERAZOSIN CAP 10MG 59746038609 JUBILANT PHARMA, INC. (formerly Trigen) yTERAZOSIN CAP 10MG 59746038610 JUBILANT PHARMA, INC. (formerly Trigen) yINTAL NEB 20MG/2ML 60793001012 KING PHARMACEUTICALS, INC. yINTAL NEB 20MG/2ML 60793001060 KING PHARMACEUTICALS, INC. yINTAL INH AER 800MCG 60793001108 KING PHARMACEUTICALS, INC. yINTAL INH AER 800MCG 60793001114 KING PHARMACEUTICALS, INC. yTAPAZOLE TAB 5MG 60793010401 KING PHARMACEUTICALS, INC. yTAPAZOLE TAB 10MG 60793010501 KING PHARMACEUTICALS, INC. yCYTOMEL TAB 5MCG 60793011501 KING PHARMACEUTICALS, INC. yCYTOMEL TAB 25MCG 60793011601 KING PHARMACEUTICALS, INC. yCYTOMEL TAB 50MCG 60793011701 KING PHARMACEUTICALS, INC. yTILADE AER 1.75/ACT 60793012001 KING PHARMACEUTICALS, INC. ySKELAXIN TAB 800MG 60793013601 KING PHARMACEUTICALS, INC. ySKELAXIN TAB 800MG 60793013605 KING PHARMACEUTICALS, INC. ySONATA CAP 5MG 60793014501 KING PHARMACEUTICALS, INC. ySONATA CAP 10MG 60793014601 KING PHARMACEUTICALS, INC. ySONATA CAP 10MG 60793014656 KING PHARMACEUTICALS, INC. yCORZIDE TAB 40/5 60793028301 KING PHARMACEUTICALS, INC. yCORZIDE TAB 80/5 60793028401 KING PHARMACEUTICALS, INC. yBICILLIN L-A INJ 600000 60793070010 KING PHARMACEUTICALS, INC. yBICILLIN L-A INJ 1200000 60793070110 KING PHARMACEUTICALS, INC. yBICILLIN L-A INJ 2400000 60793070210 KING PHARMACEUTICALS, INC. yKONSYL FIBER TAB 625MG 00224050090 KONSYL PHARMACEUTICALS, INC. yKONSYL POW 100% 00224180106 KONSYL PHARMACEUTICALS, INC. yKONSYL POW 100% 00224180107 KONSYL PHARMACEUTICALS, INC. yKONSYL POW 100% 00224180111 KONSYL PHARMACEUTICALS, INC. yKONSYL POW 100% 00224180124 KONSYL PHARMACEUTICALS, INC. yKONSYL POW 100% 00224180135 KONSYL PHARMACEUTICALS, INC. yKONSYL-D POW 50% 00224182203 KONSYL PHARMACEUTICALS, INC. yKONSYL-D POW 50% 00224182206 KONSYL PHARMACEUTICALS, INC. yKONSYL-D POW 50% 00224182207 KONSYL PHARMACEUTICALS, INC. yKONSYL-D POW 50% 00224182211 KONSYL PHARMACEUTICALS, INC. yKONSYL-D POW 50% 00224182224 KONSYL PHARMACEUTICALS, INC. yKONSYL POW SF ORANG 00224183807 KONSYL PHARMACEUTICALS, INC. yKONSYL-ORANG POW 28% 00224185206 KONSYL PHARMACEUTICALS, INC. yKONSYL-ORANG POW 28% 00224185213 KONSYL PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NIASPAN TAB 500MG ER 60598000101 KOS PHARMACEUTICALS, INC. yNIASPAN TAB 750MG ER 60598000201 KOS PHARMACEUTICALS, INC. yNIASPAN TAB 1000 ER 60598000301 KOS PHARMACEUTICALS, INC. yADVICOR TAB 500-20MG 60598000690 KOS PHARMACEUTICALS, INC. yADVICOR TAB 1000-20 60598000890 KOS PHARMACEUTICALS, INC. yADVICOR TAB 1000-40 60598000990 KOS PHARMACEUTICALS, INC. yAZMACORT AER 100MCG 60598006160 KOS PHARMACEUTICALS, INC. yHYOSCYAMINE TAB 0.125MG 62175010101 KREMERS URBAN, INC. yHYOSCYAMINE SUB 0.125MG 62175010201 KREMERS URBAN, INC. yHYOSCYAMINE ELX 0.125/5 62175010416 KREMERS URBAN, INC. yHYOSCYAMINE DRO 0.125/ML 62175010515 KREMERS URBAN, INC. yISOSORB MONO TAB 10MG 62175010601 KREMERS URBAN, INC. yISOSORB MONO TAB 20MG 62175010701 KREMERS URBAN, INC. yHYOSCYAMINE TAB 0.375 ER 62175010801 KREMERS URBAN, INC. yOMEPRAZOLE CAP 10MG 62175011432 KREMERS URBAN, INC. yOMEPRAZOLE CAP 20MG 62175011832 KREMERS URBAN, INC. yOMEPRAZOLE CAP 20MG 62175011837 KREMERS URBAN, INC. yOMEPRAZOLE CAP 20MG 62175011841 KREMERS URBAN, INC. yOMEPRAZOLE CAP 20MG 62175011843 KREMERS URBAN, INC. yISOSORB MONO TAB 60MG ER 62175011937 KREMERS URBAN, INC. yNITROGLYCER DIS 0.2MG/HR 62175012301 KREMERS URBAN, INC. yNITROGLYCER DIS 0.4MG/HR 62175012401 KREMERS URBAN, INC. yISOSORB MONO TAB 30MG ER 62175012837 KREMERS URBAN, INC. yISOSORB MONO TAB 120MG ER 62175012937 KREMERS URBAN, INC. yNIFEDIPINE TAB 30MG ER 62175026037 KREMERS URBAN, INC. yNIFEDIPINE TAB 30MG ER 62175026043 KREMERS URBAN, INC. yNIFEDIPINE TAB 30MG ER 62175026055 KREMERS URBAN, INC. yNIFEDIPINE TAB 60MG ER 62175026137 KREMERS URBAN, INC. yNIFEDIPINE TAB 60MG ER 62175026143 KREMERS URBAN, INC. yNIFEDIPINE TAB 60MG ER 62175026155 KREMERS URBAN, INC. yGLYCOLAX POW 3350 NF 62175044214 KREMERS URBAN, INC. yGLYCOLAX POW 3350 NF 62175044215 KREMERS URBAN, INC. yGLYCOLAX POW 3350 NF 62175044231 KREMERS URBAN, INC. yPEG 3350 SOL ELECTROL 62175044601 KREMERS URBAN, INC. yDICYCLOMINE CAP 10MG 00527058601 LANNETT COMPANY, INC. yDICYCLOMINE CAP 10MG 00527058605 LANNETT COMPANY, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DICYCLOMINE CAP 10MG 00527058610 LANNETT COMPANY, INC. yACETAZOLAMID TAB 250MG 00527105001 LANNETT COMPANY, INC. yACETAZOLAMID TAB 250MG 00527105010 LANNETT COMPANY, INC. ySOD CHLORIDE TAB 1GM 00527111610 LANNETT COMPANY, INC. yMETHOCARBAM TAB 750MG 00527115201 LANNETT COMPANY, INC. yMETHOCARBAM TAB 750MG 00527115205 LANNETT COMPANY, INC. yLOFENE TAB 2.5MG 00527117001 LANNETT COMPANY, INC. yLOFENE TAB 2.5MG 00527117010 LANNETT COMPANY, INC. yPRIMIDONE TAB 250MG 00527123101 LANNETT COMPANY, INC. yPRIMIDONE TAB 250MG 00527123105 LANNETT COMPANY, INC. yPRIMIDONE TAB 250MG 00527123110 LANNETT COMPANY, INC. yDICYCLOMINE TAB 20MG 00527128201 LANNETT COMPANY, INC. yDICYCLOMINE TAB 20MG 00527128205 LANNETT COMPANY, INC. yDICYCLOMINE TAB 20MG 00527128210 LANNETT COMPANY, INC. yPRIMIDONE TAB 50MG 00527130101 LANNETT COMPANY, INC. yPRIMIDONE TAB 50MG 00527130105 LANNETT COMPANY, INC. yMETHOCARBAM TAB 500MG 00527130201 LANNETT COMPANY, INC. yMETHOCARBAM TAB 500MG 00527130205 LANNETT COMPANY, INC. yTERBUTALINE TAB 5MG 00527131101 LANNETT COMPANY, INC. yTERBUTALINE TAB 5MG 00527131110 LANNETT COMPANY, INC. yBUT/ASA/CAF/ CAP COD 30MG 00527131201 LANNETT COMPANY, INC. yPILOCARPINE TAB 5MG 00527131301 LANNETT COMPANY, INC. yPHENTERMINE TAB 37.5MG 00527131701 LANNETT COMPANY, INC. yTERBUTALINE TAB 2.5MG 00527131801 LANNETT COMPANY, INC. yTERBUTALINE TAB 2.5MG 00527131810 LANNETT COMPANY, INC. yDIGOXIN TAB 0.125MG 00527132401 LANNETT COMPANY, INC. yDIGOXIN TAB 0.125MG 00527132410 LANNETT COMPANY, INC. yDIGOXIN TAB 0.25MG 00527132501 LANNETT COMPANY, INC. yDIGOXIN TAB 0.25MG 00527132510 LANNETT COMPANY, INC. yDOXYCYC MONO TAB 50MG 00527133501 LANNETT COMPANY, INC. yDOXYCYCLINE TAB 20MG 00527133601 LANNETT COMPANY, INC. yBACLOFEN TAB 20MG 00527133701 LANNETT COMPANY, INC. yDOXYCYC MONO TAB 100MG 00527133825 LANNETT COMPANY, INC. yDOXYCYC MONO TAB 100MG 00527133850 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 25MCG 00527134101 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 25MCG 00527134110 LANNETT COMPANY, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LEVOTHYROXIN TAB 50MCG 00527134201 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 50MCG 00527134210 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 75MCG 00527134301 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 75MCG 00527134310 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 88MCG 00527134401 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 88MCG 00527134410 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 100MCG 00527134501 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 100MCG 00527134510 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 112MCG 00527134601 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 112MCG 00527134610 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 125MCG 00527134701 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 125MCG 00527134710 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 150MCG 00527134901 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 150MCG 00527134910 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 175MCG 00527135001 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 175MCG 00527135010 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 200MCG 00527135101 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 200MCG 00527135110 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 300MCG 00527135201 LANNETT COMPANY, INC. yLEVOTHYROXIN TAB 300MCG 00527135210 LANNETT COMPANY, INC. yHYDROMORPHON TAB 2MG 00527135301 LANNETT COMPANY, INC. yHYDROMORPHON TAB 4MG 00527135401 LANNETT COMPANY, INC. yPROBENECID TAB 500MG 00527136701 LANNETT COMPANY, INC. yPROBENECID TAB 500MG 00527136710 LANNETT COMPANY, INC. yDANAZOL CAP 200MG 00527136901 LANNETT COMPANY, INC. yDANAZOL CAP 200MG 00527136906 LANNETT COMPANY, INC. yUNITHROID TAB 25MCG 00527137001 LANNETT COMPANY, INC. yUNITHROID TAB 50MCG 00527137101 LANNETT COMPANY, INC. yUNITHROID TAB 75MCG 00527137201 LANNETT COMPANY, INC. yUNITHROID TAB 88MCG 00527137301 LANNETT COMPANY, INC. yUNITHROID TAB 100MCG 00527137401 LANNETT COMPANY, INC. yUNITHROID TAB 112MCG 00527137501 LANNETT COMPANY, INC. yUNITHROID TAB 125MCG 00527137601 LANNETT COMPANY, INC. yUNITHROID TAB 150MCG 00527137701 LANNETT COMPANY, INC. yUNITHROID TAB 175MCG 00527137801 LANNETT COMPANY, INC. yUNITHROID TAB 200MCG 00527137901 LANNETT COMPANY, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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UNITHROID TAB 300MCG 00527138001 LANNETT COMPANY, INC. yCLINDAMYCIN CAP 150MG 00527138201 LANNETT COMPANY, INC. yCLINDAMYCIN CAP 300MG 00527138301 LANNETT COMPANY, INC. yCLINDAMYCIN CAP 300MG 00527138302 LANNETT COMPANY, INC. yCIPROFLOXACN TAB 500MG 00527138501 LANNETT COMPANY, INC. yMETHYLTESTOS TAB 2.5-1.25 00527140901 LANNETT COMPANY, INC. yMETHYLTESTOS TAB 00527141001 LANNETT COMPANY, INC. yMETHYLTESTOS TAB 00527141010 LANNETT COMPANY, INC. yBUFFERED TAB SALT 00527141701 LANNETT COMPANY, INC. yMORPHINE SUL SOL 20MG/ML 00527142536 LANNETT COMPANY, INC. yMORPHINE SUL SOL 20MG/ML 00527142562 LANNETT COMPANY, INC. yMORPHINE SUL SOL 20MG/ML 00527142563 LANNETT COMPANY, INC. yOXYCODONE CON 20MG/ML 00527142636 LANNETT COMPANY, INC. ySMZ-TMP TAB 400-80MG 00527144201 LANNETT COMPANY, INC. ySMZ/TMP DS TAB 800-160 00527144301 LANNETT COMPANY, INC. ySMZ/TMP DS TAB 800-160 00527144305 LANNETT COMPANY, INC. yBUT/ASA/CAFF CAP 00527155201 LANNETT COMPANY, INC. yEXECOF TAB 68047017001 LARKEN LABORATORIES, INC. yDROTUSS LIQ 68047019016 LARKEN LABORATORIES, INC. yDROTUSS-CP LIQ 68047019116 LARKEN LABORATORIES, INC. yEXECLEAR SYP 3.5-100 68047022016 LARKEN LABORATORIES, INC. yMYHIST-DM LIQ 68047023016 LARKEN LABORATORIES, INC. yMYHIST-PD LIQ 68047023316 LARKEN LABORATORIES, INC. yPD-HIST D SYP 4-12.5MG 68047031016 LARKEN LABORATORIES, INC. yPD-HIST D DRO 68047031030 LARKEN LABORATORIES, INC. yPD-COF SYP 68047031116 LARKEN LABORATORIES, INC. yPD-COF DRO 68047031130 LARKEN LABORATORIES, INC. yDONATUSSIN SUS DM 16477013001 LASER PHARMACEUTICALS, LLC yNEO DM SUS 16477056001 LASER PHARMACEUTICALS, LLC yNEO DM DRO 16477062030 LASER PHARMACEUTICALS, LLC yPEDIA RELIEF LIQ CGH/COLD 37205000326 LEADER yACETAMIN DRO 100MG/ML 37205000805 LEADER yACID REDUCER TAB 10MG 37205001465 LEADER yACID REDUCER TAB 10MG 37205001489 LEADER yPAIN RELIEVE TAB 500MG 37205002071 LEADER yPAIN RELIEVE TAB 500MG 37205002078 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAIN RELIEVE TAB 500MG 37205002090 LEADER yEYE WASH SOL 37205002326 LEADER yPAIN RELIEVE TAB 500MG 37205002571 LEADER yPAIN RELIEVE TAB 500MG 37205002578 LEADER yCOLD/COUGH CAP 30-10-20 37205002753 LEADER yREADY-TO-USE ENE COMPLETE 37205003011 LEADER yREADY-TO-USE ENE COMPLETE 37205003036 LEADER yPAIN RELIEVE TAB 325MG 37205003178 LEADER yARTH PAIN RE TAB 650MG 37205003471 LEADER yARTH PAIN RE TAB 650MG 37205003478 LEADER yPAIN RELIEVE TAB 500MG 37205003572 LEADER yPAIN RELIEVE TAB 500MG 37205003578 LEADER yTRIACTING LIQ NITE TIM 37205004226 LEADER yPAIN RELIEVE TAB PM X-STR 37205006071 LEADER yPAIN RELIEVE TAB PM X-STR 37205006078 LEADER yPAIN RELIEVE TAB PM X-STR 37205006171 LEADER yNASAL SPR 0.05% 37205006710 LEADER yMULTI-SYMPTO CAP COLD/CGH 37205008552 LEADER yHYDROCORT CRE 0.5% 37205010110 LEADER yBISACODYL SUP 10MG 37205010253 LEADER yMAGN CITRATE SOL 37205011038 LEADER yMOTION SICK TAB 50MG 37205011153 LEADER yGAS RELIEF CHW 80MG 37205011278 LEADER yDAIRY DIGEST TAB 3000UNIT 37205011372 LEADER yDAIRY DIGEST TAB ULTRA 37205011472 LEADER ySIMETHICONE DRO 40/0.6ML 37205011910 LEADER ySLEEP AID CAP 50MG 37205012073 LEADER ySLEEP AID TAB 25MG 37205012164 LEADER yANTACID CHW FRUIT 37205012347 LEADER yANTACID CHW REGULAR 37205012447 LEADER yBISACODYL TAB 5MG EC 37205012863 LEADER yCALDYPHEN LOT 37205013030 LEADER yDRY EYES OIN OP 37205013479 LEADER yARTIFICIAL SOL TEARS 37205013705 LEADER yEYE DROPS SOL A/R 37205013805 LEADER yEYE DROPS SOL 0.05% OP 37205013905 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ASPIRIN TAB 325MG 37205014578 LEADER yASPIRIN TAB 325MG 37205014587 LEADER yBUFFERED ASA TAB 325MG 37205015078 LEADER yCLOTRIMAZOLE CRE 1% 37205016010 LEADER yHYDROCORT OIN 1% 37205016110 LEADER yHYDROCORT CRE 1% 37205016210 LEADER yLICE KILLING SHA 37205016526 LEADER yLICE CONTROL AER 0.5% 37205016628 LEADER yIPECAC SYP 37205016910 LEADER yCAPSAICIN CRE 0.025% 37205017316 LEADER yPAIN RELIEVE TAB 500MG 37205018771 LEADER yPAIN RELIEVE TAB 500MG 37205018778 LEADER yRESTFULLY SL TAB 25MG 37205019462 LEADER yALERTNESS AI TAB 200MG 37205019573 LEADER yPAIN RELIEF TAB EFFERVES 37205019668 LEADER yANTIFUNGAL CRE 1% 37205019710 LEADER yARTHRICREAM CRE 10% 37205019821 LEADER yIBU-PRO COLD TAB /SINUS 37205019960 LEADER yANTACID CHW 500MG 37205020047 LEADER yTRIACTING SYP COLD/ALL 37205020126 LEADER yNICOTINE GUM 2MG 37205020323 LEADER yNICOTINE GUM 2MG 37205020367 LEADER yNICOTINE GUM 2MG 37205020371 LEADER yNICOTINE GUM 2MG 37205020377 LEADER yNICOTINE GUM 4MG 37205020423 LEADER yNICOTINE GUM 4MG 37205020467 LEADER yNICOTINE GUM 4MG 37205020471 LEADER yNICOTINE GUM 4MG 37205020477 LEADER yANTACID X-ST CHW 750MG 37205020580 LEADER yTRIACTING CO LIQ 15-1-5MG 37205020626 LEADER yTRIAC EXPECT SYP 15/50 37205020826 LEADER yCOLD & COUGH ELX DM 37205020926 LEADER yANTACID CHW 500MG 37205021047 LEADER yTUSSIN CF LIQ 37205021226 LEADER yTUSSIN CF LIQ 37205021234 LEADER yFIBER LAXATI TAB 625MG 37205021375 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COLD & ALLER ELX 37205021426 LEADER yCOLD & ALLER ELX 37205021434 LEADER yALLERGY TAB 4MG 37205021562 LEADER yALLERGY TAB 4MG 37205021578 LEADER yPED ELCTRLYT SOL FRUIT 37205022008 LEADER yPED ELCTRLYT SOL GRAPE 37205022108 LEADER yPED ELCTRLYT SOL UNFLAVRD 37205022208 LEADER yEYE DROPS SOL 0.05% OP 37205022405 LEADER yALLERHIST-1 TAB 1.34MG 37205022873 LEADER ySENNA TAB 187MG 37205024178 LEADER yDAY-TIME CAP COLD/FLU 37205025053 LEADER ySENNA-PLUS TAB 8.6-50MG 37205025172 LEADER yANTI-ITCH GEL MAX ST 37205025326 LEADER yNAPROXEN SOD TAB 220MG 37205026171 LEADER yNAPROXEN SOD TAB 220MG 37205026178 LEADER yNAPROXEN SOD TAB 220MG 37205026271 LEADER yNAPROXEN SOD TAB 220MG 37205026278 LEADER ySTOOL SOFTEN CAP 100MG 37205026501 LEADER yTRIPLE ANTIB OIN XTRA MAX 37205026610 LEADER yCOLD & HOT CRE 37205026846 LEADER yHOT STEAM LIQ MEDICATI 37205026926 LEADER yCOMP ALLERGY TAB 25MG 37205027062 LEADER yCOMP ALLERGY TAB 25MG 37205027078 LEADER yANTI-ITCH CRE 1-1% 37205027110 LEADER yHYDROCORT/ CRE ALOE 1% 37205027210 LEADER yTRIPLE ANTIB OIN 37205027310 LEADER yBACITRACIN OIN 500/GM 37205027510 LEADER yCOMP ALLERGY CAP 25MG 37205027762 LEADER yCOMP ALLERGY CAP 25MG 37205027778 LEADER yALLERGY CRE 37205027810 LEADER yINVISIBLE CRE ACNE 10% 37205027910 LEADER yMIGRAINE TAB FORMULA 37205028062 LEADER yMIGRAINE TAB FORMULA 37205028078 LEADER yCALDYPHEN LOT CLEAR 37205028130 LEADER yCHLD IBUPROF SUS 100/5ML 37205028226 LEADER yCHLD IBUPROF SUS 100/5ML 37205028326 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LICE TREATMN LIQ CRM RNSE 37205028516 LEADER yLICE TREATMN LIQ CRM RNSE 37205028526 LEADER yANTI-NAUSEA SOL 37205029126 LEADER yGAS RELIEF CAP SOFTGELS 37205029272 LEADER yINF PAIN RLF DRO 15/160/5 37205029305 LEADER yLAXATIVE TAB 25MG 37205029462 LEADER yGAS RELIEF CAP 125MG XS 37205029565 LEADER yTIOCONAZOLE OIN -1 37205029603 LEADER yFEMININE LAX TAB 5MG EC 37205029865 LEADER yNATURAL VEG POW 33% 37205030127 LEADER yPINK BISMUTH SUS 262/15ML 37205030234 LEADER yPINK BISMUTH SUS 262/15ML 37205030240 LEADER yNATURAL VEG POW ORANGE 37205030327 LEADER y12 HR NASAL SPR 0.05% 37205030410 LEADER yORAL SALINE SOL LAXATIVE 37205030913 LEADER yANTACID SUS REG 37205031440 LEADER yGLYCERIN SUP 1.5GM 37205031763 LEADER yINF PAIN REL DRO 80/0.8ML 37205031905 LEADER yGLYCERIN SUP 3GM 37205032063 LEADER yCIMETIDINE TAB 200MG 37205032165 LEADER ySORE THROAT AER SPRAY 37205032630 LEADER ySORE THROAT AER SPRAY 37205032730 LEADER yFLU/COLD/CGH POW HOT MED 37205033091 LEADER yBACKACHE REL TAB EX ST 37205033262 LEADER yCAL ANTACID CHW ULTRA 37205033369 LEADER yNO DRIP NASL SPR 0.05% 37205033610 LEADER yPINK BISMUTH SUS 525/15ML 37205033734 LEADER yANTI-ITCH SPR 2% 37205033816 LEADER yMENSTRUAL TAB MAX ST 37205033962 LEADER yIBUPROFEN TAB 200MG 37205034171 LEADER yIBUPROFEN TAB 200MG 37205034178 LEADER yATHLETES POW FOOT 37205034321 LEADER yANTIFUNGAL AER 1% 37205034466 LEADER yIBUPROFEN TAB 200MG 37205034571 LEADER yIBUPROFEN TAB 200MG 37205034578 LEADER yLORATADINE TAB 10MG 37205034652 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LORATADINE TAB 10MG 37205034660 LEADER yLORATADINE TAB 10MG 37205034665 LEADER yLORATADINE TAB 10MG 37205034672 LEADER yLORATADINE TAB 10MG 37205034675 LEADER yNAT VEGETABL POW 33% ORAN 37205034727 LEADER yALLERGY RELF TAB D-24 37205034852 LEADER yALLERGY RELF TAB D-24 37205034888 LEADER yALLERGY RELF TAB D-24 37205034894 LEADER ySTOOL SOFTEN TAB LAXATIVE 37205034978 LEADER yIBUPROFEN TAB 200MG 37205035071 LEADER yIBUPROFEN TAB 200MG 37205035078 LEADER yIBUPROFEN TAB 200MG 37205035085 LEADER yIBUPROFEN TAB 200MG 37205035090 LEADER yNICOTINE TD DIS 21MG/24H 37205035874 LEADER yMED CHEST OIN RUB 37205036025 LEADER yNICOTINE TD DIS 14MG/24H 37205036174 LEADER yMAGN CITRATE SOL LEMON 37205036238 LEADER yNICOTINE TD DIS 7MG/24HR 37205036374 LEADER yNATURAL VEG POW 58.6% 37205036638 LEADER yASPIRIN CHW 81MG 37205036968 LEADER yANTI-DIARRHE TAB 2MG 37205037053 LEADER yANTI-DIARRHE TAB 2MG 37205037067 LEADER yANTI-DIARRHE TAB 2MG 37205037089 LEADER yFIBER LAXTIV CAP 0.52GM 37205037278 LEADER yPAIN RELIEF TAB SINUS 37205037462 LEADER yLOPERAMIDE LIQ 1MG/5ML 37205037726 LEADER yALLERGY RELF SYP CHILD 37205037826 LEADER yMINOXIDIL SOL EX-STR 37205038016 LEADER yALLERGY RELF TAB 10MG 37205038153 LEADER yALLERGY RELF TAB 10MG 37205038167 LEADER yCHILD PN REL CHW 80MG 37205038265 LEADER yALLERGY RELF TAB REDI-TAB 37205038752 LEADER yPRENATAL TAB 27-0.8MG 37205039578 LEADER yCHILD IBUPRO SUS COLD 37205039926 LEADER yMULTI SYMPTO TAB COLD 37205040062 LEADER yHEMORRHOIDAL OIN 37205040516 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NITE-TIME CAP COLD/FLU 37205042153 LEADER yASPIRIN TAB 325MG EC 37205042978 LEADER yASPIRIN TAB 325MG EC 37205042990 LEADER yDAY-TIME LIQ COLD/FLU 37205043030 LEADER yIBU-DROPS DRO INFANTS 37205043610 LEADER yCHILD PSEUPH LIQ 15MG/5ML 37205044426 LEADER yPSEUDOEPHEDR TAB 30MG 37205044562 LEADER yPSEUDOEPHEDR TAB 30MG 37205044580 LEADER yDECONGESTANT CAP 120MG CR 37205044652 LEADER ySINUS MAX ST TAB 30-500MG 37205044762 LEADER yPAIN RELIEVE CHW 160MG JR 37205044962 LEADER yPSEUDOEPHED TAB CLD/ALRG 37205045162 LEADER yEAR WAX DROP SOL 6.5% OT 37205045705 LEADER yEAR WAX REMO SOL 6.5% OT 37205045803 LEADER yMUSCLE RUB CRE ULTRA 37205046016 LEADER yCHILD ASA CHW 81MG 37205046768 LEADER yNASAL DECON LIQ 15MG/5ML 37205047426 LEADER y8 HOUR PAIN TAB 650MG 37205047778 LEADER yFIBER POW 37205048092 LEADER yEX STR PAIN TAB RELIEVER 37205048878 LEADER yANALGESIC TAB 400-32MG 37205049378 LEADER yCHILD PAIN SUS 160/5ML 37205050826 LEADER yASA LO-DOSE TAB 81MG EC 37205051076 LEADER yASA LO-DOSE TAB 81MG EC 37205051087 LEADER yCHLD PAIN RL TAB 80MG 37205051665 LEADER yPAIN RELIEV SUS 160/5ML 37205051826 LEADER yLICE KIT SOLUTION 37205051903 LEADER ySOD CHLORIDE SOL 5% OP 37205052505 LEADER ySOD CHLORIDE OIN 5% OP 37205052683 LEADER yANTACID/ SUS SIMETH 37205053040 LEADER yRANITIDINE TAB 75MG 37205053165 LEADER yRANITIDINE TAB 75MG 37205053172 LEADER yANTACID SUS ANTI-GAS 37205053540 LEADER yANTACID SUS MAX ST 37205053640 LEADER yCHEST CONGES TAB RELIEF 37205053871 LEADER yPAIN RELIEF TAB ALRG/SIN 37205055362 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAIN RELIEF TAB COLD PE 37205055662 LEADER yPAIN RELIEF TAB COLD PE 37205056162 LEADER yINHALER INH DECONGES 37205056359 LEADER yPAIN REL CLD TAB PE DAY 37205056462 LEADER yCOMP ALLERGY ELX 12.5/5ML 37205056526 LEADER yCOMP ALLERGY ELX 12.5/5ML 37205056534 LEADER yPAIN RELIEF TAB SINUS PE 37205057162 LEADER yHEMORRHOIDAL CRE 37205057224 LEADER yMICONAZOLE 3 KIT COMBINAT 37205058303 LEADER yMICONAZOLE 3 KIT COMBO PK 37205058903 LEADER yMICONAZOLE 7 CRE 2% 37205059029 LEADER yFIBER THERAP TAB 500MG 37205059878 LEADER yTEARS PURE SOL 37205060305 LEADER yIBUPROFEN TAB 200MG 37205060571 LEADER yCHLD IBUPROF SUS 100/5ML 37205064326 LEADER yCHLD IBUPROF SUS 100/5ML 37205064426 LEADER yIBU-DROPS DRO 40MG/ML 37205064605 LEADER yHEADACHE FOR TAB ADDED ST 37205070378 LEADER yPAIN RELIEF GEL 16% 37205070421 LEADER yANTACID XTRA CHW 750MG 37205070680 LEADER yCHILD ASA CHW 81MG 37205070868 LEADER yTUSSIN DM LIQ CLEAR 37205071226 LEADER yHEMORRHOID SUP 37205071516 LEADER yPAIN RELIEV SUS 160/5ML 37205071726 LEADER yPINK BISMUTH CHW 262MG 37205072065 LEADER yANTACID EXT CHW STRENGTH 37205078078 LEADER yCHILD PAIN LIQ COLD/CGH 37205082326 LEADER yMILK OF MAGN SUS 400/5ML 37205083340 LEADER yMILK OF MAGN SUS MINT 37205083440 LEADER yNIGHT-TIME LIQ COLD 37205087530 LEADER yNIGHT-TIME LIQ COLD 37205087538 LEADER yDECONGESTANT ELX D 37205087926 LEADER yNIGHT TIME LIQ COLD 37205088030 LEADER yNIGHT TIME LIQ COLD 37205088038 LEADER ySALINE NASAL SPR 0.65% 37205093013 LEADER ySALINE NASAL SPR 0.65% 37205093021 LEADER y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TUSSIN SYP 100/5ML 37205096026 LEADER yTUSSIN SYP 100/5ML 37205096034 LEADER yTUSSIN DM SYP 100-10/5 37205097026 LEADER yTUSSIN DM SYP 100-10/5 37205097034 LEADER yDIAMOX CAP 500MG CR 00005075323 LEDERLE LABORATORIES yFIBERCON TAB 625MG 00005250002 LEDERLE LABORATORIES yFIBERCON TAB 625MG 00005250023 LEDERLE LABORATORIES yFIBERCON TAB 625MG 00005250033 LEDERLE LABORATORIES yFIBER CON TAB 625MG 00005250058 LEDERLE LABORATORIES yFIBERCON TAB 625MG 00005250086 LEDERLE LABORATORIES yPROPRANOLOL TAB 60MG 00005310223 LEDERLE LABORATORIES yPROPRANOLOL TAB 10MG 00005310931 LEDERLE LABORATORIES yPROPRANOLOL TAB 20MG 00005311031 LEDERLE LABORATORIES yPROPRANOLOL TAB 40MG 00005311131 LEDERLE LABORATORIES yZIAC TAB 5/6.25MG 00005323423 LEDERLE LABORATORIES yZIAC TAB 10/6.25 00005323538 LEDERLE LABORATORIES yZIAC TAB 2.5/6.25 00005323823 LEDERLE LABORATORIES yCIMETIDINE TAB 300MG 00005341623 LEDERLE LABORATORIES yCIMETIDINE TAB 300MG 00005341631 LEDERLE LABORATORIES ySULFASALAZIN TAB 500MG 00005396031 LEDERLE LABORATORIES yACHROMYCIN V CAP 250MG 00005488061 LEDERLE LABORATORIES yMINOCIN CAP 50MG 00005534323 LEDERLE LABORATORIES yMINOCIN CAP 100MG 00005534418 LEDERLE LABORATORIES yZINCON DANDR SHA 1% 00005545558 LEDERLE LABORATORIES yZINCON DANDR SHA 1% 00005545561 LEDERLE LABORATORIES yDECLOMYCIN TAB 150MG 00005921823 LEDERLE LABORATORIES yDECLOMYCIN TAB 300MG 00005927029 LEDERLE LABORATORIES yVANCOLED INJ 1000MG 00205315402 LEDERLE PARENTERALS yVANCOLED INJ 500MG 00205315496 LEDERLE PARENTERALS yPIPRACIL INJ 4GM 00206388018 LEDERLE PIPERACILLIN yZOSYN INJ 2G-0.25G 00206845216 LEDERLE PIPERACILLIN yZOSYN INJ 2G-0.25G 00206845217 LEDERLE PIPERACILLIN yZOSYN INJ 3-0.375G 00206845406 LEDERLE PIPERACILLIN yZOSYN INJ 3-0.375G 00206845411 LEDERLE PIPERACILLIN yZOSYN INJ 3-0.375G 00206845417 LEDERLE PIPERACILLIN yZOSYN INJ 3-0.375G 00206845455 LEDERLE PIPERACILLIN y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZOSYN INJ 4GM/0.5G 00206845511 LEDERLE PIPERACILLIN yZOSYN INJ 4GM/0.5G 00206845517 LEDERLE PIPERACILLIN yZOSYN INJ 4GM/0.5G 00206845518 LEDERLE PIPERACILLIN yZOSYN INJ 4GM/0.5G 00206845525 LEDERLE PIPERACILLIN yZOSYN INJ 36-4.5GM 00206862011 LEDERLE PIPERACILLIN yZOSYN INJ 2G-0.25G 00206885216 LEDERLE PIPERACILLIN yZOSYN INJ 2G-0.25G 00206885218 LEDERLE PIPERACILLIN yZOSYN INJ 3-0.375G 00206885416 LEDERLE PIPERACILLIN yZOSYN INJ 3-0.375G 00206885418 LEDERLE PIPERACILLIN yZOSYN INJ 4GM/0.5G 00206885516 LEDERLE PIPERACILLIN yZOSYN INJ 4GM/0.5G 00206885518 LEDERLE PIPERACILLIN yZOSYN INJ 36-4.5GM 00206885910 LEDERLE PIPERACILLIN yZOSYN SOL 2-0.25GM 00206886002 LEDERLE PIPERACILLIN yZOSYN SOL 3-0.375G 00206886102 LEDERLE PIPERACILLIN yZOSYN SOL 4-0.50GM 00206886202 LEDERLE PIPERACILLIN yENALAPRIL TAB 2.5MG 66685030100 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 66685030102 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 66685030200 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 66685030202 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 66685030300 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 66685030302 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 66685030400 LEK PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 66685030402 LEK PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 10MG 66685042100 LEK PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 10MG 66685042101 LEK PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 20MG 66685042200 LEK PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 20MG 66685042201 LEK PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 20MG 66685042203 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 2.5MG 66685070101 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 2.5MG 66685070102 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 66685070201 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 66685070202 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 66685070203 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 66685070301 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 66685070302 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 66685070303 LEK PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOPRIL TAB 20MG 66685070401 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 66685070402 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 66685070403 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 66685070501 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 66685070502 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 66685070601 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 66685070603 LEK PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 66685070604 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 875MG 66685100100 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 875MG 66685100101 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 500MG 66685100200 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 500MG 66685100202 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 66685101100 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 66685101101 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 66685101102 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 66685101200 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 66685101201 LEK PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 66685101202 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 66685170200 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 66685170201 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 66685170202 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 66685170300 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 66685170301 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 66685170302 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 66685170303 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 66685170400 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 66685170401 LEK PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 66685170402 LEK PHARMACEUTICALS, INC. yBROMOCRIPTIN TAB 2.5MG 66685590500 LEK PHARMACEUTICALS, INC. yBROMOCRIPTIN TAB 2.5MG 66685590503 LEK PHARMACEUTICALS, INC. yPANRETIN GEL 0.1% 64365050101 LIGAND PHARMACEUTICALS, INC. yTARGRETIN CAP 75MG 64365050201 LIGAND PHARMACEUTICALS, INC. yONTAK INJ 150/ML 64365050301 LIGAND PHARMACEUTICALS, INC. yTARGRETIN GEL 1% 64365050401 LIGAND PHARMACEUTICALS, INC. yAVINZA CAP 30MG CR 64365050503 LIGAND PHARMACEUTICALS, INC. yAVINZA CAP 60MG CR 64365050603 LIGAND PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AVINZA CAP 90MG CR 64365050702 LIGAND PHARMACEUTICALS, INC. yAVINZA CAP 120MG CR 64365050802 LIGAND PHARMACEUTICALS, INC. yDOLOGESIC TAB 30-500MG 54859010150 LLORENS PHARMACEUTICALS INT'L DIVISION yNUTRIVIT LIQ 800-15-1 54859050108 LLORENS PHARMACEUTICALS INT'L DIVISION yTUSNEL LIQ 54859050206 LLORENS PHARMACEUTICALS INT'L DIVISION yDOLOGESIC LIQ 30-500MG 54859051206 LLORENS PHARMACEUTICALS INT'L DIVISION yPROTEINEX LIQ 54859051508 LLORENS PHARMACEUTICALS INT'L DIVISION yPROTEINEX LIQ 54859051516 LLORENS PHARMACEUTICALS INT'L DIVISION yNEPHRONEX LIQ 54859051608 LLORENS PHARMACEUTICALS INT'L DIVISION yTUSNEL PEDI LIQ 54859054404 LLORENS PHARMACEUTICALS INT'L DIVISION yTUSNEL PEDI DRO 5-10MG/M 54859060202 LLORENS PHARMACEUTICALS INT'L DIVISION yPROTEINEX TAB 54859071512 LLORENS PHARMACEUTICALS INT'L DIVISION yNEPHRONEX TAB 1MG 54859071601 LLORENS PHARMACEUTICALS INT'L DIVISION yPELEVERUS OIN 61598010010 LTC PRODUCTS INC yPELEVERUS GO OIN 61598020010 LTC PRODUCTS INC yDYTUSS SYP 12.5/5ML 10892011265 LUNSCO, INC yFETRIN CAP 10892011410 LUNSCO, INC yPROTID TAB CR 10892012710 LUNSCO, INC yDYLIX ELX 100/15ML 10892015065 LUNSCO, INC yANABAR TAB 10892015310 LUNSCO, INC yMINTOX SUS 00904000214 MAJOR PHARMACEUTICALS yMINTOX XTRA SUS STRENGTH 00904000314 MAJOR PHARMACEUTICALS yMI-ACID SUS 00904000414 MAJOR PHARMACEUTICALS yMI-ACID SUS 00904000441 MAJOR PHARMACEUTICALS yMI-ACID MAX SUS STRENGTH 00904000514 MAJOR PHARMACEUTICALS yALLERGY TAB 4MG 00904001224 MAJOR PHARMACEUTICALS yALLERGY TAB 4MG 00904001259 MAJOR PHARMACEUTICALS yALLERGY TAB 4MG 00904001280 MAJOR PHARMACEUTICALS yANTI-DIARRHE LIQ 1MG/5ML 00904003620 MAJOR PHARMACEUTICALS yFORMULA EM SOL 00904004920 MAJOR PHARMACEUTICALS yROBAFEN DM SYP 100-10/5 00904005300 MAJOR PHARMACEUTICALS yROBAFEN DM SYP 100-10/5 00904005309 MAJOR PHARMACEUTICALS yROBAFEN DM SYP 100-10/5 00904005316 MAJOR PHARMACEUTICALS yROBAFEN DM SYP 100-10/5 00904005320 MAJOR PHARMACEUTICALS yROBAFEN DM SYP 100-10/5 00904005328 MAJOR PHARMACEUTICALS yROBAFEN SYP 100/5ML 00904006100 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ROBAFEN SYP 100/5ML 00904006109 MAJOR PHARMACEUTICALS yROBAFEN SYP 100/5ML 00904006116 MAJOR PHARMACEUTICALS yROBAFEN SYP 100/5ML 00904006120 MAJOR PHARMACEUTICALS yANUMED-HC SUP 25MG 00904016012 MAJOR PHARMACEUTICALS yANUMED-HC SUP 25MG 00904016060 MAJOR PHARMACEUTICALS yDICYCLOMINE TAB 20MG 00904019560 MAJOR PHARMACEUTICALS yDICYCLOMINE TAB 20MG 00904019580 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 10MG 00904020060 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 10MG 00904020061 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 10MG 00904020080 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 25MG 00904020160 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 25MG 00904020161 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 25MG 00904020180 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 50MG 00904020260 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 50MG 00904020261 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 50MG 00904020280 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 75MG 00904020360 MAJOR PHARMACEUTICALS yAMITRIPTYLIN TAB 75MG 00904020361 MAJOR PHARMACEUTICALS yCHLORPROPAM TAB 100MG 00904022560 MAJOR PHARMACEUTICALS yCHLORPROPAM TAB 250MG 00904022680 MAJOR PHARMACEUTICALS yAPRODINE TAB 2.5-60MG 00904025024 MAJOR PHARMACEUTICALS yAPRODINE TAB 2.5-60MG 00904025059 MAJOR PHARMACEUTICALS yCHLORZOXAZON TAB 500MG 00904030240 MAJOR PHARMACEUTICALS yCHLORZOXAZON TAB 500MG 00904030260 MAJOR PHARMACEUTICALS yVICAP FORTE CAP 00904030460 MAJOR PHARMACEUTICALS yVI-C FORTE CAP 00904030480 MAJOR PHARMACEUTICALS ySINUS RELIEF TAB 30-325MG 00904032124 MAJOR PHARMACEUTICALS ySINUS RELIEF TAB 30-325MG 00904032159 MAJOR PHARMACEUTICALS yERGOLOID MES TAB 1MG ORAL 00904033660 MAJOR PHARMACEUTICALS yASPIR-MOX TAB 00904034640 MAJOR PHARMACEUTICALS yASPIR-MOX TAB 00904034659 MAJOR PHARMACEUTICALS yASPIR-MOX IB TAB 00904034740 MAJOR PHARMACEUTICALS yASPIR-MOX IB TAB 00904034759 MAJOR PHARMACEUTICALS yCARISOPRODOL TAB 350MG 00904035560 MAJOR PHARMACEUTICALS yCARISOPRODOL TAB 350MG 00904035580 MAJOR PHARMACEUTICALS yNIFEDIPINE CAP 20MG 00904040861 MAJOR PHARMACEUTICALS y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROPRANOLOL TAB 20MG 00904041261 MAJOR PHARMACEUTICALS yPROPRANOLOL TAB 40MG 00904041461 MAJOR PHARMACEUTICALS yDOXYCYCL HYC CAP 50MG 00904042751 MAJOR PHARMACEUTICALS yDOXYCYCL HYC CAP 100MG 00904042840 MAJOR PHARMACEUTICALS yDOXYCYCL HYC CAP 100MG 00904042851 MAJOR PHARMACEUTICALS yDOXYCYCL HYC CAP 100MG 00904042861 MAJOR PHARMACEUTICALS yDOXYCYCL HYC TAB 100MG 00904043040 MAJOR PHARMACEUTICALS yDOXYCYCL HYC TAB 100MG 00904043051 MAJOR PHARMACEUTICALS yDOXYCYCL HYC TAB 100MG 00904043061 MAJOR PHARMACEUTICALS yMINTOX PLUS CHW 00904047860 MAJOR PHARMACEUTICALS yPRIMIDONE TAB 250MG 00904056060 MAJOR PHARMACEUTICALS yPRIMIDONE TAB 250MG 00904056080 MAJOR PHARMACEUTICALS yQUININE SULF TAB 260MG 00904056460 MAJOR PHARMACEUTICALS yFOLIC ACID TAB 1MG 00904062560 MAJOR PHARMACEUTICALS yFOLIC ACID TAB 1MG 00904062580 MAJOR PHARMACEUTICALS yNITROGLYCER CAP 2.5MG TD 00904064352 MAJOR PHARMACEUTICALS yNITROGLYCER CAP 2.5MG TD 00904064360 MAJOR PHARMACEUTICALS yNITROGLYCER CAP 6.5MG TD 00904064460 MAJOR PHARMACEUTICALS yNITROGLYCER CAP 9MG TD 00904064752 MAJOR PHARMACEUTICALS yNITROGLYCER CAP 9MG TD 00904064760 MAJOR PHARMACEUTICALS yDEXAPHEN SA TAB 6-120 00904066740 MAJOR PHARMACEUTICALS yDEXAPHEN SA TAB 6-120 00904066760 MAJOR PHARMACEUTICALS yANTIFUNGAL CRE 1% 00904072236 MAJOR PHARMACEUTICALS yTOLNAFTATE POW 1% 00904072645 MAJOR PHARMACEUTICALS yTRIPLE ANTIB OIN 00904073431 MAJOR PHARMACEUTICALS yTRIPLE ANTIB OIN 00904073436 MAJOR PHARMACEUTICALS yTHYROID TAB 65MG 00904076160 MAJOR PHARMACEUTICALS yTHYROID TAB 65MG 00904076180 MAJOR PHARMACEUTICALS yTHYROID TAB 130MG 00904076260 MAJOR PHARMACEUTICALS yTHYROID TAB 130MG 00904076280 MAJOR PHARMACEUTICALS yTHYROID TAB 180MG 00904076360 MAJOR PHARMACEUTICALS yDESOXIMETAS CRE 0.25% 00904076402 MAJOR PHARMACEUTICALS yMILK OF MAGN SUS 00904078814 MAJOR PHARMACEUTICALS yMILK OF MAGN SUS 00904078816 MAJOR PHARMACEUTICALS yMILK OF MAGN SUS MINT 00904078914 MAJOR PHARMACEUTICALS yAURODEX SOL OTIC 00904079335 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIOCTO LIQ 50MG/5ML 00904093616 MAJOR PHARMACEUTICALS yDAILY VITAMI LIQ 00904098516 MAJOR PHARMACEUTICALS yPOT CHLORIDE LIQ 10% 00904100716 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 0.5MG 00904105560 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 0.5MG 00904105561 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 1MG 00904105661 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 1MG 00904105680 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 2MG 00904105760 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 2MG 00904105761 MAJOR PHARMACEUTICALS yBENZTROPINE TAB 2MG 00904105780 MAJOR PHARMACEUTICALS yMETOCLOPRAM TAB 5MG 00904106940 MAJOR PHARMACEUTICALS yMETOCLOPRAM TAB 5MG 00904106960 MAJOR PHARMACEUTICALS yMETOCLOPRAM TAB 10MG 00904107040 MAJOR PHARMACEUTICALS yMETOCLOPRAM TAB 10MG 00904107060 MAJOR PHARMACEUTICALS yMETOCLOPRAM TAB 10MG 00904107061 MAJOR PHARMACEUTICALS yMETOCLOPRAM TAB 10MG 00904107080 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 25MG 00904108660 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 25MG 00904108661 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 25MG 00904108680 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 50MG 00904108760 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 50MG 00904108761 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 75MG 00904108860 MAJOR PHARMACEUTICALS yDIPYRIDAMOLE TAB 75MG 00904108861 MAJOR PHARMACEUTICALS yPOVIDONE-IOD OIN 10% 00904110231 MAJOR PHARMACEUTICALS yPOVIDONE-IOD SOL 10% 00904110309 MAJOR PHARMACEUTICALS yCYPROHEPTAD TAB 4MG 00904114560 MAJOR PHARMACEUTICALS yCYPROHEPTAD TAB 4MG 00904114561 MAJOR PHARMACEUTICALS yCYPROHEPTAD TAB 4MG 00904114580 MAJOR PHARMACEUTICALS yBANOPHEN ELX 12.5/5ML 00904122800 MAJOR PHARMACEUTICALS yBANOPHEN ELX 12.5/5ML 00904122820 MAJOR PHARMACEUTICALS ySALSALATE TAB 500MG 00904125061 MAJOR PHARMACEUTICALS ySALSALATE TAB 750MG 00904125140 MAJOR PHARMACEUTICALS ySALSALATE TAB 750MG 00904125161 MAJOR PHARMACEUTICALS yCALC ANTACID CHW 500MG 00904125792 MAJOR PHARMACEUTICALS yCALC ANTACID CHW 500MG 00904125892 MAJOR PHARMACEUTICALS yDOXEPIN HCL CAP 25MG 00904126161 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DOXEPIN HCL CAP 50MG 00904126261 MAJOR PHARMACEUTICALS yDOXEPIN HCL CAP 100MG 00904126461 MAJOR PHARMACEUTICALS yPROMETHAZINE SUP 50MG 00904129012 MAJOR PHARMACEUTICALS yCHLORAL HYDR SYP 500/5ML 00904130016 MAJOR PHARMACEUTICALS yBISMATROL SUS 524/30ML 00904131309 MAJOR PHARMACEUTICALS yBISMATROL SUS 690/30ML 00904131409 MAJOR PHARMACEUTICALS yBISMATROL CHW 262MG 00904131546 MAJOR PHARMACEUTICALS yALL-NITE CLD LIQ FORMULA 00904132216 MAJOR PHARMACEUTICALS yALL-NITE CLD LIQ FORMULA 00904132221 MAJOR PHARMACEUTICALS yALL-NITE CLD LIQ FORMULA 00904132277 MAJOR PHARMACEUTICALS yALL-NITE CLD LIQ FORMULA 00904132321 MAJOR PHARMACEUTICALS yMETRONIDAZOL TAB 250MG 00904145361 MAJOR PHARMACEUTICALS yFUROSEMIDE SOL 10MG/ML 00904147703 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 0.5MG 00904150040 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 0.5MG 00904150060 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 0.5MG 00904150061 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 0.5MG 00904150080 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 1MG 00904150160 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 1MG 00904150161 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 2MG 00904150260 MAJOR PHARMACEUTICALS yLORAZEPAM TAB 2MG 00904150261 MAJOR PHARMACEUTICALS yAPRODINE SYP 1.25-30 00904152300 MAJOR PHARMACEUTICALS yAPRODINE SYP 1.25-30 00904152320 MAJOR PHARMACEUTICALS yCLEMASTINE SYP 0.5/5ML 00904152400 MAJOR PHARMACEUTICALS yNEOTHYLLINE TAB 200MG 00904155660 MAJOR PHARMACEUTICALS yDYPHYLLIN-GG TAB 200-200 00904155860 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 100MG CR 00904161060 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 100MG CR 00904161061 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 200MG CR 00904161160 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 200MG CR 00904161161 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 200MG CR 00904161180 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 300MG CR 00904161240 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 300MG CR 00904161260 MAJOR PHARMACEUTICALS yTHEOPHYLLINE TAB 300MG CR 00904161261 MAJOR PHARMACEUTICALS yRENTAMINE TAB 00904166560 MAJOR PHARMACEUTICALS yRENTAMINE SUS PED 00904166616 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IBU-200 TAB 200MG 00904174760 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 400MG 00904174840 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 400MG 00904174860 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 400MG 00904174861 MAJOR PHARMACEUTICALS yMETHOTREXATE TAB 2.5MG 00904174960 MAJOR PHARMACEUTICALS ySORE THROAT AER MENTHOL 00904177021 MAJOR PHARMACEUTICALS ySORE THROAT AER CHERRY 00904177121 MAJOR PHARMACEUTICALS yNAPHAZOLE SOL 0.1% OP 00904190635 MAJOR PHARMACEUTICALS yGENTAMICIN SOL 0.3% OP 00904190705 MAJOR PHARMACEUTICALS yGENTAMICIN SOL 0.3% OP 00904190735 MAJOR PHARMACEUTICALS yTRIAMT/HCTZ TAB 75-50MG 00904196540 MAJOR PHARMACEUTICALS yTRIAMT/HCTZ TAB 75-50MG 00904196560 MAJOR PHARMACEUTICALS yMAPAP CHW 80MG 00904197446 MAJOR PHARMACEUTICALS yMAPAP TAB 325MG 00904198259 MAJOR PHARMACEUTICALS yMAPAP TAB 325MG 00904198260 MAJOR PHARMACEUTICALS yMAPAP TAB 325MG 00904198261 MAJOR PHARMACEUTICALS yMAPAP TAB 325MG 00904198280 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198324 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198340 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198351 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198359 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198380 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198394 MAJOR PHARMACEUTICALS yMAPAP ELX 160/5ML 00904198500 MAJOR PHARMACEUTICALS yMAPAP ELX 160/5ML 00904198516 MAJOR PHARMACEUTICALS yMAPAP ELX 160/5ML 00904198520 MAJOR PHARMACEUTICALS yMAPAP CAP 500MG 00904198759 MAJOR PHARMACEUTICALS yMAPAP CAP 500MG 00904198760 MAJOR PHARMACEUTICALS yMAPAP CAP 500MG 00904198780 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198859 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198860 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198861 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198880 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198951 MAJOR PHARMACEUTICALS yMAPAP TAB 500MG 00904198959 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG 00904200940 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ASPIRIN TAB 325MG 00904200960 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG 00904200970 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG EC 00904201159 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG EC 00904201360 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG EC 00904201372 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG EC 00904201380 MAJOR PHARMACEUTICALS yASPIRIN TAB 500MG EC 00904201452 MAJOR PHARMACEUTICALS yASPIRIN TAB 500MG EC 00904201492 MAJOR PHARMACEUTICALS yTRI-BUFF ASA TAB 325MG 00904201559 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG 00904201959 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG 00904201961 MAJOR PHARMACEUTICALS yASPIRIN TAB 325MG 00904201980 MAJOR PHARMACEUTICALS yDRYPHEN TAB 00904202139 MAJOR PHARMACEUTICALS yBANOPHEN TAB 25MG 00904203024 MAJOR PHARMACEUTICALS yBANOPHEN CAP 25MG 00904203524 MAJOR PHARMACEUTICALS yBANOPHEN CAP 25MG 00904203559 MAJOR PHARMACEUTICALS yCORTISONE AC TAB 25MG 00904204360 MAJOR PHARMACEUTICALS yDRIMINATE TAB 50MG 00904205112 MAJOR PHARMACEUTICALS yDRIMINATE TAB 50MG 00904205159 MAJOR PHARMACEUTICALS yDIPHENHYDRAM CAP 50MG 00904205661 MAJOR PHARMACEUTICALS yHYDROCHLOROT TAB 50MG 00904208980 MAJOR PHARMACEUTICALS yISONIAZID TAB 300MG 00904209660 MAJOR PHARMACEUTICALS yCALULOSE SYP 10GM/15 00904211769 MAJOR PHARMACEUTICALS yISOSORB DIN TAB 5MG 00904215061 MAJOR PHARMACEUTICALS yISOSORB DIN TAB 10MG 00904215161 MAJOR PHARMACEUTICALS yISOSORB DIN TAB 10MG 00904215180 MAJOR PHARMACEUTICALS yISOSORB DIN TAB 20MG 00904215461 MAJOR PHARMACEUTICALS yISOSORB DIN TAB 20MG 00904215480 MAJOR PHARMACEUTICALS yPREDNISONE TAB 5MG 00904215780 MAJOR PHARMACEUTICALS yMETHYLPRED PAK 4MG 00904217519 MAJOR PHARMACEUTICALS yCHLORPROMAZ TAB 100MG 00904219161 MAJOR PHARMACEUTICALS yDOK CAP 100MG 00904224461 MAJOR PHARMACEUTICALS yPOT CHLORIDE CAP 10MEQ ER 00904229561 MAJOR PHARMACEUTICALS yISOSORB DIN SUB 2.5MG 00904234260 MAJOR PHARMACEUTICALS yMECLIZINE TAB 25MG 00904235060 MAJOR PHARMACEUTICALS yMETHOCARBAM TAB 500MG 00904236460 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METHOCARBAM TAB 750MG 00904236540 MAJOR PHARMACEUTICALS yMETHOCARBAM TAB 750MG 00904236560 MAJOR PHARMACEUTICALS yMETHYLDOPA TAB 125MG 00904239960 MAJOR PHARMACEUTICALS yTETRACYCLINE CAP 500MG 00904240760 MAJOR PHARMACEUTICALS yTETRACYCLINE CAP 250MG 00904241660 MAJOR PHARMACEUTICALS yTETRACYCLINE CAP 250MG 00904241680 MAJOR PHARMACEUTICALS yEES/SULFISOX SUS 200-600 00904247504 MAJOR PHARMACEUTICALS yEES/SULFISOX SUS 200-600 00904247507 MAJOR PHARMACEUTICALS yEES/SULFISOX SUS 200-600 00904247508 MAJOR PHARMACEUTICALS yHYOSCYAMINE TAB 0.125MG 00904249660 MAJOR PHARMACEUTICALS yFIBER TAB 625MG 00904250091 MAJOR PHARMACEUTICALS yCHLORD/CLIDI CAP 5-2.5MG 00904250360 MAJOR PHARMACEUTICALS yCHLORD/CLIDI CAP 5-2.5MG 00904250380 MAJOR PHARMACEUTICALS yLICE-AID SHA 00904252820 MAJOR PHARMACEUTICALS yCALAMINE LOT 00904253300 MAJOR PHARMACEUTICALS yBELLAMINE TAB 00904254860 MAJOR PHARMACEUTICALS yNYSTAT/TRIAM CRE 00904257402 MAJOR PHARMACEUTICALS yNYSTAT/TRIAM CRE 00904257431 MAJOR PHARMACEUTICALS yNYSTAT/TRIAM CRE 00904257436 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 100MG 00904261360 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 100MG 00904261361 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 100MG 00904261380 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 300MG 00904261440 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 300MG 00904261460 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 300MG 00904261461 MAJOR PHARMACEUTICALS yALLOPURINOL TAB 300MG 00904261480 MAJOR PHARMACEUTICALS yCALLERGY LOT 1-8% 00904263321 MAJOR PHARMACEUTICALS yFLUOCIN ACET CRE 0.01% 00904266002 MAJOR PHARMACEUTICALS yGLYCERIN SUP 1.5GM 00904266612 MAJOR PHARMACEUTICALS yGLYCERIN SUP 1.5GM 00904266617 MAJOR PHARMACEUTICALS yGLYCERIN SUP 3GM 00904266717 MAJOR PHARMACEUTICALS yGLYCERIN SUP 3GM 00904266757 MAJOR PHARMACEUTICALS yGLYCERIN SUP 3GM 00904266760 MAJOR PHARMACEUTICALS yHYDROCORT TAB 20MG 00904267460 MAJOR PHARMACEUTICALS yMEDROXYPR AC TAB 10MG 00904269060 MAJOR PHARMACEUTICALS yNYSTATIN CRE 100000 00904270631 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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NYSTATIN CRE 100000 00904270636 MAJOR PHARMACEUTICALS yK-VESCENT TAB 25MEQ EF 00904272046 MAJOR PHARMACEUTICALS yK-VESCENT TAB 25MEQ EF 00904272060 MAJOR PHARMACEUTICALS ySMZ/TMP DS TAB 800-160 00904272540 MAJOR PHARMACEUTICALS ySMZ/TMP DS TAB 800-160 00904272560 MAJOR PHARMACEUTICALS ySMZ/TMP DS TAB 800-160 00904272561 MAJOR PHARMACEUTICALS ySOD SULFACET SOL 10% OP 00904272835 MAJOR PHARMACEUTICALS yTRIMETHOBENZ SUP 100MG 00904273515 MAJOR PHARMACEUTICALS yTRIMETHOBENZ SUP 200MG 00904273615 MAJOR PHARMACEUTICALS yTRIAMCINOLON OIN 0.1% 00904274327 MAJOR PHARMACEUTICALS yFLURAZEPAM CAP 15MG 00904280060 MAJOR PHARMACEUTICALS yFLURAZEPAM CAP 30MG 00904280160 MAJOR PHARMACEUTICALS yOXYBUTYNIN TAB 5MG 00904282160 MAJOR PHARMACEUTICALS yOXYBUTYNIN TAB 5MG 00904282161 MAJOR PHARMACEUTICALS yTHIOTHIXENE CAP 1MG 00904289060 MAJOR PHARMACEUTICALS yVERAPAMIL TAB 80MG 00904292060 MAJOR PHARMACEUTICALS yVERAPAMIL TAB 80MG 00904292061 MAJOR PHARMACEUTICALS yVERAPAMIL TAB 120MG 00904292440 MAJOR PHARMACEUTICALS yVERAPAMIL TAB 120MG 00904292460 MAJOR PHARMACEUTICALS yVERAPAMIL TAB 120MG 00904292461 MAJOR PHARMACEUTICALS yTOBRAMYCIN SOL 0.3% OP 00904297005 MAJOR PHARMACEUTICALS yOPTI-CLEAR SOL 0.05% OP 00904299235 MAJOR PHARMACEUTICALS yCORTOMYCIN OIN OP 1% 00904299538 MAJOR PHARMACEUTICALS yMETHADEX SUS 0.1% OP 00904300305 MAJOR PHARMACEUTICALS yDEXAMETH PHO SOL 0.1% OP 00904300605 MAJOR PHARMACEUTICALS yNEOCIDIN OIN OP 00904301238 MAJOR PHARMACEUTICALS yNEOCIDIN SOL OP 00904301610 MAJOR PHARMACEUTICALS yCORTOMYCIN SUS 1% OTIC 00904301710 MAJOR PHARMACEUTICALS yCORTOMYCIN SOL 1% OTIC 00904314110 MAJOR PHARMACEUTICALS yEAR DROPS SOL 6.5% OT 00904322035 MAJOR PHARMACEUTICALS yRON-ACID SUS 540/5ML 00904323514 MAJOR PHARMACEUTICALS yRONDAMINE TAB 4-60MG 00904324860 MAJOR PHARMACEUTICALS yRONDAMINE TR TAB 8-120 00904325060 MAJOR PHARMACEUTICALS yYOHIMBINE TAB 5MG 00904325560 MAJOR PHARMACEUTICALS yBUT/APAP/CAF TAB 00904328040 MAJOR PHARMACEUTICALS yBUT/APAP/CAF TAB 00904328060 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BACLOFEN TAB 10MG 00904336561 MAJOR PHARMACEUTICALS ySULINDAC TAB 200MG 00904337960 MAJOR PHARMACEUTICALS yHYDROCO/APAP TAB 5-500MG 00904344061 MAJOR PHARMACEUTICALS ySIMPLET TAB 00904345952 MAJOR PHARMACEUTICALS ySIMPLET TAB 00904345960 MAJOR PHARMACEUTICALS yPANCRELIPASE TAB 00904347240 MAJOR PHARMACEUTICALS yPANCRELIPASE TAB 00904347260 MAJOR PHARMACEUTICALS yBOROFAIR SOL 2% OTIC 00904352403 MAJOR PHARMACEUTICALS yDISPOSABLE ENE 00904353578 MAJOR PHARMACEUTICALS yMEGESTROL AC TAB 40MG 00904357161 MAJOR PHARMACEUTICALS yTRIA ORADENT PST 0.1% 00904364368 MAJOR PHARMACEUTICALS yCOLD SYMPTOM TAB RELIEF 00904365024 MAJOR PHARMACEUTICALS yCARBAMAZEPIN TAB 200MG 00904385560 MAJOR PHARMACEUTICALS yCARBAMAZEPIN TAB 200MG 00904385561 MAJOR PHARMACEUTICALS yDEEP SEA SPR 0.65% 00904386575 MAJOR PHARMACEUTICALS yBUTALBITAL TAB CPD 00904389260 MAJOR PHARMACEUTICALS yBUTALBITAL TAB CPD 00904389280 MAJOR PHARMACEUTICALS yPHENTERMINE CAP 30MG 00904392160 MAJOR PHARMACEUTICALS yBUTALBITAL CAP CPD 00904393460 MAJOR PHARMACEUTICALS yTRAZODONE TAB 50MG 00904399061 MAJOR PHARMACEUTICALS yTRAZODONE TAB 100MG 00904399161 MAJOR PHARMACEUTICALS yTRAZODONE TAB 150MG 00904399260 MAJOR PHARMACEUTICALS yTRAZODONE TAB 150MG 00904399270 MAJOR PHARMACEUTICALS yASPIRIN CHW 81MG 00904404073 MAJOR PHARMACEUTICALS yORAL PEROXID SOL 10% 00904406203 MAJOR PHARMACEUTICALS ySLEEP TAB 25MG 00904427451 MAJOR PHARMACEUTICALS yALCOHOL PREP PAD 00904427760 MAJOR PHARMACEUTICALS yTHERA-DERM LOT 00904429909 MAJOR PHARMACEUTICALS yTHERA-DERM OIL BATH 00904430309 MAJOR PHARMACEUTICALS yLIQUITEARS SOL 00904501735 MAJOR PHARMACEUTICALS yNATURAL SOL BALANCE 00904501835 MAJOR PHARMACEUTICALS ySORE THROAT LOZ CHERRY 00904502198 MAJOR PHARMACEUTICALS yAZO-GESIC TAB 95MG 00904502546 MAJOR PHARMACEUTICALS yCAPTOPRIL TAB 12.5MG 00904504561 MAJOR PHARMACEUTICALS yCAPTOPRIL TAB 25MG 00904504660 MAJOR PHARMACEUTICALS yCAPTOPRIL TAB 25MG 00904504661 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CAPTOPRIL TAB 25MG 00904504680 MAJOR PHARMACEUTICALS yCAPTOPRIL TAB 50MG 00904504760 MAJOR PHARMACEUTICALS yCAPTOPRIL TAB 50MG 00904504761 MAJOR PHARMACEUTICALS yCAPTOPRIL TAB 50MG 00904504780 MAJOR PHARMACEUTICALS yPEDIA RELIEF LIQ CGH/COLD 00904505020 MAJOR PHARMACEUTICALS yROBAFEN PED SYP 7.5/5ML 00904505120 MAJOR PHARMACEUTICALS ySUDOGEST TAB 30MG 00904505324 MAJOR PHARMACEUTICALS ySUDOGEST TAB 30MG 00904505359 MAJOR PHARMACEUTICALS yBISCOLAX SUP 10MG 00904505812 MAJOR PHARMACEUTICALS yBISCOLAX SUP 10MG 00904505860 MAJOR PHARMACEUTICALS yMEDI PAD 00904505960 MAJOR PHARMACEUTICALS yMAPAP CHILD SYP COLD/CGH 00904506020 MAJOR PHARMACEUTICALS yROBAFEN AC SYP 100-10/5 00904506500 MAJOR PHARMACEUTICALS yROBAFEN AC SYP 100-10/5 00904506516 MAJOR PHARMACEUTICALS yGAS RELIEF DRO 40/0.6ML 00904506730 MAJOR PHARMACEUTICALS yMI-ACID GAS CHW 80MG 00904506860 MAJOR PHARMACEUTICALS yMEDICATED POW BODY 00904509877 MAJOR PHARMACEUTICALS yASPIRCAF TAB 400-30MG 00904510159 MAJOR PHARMACEUTICALS yHYDROXYCHLOR TAB 200MG 00904510760 MAJOR PHARMACEUTICALS yNEOMYCIN/DEX SOL 0.5-0.1% 00904511205 MAJOR PHARMACEUTICALS yMI-ACID CHW 00904511571 MAJOR PHARMACEUTICALS yMAPAP CHILD SUS 160/5ML 00904511620 MAJOR PHARMACEUTICALS yPED ELCTRLYT SOL FRUIT 00904511869 MAJOR PHARMACEUTICALS yHYOSCYAMINE SUB 0.125MG 00904512060 MAJOR PHARMACEUTICALS yHEM-PREP CRE 00904512437 MAJOR PHARMACEUTICALS ySUDOGEST TAB 60MG 00904512546 MAJOR PHARMACEUTICALS ySUDOGEST TAB 60MG 00904512559 MAJOR PHARMACEUTICALS yHYDROCO/APAP TAB 10-650MG 00904512760 MAJOR PHARMACEUTICALS ySULF/PRED NA SOL OP 00904512810 MAJOR PHARMACEUTICALS yPAIN RELIEVE TAB PLUS 00904513559 MAJOR PHARMACEUTICALS yBUT/ASA/CAF/ CAP COD 30MG 00904514060 MAJOR PHARMACEUTICALS yPHENAGESIC TAB 00904514159 MAJOR PHARMACEUTICALS yBANOPHEN CAP 25MG 00904514724 MAJOR PHARMACEUTICALS yGUAIFENESIN TAB 200MG 00904515460 MAJOR PHARMACEUTICALS ySENNA TAB 8.6MG 00904516559 MAJOR PHARMACEUTICALS ySENNA TAB 8.6MG 00904516561 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SENNA TAB 8.6MG 00904516580 MAJOR PHARMACEUTICALS yLUBRIFRESH OIN P.M. 00904516838 MAJOR PHARMACEUTICALS yBANOPHEN LIQ 12.5/5ML 00904517416 MAJOR PHARMACEUTICALS yBANOPHEN LIQ 12.5/5ML 00904517428 MAJOR PHARMACEUTICALS yROBAFEN DM SYP 100-10/5 00904518020 MAJOR PHARMACEUTICALS yHEMORRHOIDAL OIN PREP 00904518402 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 600MG 00904518640 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 600MG 00904518660 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 600MG 00904518661 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 800MG 00904518740 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 800MG 00904518760 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 800MG 00904518761 MAJOR PHARMACEUTICALS yNAT FIBER POW THERAPY 00904519965 MAJOR PHARMACEUTICALS yNAT FIBER POW THERAPY 00904519966 MAJOR PHARMACEUTICALS yNAT FIBER POW THERAPY 00904520065 MAJOR PHARMACEUTICALS yNAT FIBER POW THERAPY 00904520066 MAJOR PHARMACEUTICALS yASPIRIN TAB 975MG EC 00904521260 MAJOR PHARMACEUTICALS yTWICE-A-DAY SPR 0.05% 00904521730 MAJOR PHARMACEUTICALS yTWICE-A-DAY SPR 0.05% 00904521735 MAJOR PHARMACEUTICALS yTRAZODONE TAB 50MG 00904521940 MAJOR PHARMACEUTICALS yTRAZODONE TAB 50MG 00904521960 MAJOR PHARMACEUTICALS yTRAZODONE TAB 50MG 00904521980 MAJOR PHARMACEUTICALS yTRAZODONE TAB 100MG 00904522040 MAJOR PHARMACEUTICALS yTRAZODONE TAB 100MG 00904522060 MAJOR PHARMACEUTICALS yBACLOFEN TAB 20MG 00904522261 MAJOR PHARMACEUTICALS yLACTASE ENZ TAB 3000UNIT 00904522452 MAJOR PHARMACEUTICALS ySCALP AID LIQ 00904522599 MAJOR PHARMACEUTICALS yMEDROXYPR AC TAB 2.5MG 00904522760 MAJOR PHARMACEUTICALS yMEDROXYPR AC TAB 5MG 00904522860 MAJOR PHARMACEUTICALS yNAPROXEN SOD TAB 220MG 00904522951 MAJOR PHARMACEUTICALS yNAPROXEN SOD TAB 220MG 00904522959 MAJOR PHARMACEUTICALS yALL DAY RELI TAB 220MG 00904523051 MAJOR PHARMACEUTICALS yALL DAY RELI TAB 220MG 00904523059 MAJOR PHARMACEUTICALS yTIMOLOL MAL SOL 0.5% OP 00904524805 MAJOR PHARMACEUTICALS yTIMOLOL MAL SOL 0.5% OP 00904524810 MAJOR PHARMACEUTICALS yTIMOLOL MAL SOL 0.5% OP 00904524835 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KAO-TIN LIQ ADV FORM 00904524909 MAJOR PHARMACEUTICALS yKAO-TIN LIQ ADV FORM 00904524916 MAJOR PHARMACEUTICALS yINF MAPAP DRO 80/0.8ML 00904525530 MAJOR PHARMACEUTICALS yINF MAPAP DRO 80/0.8ML 00904525535 MAJOR PHARMACEUTICALS yMAPAP CHW 80MG 00904525646 MAJOR PHARMACEUTICALS yMAPAP CHW 80MG 00904525846 MAJOR PHARMACEUTICALS yTHERAPEUTIC SHA SHAMPOO 00904525944 MAJOR PHARMACEUTICALS yRANITIDINE TAB 150MG 00904526140 MAJOR PHARMACEUTICALS yRANITIDINE TAB 150MG 00904526152 MAJOR PHARMACEUTICALS yRANITIDINE TAB 150MG 00904526161 MAJOR PHARMACEUTICALS yRANITIDINE TAB 300MG 00904526246 MAJOR PHARMACEUTICALS yRANITIDINE TAB 300MG 00904526261 MAJOR PHARMACEUTICALS yRANITIDINE TAB 300MG 00904526270 MAJOR PHARMACEUTICALS ySELEGILINE TAB 5MG 00904526652 MAJOR PHARMACEUTICALS yMULTIVITE/FL CHW 0.5MG 00904527460 MAJOR PHARMACEUTICALS yMULTIVITE/FL CHW 1MG 00904527560 MAJOR PHARMACEUTICALS yPED ELCTRLYT SOL GRAPE 00904527669 MAJOR PHARMACEUTICALS yLUBRISOFT LOT UNSCENTE 00904530016 MAJOR PHARMACEUTICALS yHEM-PREP SUP 00904530424 MAJOR PHARMACEUTICALS yDIPHENHYDRAM CAP 25MG 00904530660 MAJOR PHARMACEUTICALS yDIPHENHYDRAM CAP 25MG 00904530661 MAJOR PHARMACEUTICALS yDIPHENHYDRAM CAP 25MG 00904530680 MAJOR PHARMACEUTICALS yDIPHENHYDRAM CAP 50MG 00904530760 MAJOR PHARMACEUTICALS yDIPHENHYDRAM CAP 50MG 00904530780 MAJOR PHARMACEUTICALS yCHLD IBUPROF SUS 100/5ML 00904530909 MAJOR PHARMACEUTICALS yCHLD IBUPROF SUS 100/5ML 00904530920 MAJOR PHARMACEUTICALS yMAG OXIDE TAB 400MG 00904531118 MAJOR PHARMACEUTICALS yFEMATROL TAB 5MG EC 00904531246 MAJOR PHARMACEUTICALS ySOD CHLORIDE SOL 5% OP 00904531435 MAJOR PHARMACEUTICALS ySOD CHLORIDE OIN 5% OP 00904531538 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904532324 MAJOR PHARMACEUTICALS yACID REDUCER TAB 200MG 00904533646 MAJOR PHARMACEUTICALS yPRENATAL TAB PLUS/FE 00904533960 MAJOR PHARMACEUTICALS yMULT VIT-BET CHW FL0.25MG 00904534060 MAJOR PHARMACEUTICALS yCLONAZEPAM TAB 0.5MG 00904534261 MAJOR PHARMACEUTICALS yCLONAZEPAM TAB 0.5MG 00904534280 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLONAZEPAM TAB 1MG 00904534360 MAJOR PHARMACEUTICALS yCLONAZEPAM TAB 1MG 00904534361 MAJOR PHARMACEUTICALS yCLONAZEPAM TAB 2MG 00904534440 MAJOR PHARMACEUTICALS yCLONAZEPAM TAB 2MG 00904534460 MAJOR PHARMACEUTICALS yCLONAZEPAM TAB 2MG 00904534461 MAJOR PHARMACEUTICALS yK-VESCENT POW 20MEQ 00904534646 MAJOR PHARMACEUTICALS ySUDOGEST TAB CLD/ALRG 00904535124 MAJOR PHARMACEUTICALS yBANOPHEN CRE 00904535431 MAJOR PHARMACEUTICALS yACID GONE CHW 00904536560 MAJOR PHARMACEUTICALS ySUDOGEST LIQ 15MG/5ML 00904536720 MAJOR PHARMACEUTICALS yEYE WASH SOL 00904537720 MAJOR PHARMACEUTICALS yTICLOPIDINE TAB 250MG 00904537840 MAJOR PHARMACEUTICALS yTICLOPIDINE TAB 250MG 00904537846 MAJOR PHARMACEUTICALS yTICLOPIDINE TAB 250MG 00904537852 MAJOR PHARMACEUTICALS yTICLOPIDINE TAB 250MG 00904537861 MAJOR PHARMACEUTICALS yGEMFIBROZIL TAB 600MG 00904537940 MAJOR PHARMACEUTICALS yGEMFIBROZIL TAB 600MG 00904537952 MAJOR PHARMACEUTICALS yGEMFIBROZIL TAB 600MG 00904537961 MAJOR PHARMACEUTICALS yDILTIAZEM CAP 240MG XR 00904538260 MAJOR PHARMACEUTICALS yDILTIAZEM CAP 240MG XR 00904538261 MAJOR PHARMACEUTICALS yATENOLOL TAB 25MG 00904539260 MAJOR PHARMACEUTICALS yFERREX 150 CAP 150MG 00904539561 MAJOR PHARMACEUTICALS yRANITIDINE TAB 75MG 00904539915 MAJOR PHARMACEUTICALS yRANITIDINE TAB 75MG 00904539946 MAJOR PHARMACEUTICALS yRANITIDINE TAB 75MG 00904539952 MAJOR PHARMACEUTICALS ySOD FLUORIDE CHW 0.5MG 00904540080 MAJOR PHARMACEUTICALS yGG/PSE CR TAB 600-120 00904540440 MAJOR PHARMACEUTICALS yGG/PSE CR TAB 600-120 00904540460 MAJOR PHARMACEUTICALS yFAST DISSOLV CHW ANTACID 00904541164 MAJOR PHARMACEUTICALS yIBU-PRO COLD TAB /SINUS 00904541295 MAJOR PHARMACEUTICALS yPANCRELIPASE CAP 4500UNIT 00904541360 MAJOR PHARMACEUTICALS yPANCRELIPASE CAP 4500UNIT 00904541370 MAJOR PHARMACEUTICALS yMICONAZOLE 3 KIT COMBO PK 00904541501 MAJOR PHARMACEUTICALS ySUCRALFATE TAB 1GM 00904543840 MAJOR PHARMACEUTICALS ySUCRALFATE TAB 1GM 00904543860 MAJOR PHARMACEUTICALS ySUCRALFATE TAB 1GM 00904543861 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIMETIDINE TAB 300MG 00904544540 MAJOR PHARMACEUTICALS yCIMETIDINE TAB 300MG 00904544560 MAJOR PHARMACEUTICALS yCIMETIDINE TAB 300MG 00904544561 MAJOR PHARMACEUTICALS yCIMETIDINE TAB 400MG 00904544640 MAJOR PHARMACEUTICALS yCIMETIDINE TAB 400MG 00904544660 MAJOR PHARMACEUTICALS yCIMETIDINE TAB 400MG 00904544661 MAJOR PHARMACEUTICALS yCIMETIDINE TAB 800MG 00904544761 MAJOR PHARMACEUTICALS yPENTOXIFYLLI TAB 400MG ER 00904544840 MAJOR PHARMACEUTICALS yPENTOXIFYLLI TAB 400MG ER 00904544860 MAJOR PHARMACEUTICALS yPENTOXIFYLLI TAB 400MG ER 00904544861 MAJOR PHARMACEUTICALS ySENNA SYP 00904545209 MAJOR PHARMACEUTICALS yGAS FREE CAP 125MG XS 00904545846 MAJOR PHARMACEUTICALS yIBUPROFEN SUS INFANTS 00904546330 MAJOR PHARMACEUTICALS yCHLD IBUPRFN DRO 40MG/ML 00904546335 MAJOR PHARMACEUTICALS yCHLD IBUPROF SUS 100/5ML 00904546420 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 1MG 00904548260 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 10MG 00904548560 MAJOR PHARMACEUTICALS yCERTA-VITE TAB SR/LUTEN 00904548652 MAJOR PHARMACEUTICALS yCERTA-VITE TAB SR/LUTEN 00904548689 MAJOR PHARMACEUTICALS yCOUGH DROPS LOZ CHERRY 00904548746 MAJOR PHARMACEUTICALS yCOUGH DROPS LOZ HON LEM 00904548846 MAJOR PHARMACEUTICALS yMENTHOL COUG LOZ 00904548946 MAJOR PHARMACEUTICALS yMIGRATINE CAP 00904549160 MAJOR PHARMACEUTICALS yNITROGLYCER DIS 0.2MG/HR 00904549546 MAJOR PHARMACEUTICALS yNITROGLYCER DIS 0.4MG/HR 00904549646 MAJOR PHARMACEUTICALS yNITROGLYCER DIS 0.6MG/HR 00904549746 MAJOR PHARMACEUTICALS yENALAPRIL TAB 5MG 00904550260 MAJOR PHARMACEUTICALS yENALAPRIL TAB 5MG 00904550261 MAJOR PHARMACEUTICALS yENALAPRIL TAB 5MG 00904550280 MAJOR PHARMACEUTICALS ySENNA PLUS TAB 8.6-50MG 00904551252 MAJOR PHARMACEUTICALS ySENNA PLUS TAB 8.6-50MG 00904551261 MAJOR PHARMACEUTICALS ySENNA PLUS TAB 8.6-50MG 00904551280 MAJOR PHARMACEUTICALS yDOXAZOSIN TAB 1MG 00904552260 MAJOR PHARMACEUTICALS yDOXAZOSIN TAB 1MG 00904552261 MAJOR PHARMACEUTICALS yDOXAZOSIN TAB 2MG 00904552360 MAJOR PHARMACEUTICALS yDOXAZOSIN TAB 2MG 00904552361 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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DOXAZOSIN TAB 4MG 00904552460 MAJOR PHARMACEUTICALS yDOXAZOSIN TAB 4MG 00904552461 MAJOR PHARMACEUTICALS yDOXAZOSIN TAB 8MG 00904552560 MAJOR PHARMACEUTICALS yHEARTBURN TAB RELIEF 00904552949 MAJOR PHARMACEUTICALS yHEARTBURN TAB RELIEF 00904552952 MAJOR PHARMACEUTICALS yHEARTBURN TAB RELIEF 00904552987 MAJOR PHARMACEUTICALS yROBAFEN CF SYP 00904553009 MAJOR PHARMACEUTICALS yROBAFEN CF SYP 00904553020 MAJOR PHARMACEUTICALS yEFFERVESCENT TAB COLD REL 00904553473 MAJOR PHARMACEUTICALS yNAPROXEN TAB 250MG 00904553561 MAJOR PHARMACEUTICALS yNAPROXEN TAB 375MG 00904553661 MAJOR PHARMACEUTICALS yNAPROXEN TAB 500MG 00904553761 MAJOR PHARMACEUTICALS yDIMAPHEN DM ELX 00904554120 MAJOR PHARMACEUTICALS yDIMAPHEN ELX 00904554209 MAJOR PHARMACEUTICALS yDIMAPHEN ELX 00904554220 MAJOR PHARMACEUTICALS yGG/PSE TAB 1200/120 00904554360 MAJOR PHARMACEUTICALS yBANOPHEN TAB 25MG 00904555124 MAJOR PHARMACEUTICALS yBANOPHEN TAB 25MG 00904555159 MAJOR PHARMACEUTICALS yPEDIA RELIEF DRO INFANT 00904555235 MAJOR PHARMACEUTICALS yFAMOTIDINE TAB 20MG 00904555346 MAJOR PHARMACEUTICALS yFAMOTIDINE TAB 20MG 00904555360 MAJOR PHARMACEUTICALS yFAMOTIDINE TAB 20MG 00904555361 MAJOR PHARMACEUTICALS yFAMOTIDINE TAB 20MG 00904555380 MAJOR PHARMACEUTICALS yFAMOTIDINE TAB 40MG 00904555446 MAJOR PHARMACEUTICALS yFAMOTIDINE TAB 40MG 00904555461 MAJOR PHARMACEUTICALS yTRAMADOL HCL TAB 50MG 00904555640 MAJOR PHARMACEUTICALS yTRAMADOL HCL TAB 50MG 00904555660 MAJOR PHARMACEUTICALS yTRAMADOL HCL TAB 50MG 00904555661 MAJOR PHARMACEUTICALS yPRIMIDONE TAB 50MG 00904555940 MAJOR PHARMACEUTICALS yPRIMIDONE TAB 50MG 00904555960 MAJOR PHARMACEUTICALS yLITHIUM CARB CAP 300MG 00904556860 MAJOR PHARMACEUTICALS yLITHIUM CARB CAP 300MG 00904556880 MAJOR PHARMACEUTICALS yRHINATATE-NF SUS PEDI 00904557116 MAJOR PHARMACEUTICALS yGAS RELIEF CAP 180MG 00904557252 MAJOR PHARMACEUTICALS yRONDAMINE DM DRO 00904557330 MAJOR PHARMACEUTICALS yRONDAMINE DM SYP 00904557416 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHLD IBUPROF SUS 100/5ML 00904557720 MAJOR PHARMACEUTICALS yGUANFACINE TAB 1MG 00904557960 MAJOR PHARMACEUTICALS yGUANFACINE TAB 2MG 00904558060 MAJOR PHARMACEUTICALS yLOVASTATIN TAB 10MG 00904558152 MAJOR PHARMACEUTICALS yLOVASTATIN TAB 20MG 00904558252 MAJOR PHARMACEUTICALS yLOVASTATIN TAB 40MG 00904558352 MAJOR PHARMACEUTICALS yINDOMETHACIN CAP 75MG ER 00904558452 MAJOR PHARMACEUTICALS yINDOMETHACIN CAP 75MG ER 00904558460 MAJOR PHARMACEUTICALS yGG/PE TAB 30-600MG 00904558560 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 5MG 00904558740 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 5MG 00904558760 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 5MG 00904558761 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 10MG 00904558840 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 10MG 00904558860 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 10MG 00904558861 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 15MG 00904558960 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 15MG 00904558961 MAJOR PHARMACEUTICALS yBUSPIRONE TAB 15MG 00904558993 MAJOR PHARMACEUTICALS yNAPROXEN TAB 375MG 00904559040 MAJOR PHARMACEUTICALS yNAPROXEN TAB 375MG 00904559060 MAJOR PHARMACEUTICALS yNAPROXEN TAB 500MG 00904559140 MAJOR PHARMACEUTICALS yNAPROXEN TAB 500MG 00904559160 MAJOR PHARMACEUTICALS yFERRIC PS ELX 100/5ML 00904559309 MAJOR PHARMACEUTICALS yMETFORMIN TAB 500MG 00904560152 MAJOR PHARMACEUTICALS yMETFORMIN TAB 500MG 00904560161 MAJOR PHARMACEUTICALS yMETFORMIN TAB 500MG 00904560180 MAJOR PHARMACEUTICALS yMETFORMIN TAB 500MG 00904560189 MAJOR PHARMACEUTICALS yMETFORMIN TAB 850MG 00904560240 MAJOR PHARMACEUTICALS yMETFORMIN TAB 850MG 00904560253 MAJOR PHARMACEUTICALS yMETFORMIN TAB 850MG 00904560261 MAJOR PHARMACEUTICALS yMETFORMIN TAB 850MG 00904560289 MAJOR PHARMACEUTICALS yMETFORMIN TAB 1000MG 00904560340 MAJOR PHARMACEUTICALS yMETFORMIN TAB 1000MG 00904560361 MAJOR PHARMACEUTICALS yMETFORMIN TAB 1000MG 00904560389 MAJOR PHARMACEUTICALS yMETFORMIN TAB 1000MG 00904560393 MAJOR PHARMACEUTICALS yHISDEC LIQ 2-30MG 00904560616 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRIL TAB 2.5MG 00904560960 MAJOR PHARMACEUTICALS yENALAPRIL TAB 2.5MG 00904560961 MAJOR PHARMACEUTICALS yENALAPRIL TAB 10MG 00904561060 MAJOR PHARMACEUTICALS yENALAPRIL TAB 10MG 00904561061 MAJOR PHARMACEUTICALS yENALAPRIL TAB 10MG 00904561080 MAJOR PHARMACEUTICALS yENALAPRIL TAB 20MG 00904561160 MAJOR PHARMACEUTICALS yENALAPRIL TAB 20MG 00904561161 MAJOR PHARMACEUTICALS yENALAPRIL TAB 20MG 00904561180 MAJOR PHARMACEUTICALS yALLERGY/CONG TAB RELIEF 00904562415 MAJOR PHARMACEUTICALS yALLERGY/CONG TAB RELIEF 00904562466 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 100MG 00904563161 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 100MG 00904563189 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 300MG 00904563246 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 300MG 00904563253 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 300MG 00904563261 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 300MG 00904563289 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 300MG 00904563293 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 400MG 00904563361 MAJOR PHARMACEUTICALS yGABAPENTIN CAP 400MG 00904563389 MAJOR PHARMACEUTICALS yMETFORMIN TAB 500MG 00904563461 MAJOR PHARMACEUTICALS yMETFORMIN TAB 850MG 00904563561 MAJOR PHARMACEUTICALS yMETFORMIN TAB 1000MG 00904563661 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 2.5MG 00904563761 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 5MG 00904563843 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 5MG 00904563846 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 5MG 00904563861 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 5MG 00904563889 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 10MG 00904563943 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 10MG 00904563946 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 10MG 00904563948 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 10MG 00904563961 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 10MG 00904563989 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 10MG 00904563993 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 20MG 00904564043 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 20MG 00904564046 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 20MG 00904564048 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOPRIL TAB 20MG 00904564061 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 20MG 00904564089 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 20MG 00904564093 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564243 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564246 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564248 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564252 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564261 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564289 MAJOR PHARMACEUTICALS yLISINOPRIL TAB 40MG 00904564293 MAJOR PHARMACEUTICALS yDOK PLUS TAB NEW FORM 00904564360 MAJOR PHARMACEUTICALS yDOK PLUS TAB NEW FORM 00904564361 MAJOR PHARMACEUTICALS yDOK PLUS TAB NEW FORM 00904564380 MAJOR PHARMACEUTICALS yQUININE SULF CAP 325MG 00904564860 MAJOR PHARMACEUTICALS yLITHIUM CARB TAB 300MG ER 00904564960 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 1MG 00904565060 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 1MG 00904565061 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 2MG 00904565160 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 2MG 00904565161 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 5MG 00904565260 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 5MG 00904565261 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 10MG 00904565360 MAJOR PHARMACEUTICALS yTERAZOSIN CAP 10MG 00904565361 MAJOR PHARMACEUTICALS yMETHOCARBAM TAB 500MG 00904565440 MAJOR PHARMACEUTICALS yCLONIDINE TAB 0.1MG 00904565661 MAJOR PHARMACEUTICALS yCLONIDINE TAB 0.2MG 00904565761 MAJOR PHARMACEUTICALS yCLONIDINE TAB 0.3MG 00904565861 MAJOR PHARMACEUTICALS yORAL SALINE SOL LAXATIVE 00904566656 MAJOR PHARMACEUTICALS yALLERGY RELF SYP 5MG/5ML 00904567120 MAJOR PHARMACEUTICALS yFIBER THERAP TAB 500MG 00904567460 MAJOR PHARMACEUTICALS ySOLUBLE FIB POW THERAPY 00904567516 MAJOR PHARMACEUTICALS yPAROXETINE TAB 10MG 00904567661 MAJOR PHARMACEUTICALS yPAROXETINE TAB 20MG 00904567761 MAJOR PHARMACEUTICALS yPAROXETINE TAB 30MG 00904567861 MAJOR PHARMACEUTICALS yPAROXETINE TAB 40MG 00904567961 MAJOR PHARMACEUTICALS yCHILD IBUPRO SUS COLD 00904568120 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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OMEPRAZOLE CAP 20MG 00904568461 MAJOR PHARMACEUTICALS yIBUPROFEN JR CHW 100MG 00904569124 MAJOR PHARMACEUTICALS yMICONAZOLE 3 KIT COMBO PK 00904569368 MAJOR PHARMACEUTICALS yALLERGY RELF TAB 10MG 00904569987 MAJOR PHARMACEUTICALS yTIZANIDINE TAB 2MG 00904570261 MAJOR PHARMACEUTICALS yTIZANIDINE TAB 4MG 00904570361 MAJOR PHARMACEUTICALS yKAO-TIN SUS 262/15ML 00904570909 MAJOR PHARMACEUTICALS yKAO-TIN SUS 262/15ML 00904570916 MAJOR PHARMACEUTICALS yNASAL DECONG SPR 0.05% 00904571130 MAJOR PHARMACEUTICALS yNASAL DECONG SPR 0.05% 00904571135 MAJOR PHARMACEUTICALS yOMEPRAZOLE CAP 20MG 00904571589 MAJOR PHARMACEUTICALS yFIBER THERAP CAP 0.52GM 00904571691 MAJOR PHARMACEUTICALS yMINTOX SUS 00904572114 MAJOR PHARMACEUTICALS yCOUGH DROPS LOZ CHERRY 00904572246 MAJOR PHARMACEUTICALS yCOUGH DROPS LOZ HON LEMN 00904572346 MAJOR PHARMACEUTICALS yCOUGH DROPS LOZ MENTHOL 00904572446 MAJOR PHARMACEUTICALS yMINTOX SUS MAX STR 00904572514 MAJOR PHARMACEUTICALS yCLEAR-ATADIN TAB D 24HR 00904572615 MAJOR PHARMACEUTICALS yCLEAR-ATADIN TAB D 24HR 00904572648 MAJOR PHARMACEUTICALS yCLEAR-ATADIN SYP 5MG/5ML 00904572720 MAJOR PHARMACEUTICALS yCLEAR-ATADIN TAB 10MG 00904572815 MAJOR PHARMACEUTICALS yCLEAR-ATADIN TAB 10MG 00904572887 MAJOR PHARMACEUTICALS yCLEAR-ATADIN TAB 10MG 00904572889 MAJOR PHARMACEUTICALS yNIGHT TIME CAP 00904572912 MAJOR PHARMACEUTICALS yDAY TIME CAP COLD/FLU 00904573012 MAJOR PHARMACEUTICALS yPETROLEUM GEL JELLY 00904573182 MAJOR PHARMACEUTICALS yTHERAPY ICE GEL 2% 00904573226 MAJOR PHARMACEUTICALS ySUDOGEST PE TAB 10MG 00904573373 MAJOR PHARMACEUTICALS yNICORELIEF GUM 2MG 00904573411 MAJOR PHARMACEUTICALS yNICORELIEF GUM 2MG 00904573451 MAJOR PHARMACEUTICALS yNICORELIEF GUM 2MG 00904573495 MAJOR PHARMACEUTICALS yNICORELIEF GUM 4MG 00904573511 MAJOR PHARMACEUTICALS yNICORELIEF GUM 4MG 00904573551 MAJOR PHARMACEUTICALS yNICORELIEF GUM 4MG 00904573595 MAJOR PHARMACEUTICALS yNICORELIEF GUM 2MG 00904573611 MAJOR PHARMACEUTICALS yNICORELIEF GUM 2MG 00904573651 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NICORELIEF GUM 2MG 00904573695 MAJOR PHARMACEUTICALS yNICORELIEF GUM 4MG 00904573711 MAJOR PHARMACEUTICALS yNICORELIEF GUM 4MG 00904573751 MAJOR PHARMACEUTICALS yNICORELIEF GUM 4MG 00904573795 MAJOR PHARMACEUTICALS yCARB/LEVO ER TAB 25/100 00904574961 MAJOR PHARMACEUTICALS yCARB/LEVO ER TAB 50-200MG 00904575061 MAJOR PHARMACEUTICALS yCHLDS MAPAP TAB 80MG RT 00904575146 MAJOR PHARMACEUTICALS yROBAFEN CGH CAP 15MG 00904575295 MAJOR PHARMACEUTICALS yMENSTRUAL TAB COMPLETE 00904575360 MAJOR PHARMACEUTICALS yJUNIOR MAPAP TAB 160MG RT 00904575424 MAJOR PHARMACEUTICALS yPOLYETH GLYC POW 3350 NF 00904575526 MAJOR PHARMACEUTICALS yPOLYETH GLYC POW 3350 NF 00904575527 MAJOR PHARMACEUTICALS yMUCUS RELIEF TAB 400MG 00904575846 MAJOR PHARMACEUTICALS yMUCUS RELIEF TAB 400MG 00904575852 MAJOR PHARMACEUTICALS yMUCUS RELIEF TAB DM 00904575946 MAJOR PHARMACEUTICALS yMUCUS RELIEF TAB DM 00904575952 MAJOR PHARMACEUTICALS yDAY TIME CAP COLD/FLU 00904576312 MAJOR PHARMACEUTICALS yNIGHT TIME CAP COLD/FLU 00904576412 MAJOR PHARMACEUTICALS yMAPAP SINUS TAB PE 00904576524 MAJOR PHARMACEUTICALS yMAPAP ARTHRI TAB 650MG 00904576960 MAJOR PHARMACEUTICALS yROBAFEN CF SYP CGH/COLD 00904577009 MAJOR PHARMACEUTICALS yROBAFEN CF SYP CGH/COLD 00904577020 MAJOR PHARMACEUTICALS yMUCUSRELIEF TAB DM 00904577146 MAJOR PHARMACEUTICALS yMUCUSRELIEF TAB DM 00904577152 MAJOR PHARMACEUTICALS yALL-NITE LIQ COLD/FLU 00904577621 MAJOR PHARMACEUTICALS yALL-NITE LIQ COLD/FLU 00904577721 MAJOR PHARMACEUTICALS yKAO-TIN CAP 240MG 00904577960 MAJOR PHARMACEUTICALS yHEARTBURN TAB RELIEF 00904578017 MAJOR PHARMACEUTICALS yHEARTBURN TAB RELIEF 00904578051 MAJOR PHARMACEUTICALS yDIMAPHEN ELX CHILDREN 00904578109 MAJOR PHARMACEUTICALS yDIMAPHEN ELX CHILDREN 00904578120 MAJOR PHARMACEUTICALS yDIMAPHEN DM ELX COLD/CGH 00904578220 MAJOR PHARMACEUTICALS yMAPAP SINUS TAB MAX STR 00904578324 MAJOR PHARMACEUTICALS yMAPAP JR STR TAB 160MG 00904758924 MAJOR PHARMACEUTICALS yFIBER-EZE POW 28% CIT 00904761471 MAJOR PHARMACEUTICALS yMIGRATINE CAP 00904762260 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MIGRATINE CAP 00904762270 MAJOR PHARMACEUTICALS yHYDROCORT CRE 1% 00904762331 MAJOR PHARMACEUTICALS yHYDROCORT OIN 1% 00904762431 MAJOR PHARMACEUTICALS yHYDROCO/APAP TAB 7.5-750 00904763261 MAJOR PHARMACEUTICALS yNIGHT TIME CAP LIQUID 00904763312 MAJOR PHARMACEUTICALS yMAPAP PM TAB 25-500MG 00904765151 MAJOR PHARMACEUTICALS yMAPAP COLD TAB FORMULA 00904765524 MAJOR PHARMACEUTICALS yALBUTEROL NEB 0.5% 00904765855 MAJOR PHARMACEUTICALS yPED ELCTRLYT SOL PLAIN 00904765909 MAJOR PHARMACEUTICALS yPED ELCTRLYT SOL PLAIN 00904765969 MAJOR PHARMACEUTICALS yANU-MED SUP 00904768822 MAJOR PHARMACEUTICALS yMAPAP SUP 120MG 00904769212 MAJOR PHARMACEUTICALS yCAL ANTACID CHW 750MG XS 00904769591 MAJOR PHARMACEUTICALS yMINTOX CHW 00904769660 MAJOR PHARMACEUTICALS yPROPOXY HCL CAP 65MG 00904770061 MAJOR PHARMACEUTICALS yPROPO-N/APAP TAB 100-650 00904770240 MAJOR PHARMACEUTICALS yPROPO-N/APAP TAB 100-650 00904770280 MAJOR PHARMACEUTICALS yPROPO-N/APAP TAB 100-650 00904770340 MAJOR PHARMACEUTICALS yASPIR-LOW TAB 81MG EC 00904770418 MAJOR PHARMACEUTICALS yASPIR-LOW TAB 81MG EC 00904770470 MAJOR PHARMACEUTICALS yASPIR-LOW TAB 81MG EC 00904770480 MAJOR PHARMACEUTICALS yCARB/LEVO TAB 10-100MG 00904771861 MAJOR PHARMACEUTICALS yCARB/LEVO TAB 25-100MG 00904771961 MAJOR PHARMACEUTICALS yCARB/LEVO TAB 25-250MG 00904772061 MAJOR PHARMACEUTICALS yDESONIDE CRE 0.05% 00904772402 MAJOR PHARMACEUTICALS yDESONIDE CRE 0.05% 00904772436 MAJOR PHARMACEUTICALS yANTI-DIARRHE TAB 2MG 00904772512 MAJOR PHARMACEUTICALS yANTI-DIARRHE TAB 2MG 00904772524 MAJOR PHARMACEUTICALS yRON ACID SUS PLUS 00904772614 MAJOR PHARMACEUTICALS yACID GONE SUS 00904772714 MAJOR PHARMACEUTICALS yCLEMASTINE TAB 1.34MG 00904772988 MAJOR PHARMACEUTICALS yMICONAZOLE CRE 2% 00904773445 MAJOR PHARMACEUTICALS yMICONAZOLE CRE 2% 00904773457 MAJOR PHARMACEUTICALS yBENZONATATE CAP 100MG 00904773760 MAJOR PHARMACEUTICALS yDENTURE TAB 00904774439 MAJOR PHARMACEUTICALS yMINERIN CRE 00904775127 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MINERIN LOT 00904775216 MAJOR PHARMACEUTICALS yCALLERGY LOT CLEAR 00904776021 MAJOR PHARMACEUTICALS yMAPAP SUP 650MG 00904776812 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 50MG 00904777261 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 100MG 00904777360 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 100MG 00904777361 MAJOR PHARMACEUTICALS yAPAP/CODEINE ELX 120-12/5 00904777516 MAJOR PHARMACEUTICALS yCLOTRIMAZOLE CRE 1% VAG 00904777645 MAJOR PHARMACEUTICALS yPSEUDOCHLOR CAP 8-120 CR 00904777770 MAJOR PHARMACEUTICALS yVERAPAMIL TAB 40MG 00904779960 MAJOR PHARMACEUTICALS yCYCLOBENZAPR TAB 10MG 00904780940 MAJOR PHARMACEUTICALS yCYCLOBENZAPR TAB 10MG 00904780960 MAJOR PHARMACEUTICALS yCYCLOBENZAPR TAB 10MG 00904780961 MAJOR PHARMACEUTICALS yCYCLOBENZAPR TAB 10MG 00904780980 MAJOR PHARMACEUTICALS yTRI-A-VITE CHW W/FL 1MG 00904781060 MAJOR PHARMACEUTICALS yDAY TIME LIQ CAP 00904781512 MAJOR PHARMACEUTICALS yCURES ATHLET CRE FOOT 00904782231 MAJOR PHARMACEUTICALS yCURES ATHLET CRE FOOT 00904782236 MAJOR PHARMACEUTICALS yCAMPHOR/PHEN LIQ 00904785175 MAJOR PHARMACEUTICALS yTHYROID TAB 30MG 00904786560 MAJOR PHARMACEUTICALS yTHYROID TAB 30MG 00904786580 MAJOR PHARMACEUTICALS ySENIOR TONIC ELX 00904787416 MAJOR PHARMACEUTICALS yATENOL/CHLOR TAB 50-25MG 00904788160 MAJOR PHARMACEUTICALS yDOK CAP 100MG 00904788959 MAJOR PHARMACEUTICALS yDOK CAP 100MG 00904788960 MAJOR PHARMACEUTICALS yDOK CAP 100MG 00904788980 MAJOR PHARMACEUTICALS yDOK PLUS CAP 100-30 00904789060 MAJOR PHARMACEUTICALS yDOK CAP 250MG 00904789159 MAJOR PHARMACEUTICALS ySULFOLAX CAP 240MG 00904789259 MAJOR PHARMACEUTICALS yDICYCLOMINE CAP 10MG 00904789680 MAJOR PHARMACEUTICALS yMAG-DELAY TAB 00904791152 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791251 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791259 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791451 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791459 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791461 MAJOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IBUPROFEN TAB 200MG 00904791524 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791540 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791551 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791559 MAJOR PHARMACEUTICALS yIBUPROFEN TAB 200MG 00904791570 MAJOR PHARMACEUTICALS yPHENAZOPYRID TAB 100MG 00904792260 MAJOR PHARMACEUTICALS yPHENAZOPYRID TAB 200MG 00904792360 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 5MG 00904792440 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 5MG 00904792460 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 5MG 00904792461 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 5MG 00904792480 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 10MG 00904792540 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 10MG 00904792560 MAJOR PHARMACEUTICALS yGLIPIZIDE TAB 10MG 00904792580 MAJOR PHARMACEUTICALS yERYTHROMYCIN OIN OP 00904792638 MAJOR PHARMACEUTICALS yBISACODYL TAB 5MG EC 00904792717 MAJOR PHARMACEUTICALS yBISACODYL TAB 5MG EC 00904792760 MAJOR PHARMACEUTICALS yBISACODYL TAB 5MG EC 00904792761 MAJOR PHARMACEUTICALS yBISACODYL TAB 5MG EC 00904792780 MAJOR PHARMACEUTICALS yFORMULA B TAB PLUS 00904792960 MAJOR PHARMACEUTICALS yNEO/POLY/DEX OIN 0.1% OP 00904793838 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 50MG 00904794660 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 50MG 00904794680 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 100MG 00904794760 MAJOR PHARMACEUTICALS yMETOPROLOL TAB 100MG 00904794780 MAJOR PHARMACEUTICALS yPAIN RELIEF TAB EFFERVES 00904794873 MAJOR PHARMACEUTICALS yMAPAP SINUS TAB MAX-STR 00904795424 MAJOR PHARMACEUTICALS ySTAY AWAKE TAB 200MG 00904795544 MAJOR PHARMACEUTICALS yANAGRELIDE CAP 0.5MG 00406007101 MALLINCKRODT INC. yANAGRELIDE CAP 1MG 00406007201 MALLINCKRODT INC. yDEPADE TAB 50MG 00406009201 MALLINCKRODT INC. yDEPADE TAB 50MG 00406009203 MALLINCKRODT INC. yHYDROCO/APAP TAB 5-500MG 00406035701 MALLINCKRODT INC. yHYDROCO/APAP TAB 5-500MG 00406035705 MALLINCKRODT INC. yHYDROCO/APAP TAB 5-500MG 00406035733 MALLINCKRODT INC. yHYDROCO/APAP TAB 5-500MG 00406035762 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCO/APAP TAB 5-500MG 00406035791 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-500 00406035801 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-500 00406035805 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-500 00406035833 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-500 00406035862 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-650 00406035901 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-650 00406035905 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-750 00406036001 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-750 00406036005 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-650MG 00406036101 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-650MG 00406036105 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-650MG 00406036162 MALLINCKRODT INC. yHYDROCO/APAP TAB 10/660MG 00406036201 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-500MG 00406036301 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-500MG 00406036305 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-500MG 00406036362 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-500MG 00406036391 MALLINCKRODT INC. yHYDROCO/APAP TAB 5-325MG 00406036501 MALLINCKRODT INC. yHYDROCO/APAP TAB 5-325MG 00406036562 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-325 00406036601 MALLINCKRODT INC. yHYDROCO/APAP TAB 7.5-325 00406036662 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-325MG 00406036701 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-325MG 00406036705 MALLINCKRODT INC. yHYDROCO/APAP TAB 10-325MG 00406036762 MALLINCKRODT INC. yHYDROCODONE/ SOL APAP 00406037516 MALLINCKRODT INC. yDIPHEN/ATROP TAB 2.5MG 00406046301 MALLINCKRODT INC. yDIPHEN/ATROP TAB 2.5MG 00406046310 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-15MG 00406048301 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-15MG 00406048310 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048401 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048403 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048410 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048420 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048433 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048450 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-30MG 00406048462 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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APAP/CODEINE TAB 300-60MG 00406048501 MALLINCKRODT INC. yAPAP/CODEINE TAB 300-60MG 00406048505 MALLINCKRODT INC. yOXYCOD/APAP TAB 5-325MG 00406051201 MALLINCKRODT INC. yOXYCOD/APAP TAB 5-325MG 00406051205 MALLINCKRODT INC. yOXYCOD/APAP TAB 5-325MG 00406051232 MALLINCKRODT INC. yOXYCOD/APAP TAB 5-325MG 00406051262 MALLINCKRODT INC. yOXYCOD/APAP TAB 5-325MG 00406051291 MALLINCKRODT INC. yOXYCOD-APAP TAB 7.5-325 00406052201 MALLINCKRODT INC. yOXYCODO-APAP TAB 10-325 00406052301 MALLINCKRODT INC. yOXYCODO-APAP TAB 10-325 00406052362 MALLINCKRODT INC. yMETHADOSE CON 10MG/ML 00406052710 MALLINCKRODT INC. yOXYCOD/APAP CAP 5-500MG 00406053201 MALLINCKRODT INC. yOXYCOD/APAP CAP 5-500MG 00406053205 MALLINCKRODT INC. yMETHADOSE TAB 40MG 00406054034 MALLINCKRODT INC. yOXYCODONE TAB 5MG 00406055201 MALLINCKRODT INC. yOXYCODONE TAB 5MG 00406055232 MALLINCKRODT INC. yOXYCODONE TAB 5MG 00406055262 MALLINCKRODT INC. yOXYCODONE CAP 5MG 00406055401 MALLINCKRODT INC. yOXYCO/APAP TAB 10-650 00406056201 MALLINCKRODT INC. yFLUOXETINE CAP 10MG 00406066101 MALLINCKRODT INC. yFLUOXETINE CAP 10MG 00406066105 MALLINCKRODT INC. yFLUOXETINE CAP 10MG 00406066191 MALLINCKRODT INC. yFLUOXETINE CAP 20MG 00406066301 MALLINCKRODT INC. yFLUOXETINE CAP 20MG 00406066303 MALLINCKRODT INC. yFLUOXETINE CAP 20MG 00406066305 MALLINCKRODT INC. yFLUOXETINE CAP 20MG 00406066362 MALLINCKRODT INC. yFLUOXETINE CAP 20MG 00406066391 MALLINCKRODT INC. yFLUOXETINE SOL 20MG/5ML 00406066701 MALLINCKRODT INC. ySUFENTANIL POW CITRATE 00406067252 MALLINCKRODT INC. yLEVORPHANOL POW TARTRATE 00406073552 MALLINCKRODT INC. yMORPHINE SUL SOL 20MG/ML 00406082903 MALLINCKRODT INC. yMORPHINE SUL SOL 20MG/ML 00406082912 MALLINCKRODT INC. yMORPHINE SUL SOL 20MG/ML 00406082915 MALLINCKRODT INC. yMORPHINE SUL SOL 20MG/ML 00406082924 MALLINCKRODT INC. yMORPHINE SUL SOL 20MG/ML 00406083015 MALLINCKRODT INC. yMORPHINE SUL SOL 20MG/ML 00406083024 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MORPHINE SUL SOL 20MG/ML 00406083030 MALLINCKRODT INC. yBUT/APAP/CAF TAB 00406097001 MALLINCKRODT INC. yBUT/APAP/CAF TAB 00406097005 MALLINCKRODT INC. yMETHYLIN TAB 5MG 00406112101 MALLINCKRODT INC. yMETHYLIN TAB 5MG 00406112110 MALLINCKRODT INC. yMETHYLIN TAB 10MG 00406112201 MALLINCKRODT INC. yMETHYLIN TAB 10MG 00406112210 MALLINCKRODT INC. yMETHYLIN TAB 20MG 00406112401 MALLINCKRODT INC. yMETHYLIN TAB 20MG 00406112410 MALLINCKRODT INC. yFENTANYL POW CITRATE 00406113052 MALLINCKRODT INC. yNALTREXONE TAB 50MG 00406117001 MALLINCKRODT INC. yNALTREXONE TAB 50MG 00406117003 MALLINCKRODT INC. yPROPOXYPHENE POW NAPSYLAT 00406128355 MALLINCKRODT INC. yPROPOXYPHENE POW NAPSYLAT 00406128356 MALLINCKRODT INC. yPROPOXYPHENE POW NAPSYLAT 00406128357 MALLINCKRODT INC. yMETHYLIN ER TAB 10MG 00406142301 MALLINCKRODT INC. yNALOXONE HCL POW 00406149252 MALLINCKRODT INC. yMETHADONE POW 00406151056 MALLINCKRODT INC. yMETHADONE POW 00406151057 MALLINCKRODT INC. yMETHADONE POW 00406151059 MALLINCKRODT INC. yCOCAINE HCL POW 00406152053 MALLINCKRODT INC. yCOCAINE HCL POW 00406152055 MALLINCKRODT INC. yMORPHINE POW SULFATE 00406152153 MALLINCKRODT INC. yMORPHINE POW SULFATE 00406152155 MALLINCKRODT INC. yMORPHINE POW SULFATE 00406152156 MALLINCKRODT INC. yMORPHINE POW SULFATE 00406152157 MALLINCKRODT INC. yCODEINE POW PHOSPHAT 00406154832 MALLINCKRODT INC. yCODEINE POW PHOSPHAT 00406154835 MALLINCKRODT INC. yMETHYLPHENID POW HCL 00406157155 MALLINCKRODT INC. yHYDROCODONE CRY BITARTRA 00406158253 MALLINCKRODT INC. yHYDROCODONE CRY BITARTRA 00406158257 MALLINCKRODT INC. yMEPERIDINE POW 00406158555 MALLINCKRODT INC. yPROPO-N/APAP TAB 100-650 00406172101 MALLINCKRODT INC. yPROPO-N/APAP TAB 100-650 00406172105 MALLINCKRODT INC. yPROPO-N/APAP TAB 100-650 00406172110 MALLINCKRODT INC. yPROPO-N/APAP TAB 100-650 00406177201 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROPO-N/APAP TAB 100-650 00406177205 MALLINCKRODT INC. yPROPO-N/APAP TAB 100-650 00406177210 MALLINCKRODT INC. yPROPO-N/APAP TAB 100-650 00406177262 MALLINCKRODT INC. yATENOLOL TAB 25MG 00406202201 MALLINCKRODT INC. yATENOLOL TAB 25MG 00406202210 MALLINCKRODT INC. yATENOLOL TAB 50MG 00406202301 MALLINCKRODT INC. yATENOLOL TAB 50MG 00406202310 MALLINCKRODT INC. yATENOLOL TAB 100MG 00406202401 MALLINCKRODT INC. yATENOLOL TAB 100MG 00406202410 MALLINCKRODT INC. yMETFORMIN TAB 500MG 00406202801 MALLINCKRODT INC. yMETFORMIN TAB 500MG 00406202805 MALLINCKRODT INC. yMETFORMIN TAB 500MG 00406202810 MALLINCKRODT INC. yMETFORMIN TAB 850MG 00406202901 MALLINCKRODT INC. yMETFORMIN TAB 850MG 00406202905 MALLINCKRODT INC. yMETFORMIN TAB 1000MG 00406203001 MALLINCKRODT INC. yMETFORMIN TAB 1000MG 00406203005 MALLINCKRODT INC. yPROMETHAZINE TAB 12.5MG 00406204001 MALLINCKRODT INC. yPROMETHAZINE TAB 25MG 00406204101 MALLINCKRODT INC. yPROMETHAZINE TAB 50MG 00406204201 MALLINCKRODT INC. yRIBAVIRIN TAB 200MG 00406204616 MALLINCKRODT INC. yWARFARIN TAB 1MG 00406205201 MALLINCKRODT INC. yWARFARIN TAB 1MG 00406205210 MALLINCKRODT INC. yWARFARIN TAB 2MG 00406205301 MALLINCKRODT INC. yWARFARIN TAB 2MG 00406205310 MALLINCKRODT INC. yWARFARIN TAB 3MG 00406205401 MALLINCKRODT INC. yWARFARIN TAB 3MG 00406205410 MALLINCKRODT INC. yWARFARIN TAB 4MG 00406205501 MALLINCKRODT INC. yWARFARIN TAB 4MG 00406205510 MALLINCKRODT INC. yWARFARIN TAB 5MG 00406205601 MALLINCKRODT INC. yWARFARIN TAB 5MG 00406205610 MALLINCKRODT INC. yWARFARIN TAB 6MG 00406205701 MALLINCKRODT INC. yWARFARIN TAB 7.5MG 00406205801 MALLINCKRODT INC. yWARFARIN TAB 10MG 00406205901 MALLINCKRODT INC. yWARFARIN TAB 2.5MG 00406206401 MALLINCKRODT INC. yWARFARIN TAB 2.5MG 00406206410 MALLINCKRODT INC. yRIBAVIRIN CAP 200MG 00406226042 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RIBAVIRIN CAP 200MG 00406226056 MALLINCKRODT INC. yRIBAVIRIN CAP 200MG 00406226070 MALLINCKRODT INC. yRIBAVIRIN CAP 200MG 00406226084 MALLINCKRODT INC. yMETHADONE TAB DSP 40MG 00406254001 MALLINCKRODT INC. yPENTAZOCINE/ TAB NALOXONE 00406311801 MALLINCKRODT INC. yHYDROMORPHON TAB 2MG 00406324301 MALLINCKRODT INC. yHYDROMORPHON TAB 4MG 00406324401 MALLINCKRODT INC. yHYDROMORPHON POW HCL 00406324552 MALLINCKRODT INC. yHYDROMORPHON TAB 8MG 00406324901 MALLINCKRODT INC. yMETHADOSE TAB 10MG 00406345434 MALLINCKRODT INC. yANEXSIA TAB 500-5MG 00406536101 MALLINCKRODT INC. yANEXSIA TAB 7.5-650 00406536201 MALLINCKRODT INC. yANEXSIA TAB 7.5-650 00406536205 MALLINCKRODT INC. yANEXSIA TAB 10/660MG 00406536301 MALLINCKRODT INC. yANEXSIA TAB 10/660MG 00406536305 MALLINCKRODT INC. yMETHADONE TAB 5MG 00406575501 MALLINCKRODT INC. yMETHADONE TAB 10MG 00406577101 MALLINCKRODT INC. yMETHADOSE TAB 5MG 00406697434 MALLINCKRODT INC. yMEPERIDINE TAB 50MG 00406711301 MALLINCKRODT INC. yMEPERIDINE TAB 100MG 00406711501 MALLINCKRODT INC. yTRAMADOL HCL TAB 50MG 00406717101 MALLINCKRODT INC. yTRAMADOL HCL TAB 50MG 00406717105 MALLINCKRODT INC. yTRAMADOL HCL TAB 50MG 00406717133 MALLINCKRODT INC. yTRAMADOL HCL TAB 50MG 00406717162 MALLINCKRODT INC. yMORPHINE SUL TAB 15MG ER 00406831501 MALLINCKRODT INC. yMORPHINE SUL TAB 15MG ER 00406831505 MALLINCKRODT INC. yMORPHINE SUL TAB 15MG ER 00406831532 MALLINCKRODT INC. yMORPHINE SUL TAB 200MG ER 00406832001 MALLINCKRODT INC. yMORPHINE SUL TAB 30MG ER 00406833001 MALLINCKRODT INC. yMORPHINE SUL TAB 30MG ER 00406833005 MALLINCKRODT INC. yMORPHINE SUL TAB 30MG ER 00406833032 MALLINCKRODT INC. yMORPHINE SUL TAB 60MG ER 00406838001 MALLINCKRODT INC. yMORPHINE SUL TAB 60MG ER 00406838005 MALLINCKRODT INC. yMORPHINE SUL TAB 60MG ER 00406838032 MALLINCKRODT INC. yMORPHINE SUL TAB 60MG ER 00406838062 MALLINCKRODT INC. yMORPHINE SUL TAB 100MG ER 00406839001 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MORPHINE SUL TAB 100MG ER 00406839005 MALLINCKRODT INC. yMORPHINE SUL TAB 100MG ER 00406839062 MALLINCKRODT INC. yOXYCODONE TAB 15MG 00406851501 MALLINCKRODT INC. yOXYCODONE TAB 30MG 00406853001 MALLINCKRODT INC. yOXYCODONE SOL 5MG/5ML 00406855550 MALLINCKRODT INC. yOXYCODONE CON 20MG/ML 00406855830 MALLINCKRODT INC. yMETHADOSE SF CON 10MG/ML 00406872510 MALLINCKRODT INC. yOXYCODONE POW HCL 00406886553 MALLINCKRODT INC. yOXYCODONE POW HCL 00406886557 MALLINCKRODT INC. yTUSSIZONE-12 TAB 5-60MG 00406886701 MALLINCKRODT INC. yTUSSIZONE-12 SUS 4-30MG/5 00406886916 MALLINCKRODT INC. yTUSSIZONE-12 SUS 4-30MG/5 00406886944 MALLINCKRODT INC. yAMPHETAMINE TAB 7.5MG 00406888401 MALLINCKRODT INC. yAMPHETAMINE TAB 15MG 00406888501 MALLINCKRODT INC. yAMPHETAMINE TAB 12.5MG 00406888601 MALLINCKRODT INC. yAMPHETAMINE TAB 5MG 00406889101 MALLINCKRODT INC. yAMPHETAMINE TAB 10MG 00406889201 MALLINCKRODT INC. yAMPHETAMINE TAB 20MG 00406889301 MALLINCKRODT INC. yAMPHETAMINE TAB 30MG 00406889401 MALLINCKRODT INC. yDEXTROAMPHET TAB 5MG 00406895801 MALLINCKRODT INC. yDEXTROAMPHET TAB 10MG 00406895901 MALLINCKRODT INC. yDEXTROAMPHET CAP 5MG CR 00406896001 MALLINCKRODT INC. yDEXTROAMPHET CAP 10MG CR 00406896101 MALLINCKRODT INC. yDEXTROAMPHET CAP 15MG CR 00406896201 MALLINCKRODT INC. yANAFRANIL CAP 50MG 00406990701 MALLINCKRODT INC. yANAFRANIL CAP 50MG 00406990703 MALLINCKRODT INC. yANAFRANIL CAP 50MG 00406990762 MALLINCKRODT INC. yANAFRANIL CAP 75MG 00406990801 MALLINCKRODT INC. yANAFRANIL CAP 75MG 00406990803 MALLINCKRODT INC. yPAMELOR CAP 10MG 00406991001 MALLINCKRODT INC. yPAMELOR CAP 25MG 00406991101 MALLINCKRODT INC. yPAMELOR CAP 50MG 00406991201 MALLINCKRODT INC. yPAMELOR CAP 75MG 00406991301 MALLINCKRODT INC. yRESTORIL CAP 22.5MG 00406991403 MALLINCKRODT INC. yRESTORIL CAP 7.5MG 00406991501 MALLINCKRODT INC. yRESTORIL CAP 15MG 00406991601 MALLINCKRODT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RESTORIL CAP 15MG 00406991605 MALLINCKRODT INC. yRESTORIL CAP 30MG 00406991701 MALLINCKRODT INC. yRESTORIL CAP 30MG 00406991705 MALLINCKRODT INC. yPAMELOR SOL 10MG/5ML 00406991816 MALLINCKRODT INC. yTOFRANIL TAB 10MG 00406992001 MALLINCKRODT INC. yTOFRANIL TAB 25MG 00406992101 MALLINCKRODT INC. yTOFRANIL TAB 50MG 00406992201 MALLINCKRODT INC. yTOFRANIL-PM CAP 75MG 00406992301 MALLINCKRODT INC. yTOFRANIL-PM CAP 75MG 00406992303 MALLINCKRODT INC. yTOFRANIL-PM CAP 100MG 00406992401 MALLINCKRODT INC. yTOFRANIL-PM CAP 100MG 00406992403 MALLINCKRODT INC. yTOFRANIL-PM CAP 125MG 00406992501 MALLINCKRODT INC. yTOFRANIL-PM CAP 125MG 00406992503 MALLINCKRODT INC. yTOFRANIL-PM CAP 150MG 00406992601 MALLINCKRODT INC. yTOFRANIL-PM CAP 150MG 00406992603 MALLINCKRODT INC. yIMIPRAM PAM CAP 75MG 00406993103 MALLINCKRODT INC. yIMIPRAM PAM CAP 100MG 00406993203 MALLINCKRODT INC. yIMIPRAM PAM CAP 125MG 00406993303 MALLINCKRODT INC. yIMIPRAM PAM CAP 150MG 00406993403 MALLINCKRODT INC. yBRONCOMAR-1 ELX 12939013216 MARLOP PHARMACEUTICALS, INC. yCLUSIMAR SYP 12939016008 MARLOP PHARMACEUTICALS, INC. yLAXMAR POW 50% 12939021514 MARLOP PHARMACEUTICALS, INC. yLAXMAR POW ORANGE 12939021614 MARLOP PHARMACEUTICALS, INC. yDOLOTIC SOL OTIC 12939023015 MARLOP PHARMACEUTICALS, INC. yVIGOMAR FORT TAB 12939030410 MARLOP PHARMACEUTICALS, INC. yMARTINIC CAP 12939030541 MARLOP PHARMACEUTICALS, INC. yPROMAR CAP 12939031530 MARLOP PHARMACEUTICALS, INC. yTINAMAR SOL 1% 12939042130 MARLOP PHARMACEUTICALS, INC. yTINAMAR CRE 1% 12939042315 MARLOP PHARMACEUTICALS, INC. yMARDROPS-EX LIQ 12939043030 MARLOP PHARMACEUTICALS, INC. yMARDROPS-DX LIQ 12939043530 MARLOP PHARMACEUTICALS, INC. yVIMAR/IRON SYP FORTE 12939050408 MARLOP PHARMACEUTICALS, INC. yCALCIO DEL TAB MAR 12939051760 MARLOP PHARMACEUTICALS, INC. yAPETIMAR SYP /IRON 12939099831 MARLOP PHARMACEUTICALS, INC. yPRE-HIST-D TAB ER 00682010001 MARNEL PHARMACEUTICAL, INC. yURIMAR-T TAB 00682033401 MARNEL PHARMACEUTICAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MARCOF SYP EXPCTRNT 00682042016 MARNEL PHARMACEUTICAL, INC. yMARGESIC CAP 00682080401 MARNEL PHARMACEUTICAL, INC. yMARGESIC-H CAP 500-5MG 00682080801 MARNEL PHARMACEUTICAL, INC. yMARTEN-TAB TAB 50-325 00682140001 MARNEL PHARMACEUTICAL, INC. yMARNATAL-F MIS PLUS DUO 00682250001 MARNEL PHARMACEUTICAL, INC. yBACMIN TAB 00682300101 MARNEL PHARMACEUTICAL, INC. yOTOMAR-HC DRO 00682908015 MARNEL PHARMACEUTICAL, INC. ySUCRALFATE TAB 1GM 52555005701 MARTEC USA, LLC ySUCRALFATE TAB 1GM 52555005705 MARTEC USA, LLC yCIPROFLOXACN TAB 250MG 52555077401 MARTEC USA, LLC yCIPROFLOXACN TAB 500MG 52555077501 MARTEC USA, LLC yCIPROFLOXACN TAB 750MG 52555077601 MARTEC USA, LLC yCLINDAMYCIN CAP 300MG 52555078601 MARTEC USA, LLC yNITROFURANTN CAP 100MG 52555078701 MARTEC USA, LLC yPIROXICAM CAP 10MG 52555097201 MARTEC USA, LLC yPIROXICAM CAP 20MG 52555097301 MARTEC USA, LLC yPIROXICAM CAP 20MG 52555097305 MARTEC USA, LLC yACETYLCYST SOL 10% 61703020331 MAYNE PHARMA (USA) INC. yACETYLCYST SOL 20% 61703020431 MAYNE PHARMA (USA) INC. yMETOCLOPRAM INJ 5MG/ML 61703021007 MAYNE PHARMA (USA) INC. yMETOCLOPRAM INJ 5MG/ML 61703021011 MAYNE PHARMA (USA) INC. yMETOCLOPRAM INJ 5MG/ML 61703021021 MAYNE PHARMA (USA) INC. yMETOCLOPRAM INJ 5MG/ML 61703021035 MAYNE PHARMA (USA) INC. yMORPHINE SUL INJ 25MG/ML 61703022321 MAYNE PHARMA (USA) INC. yMORPHINE SUL INJ 50MG/ML 61703022521 MAYNE PHARMA (USA) INC. yMORPHINE SUL INJ 50MG/ML 61703022543 MAYNE PHARMA (USA) INC. yENALAPRILAT INJ 1.25/ML 61703023716 MAYNE PHARMA (USA) INC. yENALAPRILAT INJ 1.25/ML 61703023744 MAYNE PHARMA (USA) INC. yAMIODARONE INJ 50MG/ML 61703024103 MAYNE PHARMA (USA) INC. yMILRINONE INJ 1MG/ML 61703024221 MAYNE PHARMA (USA) INC. yMILRINONE INJ 1MG/ML 61703024232 MAYNE PHARMA (USA) INC. yMILRINONE INJ 1MG/ML 61703024250 MAYNE PHARMA (USA) INC. yHYDROMORPHON INJ 10MG/ML 61703024345 MAYNE PHARMA (USA) INC. yHYDROMORPHON INJ 10MG/ML 61703024350 MAYNE PHARMA (USA) INC. yHYDROMORPHON INJ 10MG/ML 61703024353 MAYNE PHARMA (USA) INC. yHYDROMORPHON INJ 2MG/ML 61703024615 MAYNE PHARMA (USA) INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CYTARABINE INJ 20MG/ML 61703030346 MAYNE PHARMA (USA) INC. yCYTARABINE INJ 20MG/ML 61703030436 MAYNE PHARMA (USA) INC. yVINCRISTINE INJ 1MG/ML 61703030906 MAYNE PHARMA (USA) INC. yVINCRISTINE INJ 1MG/ML 61703030916 MAYNE PHARMA (USA) INC. yATRACURIUM INJ 10MG/ML 61703031253 MAYNE PHARMA (USA) INC. yATRACURIUM INJ 10MG/ML 61703031332 MAYNE PHARMA (USA) INC. yBUTORPHANOL INJ 1MG/ML 61703031745 MAYNE PHARMA (USA) INC. yBUTORPHANOL INJ 2MG/ML 61703031845 MAYNE PHARMA (USA) INC. yCYTARABINE INJ 100MG/ML 61703031922 MAYNE PHARMA (USA) INC. yMIDAZOLAM INJ 5MG/ML 61703032107 MAYNE PHARMA (USA) INC. yMIDAZOLAM INJ 5MG/ML 61703032132 MAYNE PHARMA (USA) INC. yMIDAZOLAM INJ 5MG/ML 61703032142 MAYNE PHARMA (USA) INC. yMIDAZOLAM INJ 5MG/ML 61703032153 MAYNE PHARMA (USA) INC. yBLEOMYCIN INJ 30UNIT 61703032322 MAYNE PHARMA (USA) INC. yPAMIDRONATE SOL 3MG/ML 61703032439 MAYNE PHARMA (USA) INC. yPAMIDRONATE SOL 6MG/ML 61703032518 MAYNE PHARMA (USA) INC. yPAMIDRONATE SOL 9MG/ML 61703032618 MAYNE PHARMA (USA) INC. yDACARBAZINE INJ 200MG 61703032722 MAYNE PHARMA (USA) INC. yFUDR INJ 0.5GM 61703033109 MAYNE PHARMA (USA) INC. yBLEOMYCIN INJ 15UNIT 61703033218 MAYNE PHARMA (USA) INC. yCARBOPLATIN INJ 50MG/5ML 61703033918 MAYNE PHARMA (USA) INC. yCARBOPLATIN INJ 150/15ML 61703033922 MAYNE PHARMA (USA) INC. yCARBOPLATIN INJ 450/45ML 61703033950 MAYNE PHARMA (USA) INC. yCARBOPLATIN INJ 600/60ML 61703033956 MAYNE PHARMA (USA) INC. yVINORELBINE INJ 10MG/ML 61703034106 MAYNE PHARMA (USA) INC. yVINORELBINE INJ 10MG/ML 61703034109 MAYNE PHARMA (USA) INC. yPACLITAXEL INJ 6MG/ML 61703034209 MAYNE PHARMA (USA) INC. yPACLITAXEL INJ 6MG/ML 61703034222 MAYNE PHARMA (USA) INC. yPACLITAXEL INJ 6MG/ML 61703034250 MAYNE PHARMA (USA) INC. yMITOXANTRON INJ 2MG/ML 61703034318 MAYNE PHARMA (USA) INC. yMITOXANTRON INJ 2MG/ML 61703034365 MAYNE PHARMA (USA) INC. yMITOXANTRON INJ 2MG/ML 61703034366 MAYNE PHARMA (USA) INC. yEPIRUBICIN INJ 50MG 61703034735 MAYNE PHARMA (USA) INC. yMETHOTREXATE INJ 25MG/ML 61703035038 MAYNE PHARMA (USA) INC. yMETHYLENE BL INJ 1% 61703040232 MAYNE PHARMA (USA) INC. yMETHYLENE BL INJ 1% 61703040242 MAYNE PHARMA (USA) INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METHOTREXATE INJ 25MG/ML 61703040841 MAYNE PHARMA (USA) INC. yFLUCONAZOLE/ INJ NACL 200 61703041463 MAYNE PHARMA (USA) INC. yFLUCONAZOLE/ INJ NACL 400 61703041464 MAYNE PHARMA (USA) INC. yM.V.I-12 W/O INJ VIT K 61703042381 MAYNE PHARMA (USA) INC. yM.V.I-12 W/O INJ VIT K 61703042383 MAYNE PHARMA (USA) INC. yHYDROMORPHON INJ 10MG/ML 61703042594 MAYNE PHARMA (USA) INC. yHYDROMORPHON INJ 10MG/ML 61703042595 MAYNE PHARMA (USA) INC. ySM ASPIRIN TAB 325MG 49348000110 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN TAB 325MG 49348000114 MCKESSON CORPORATION VALU-RITE yRUB ALCOHOL SOL 70% ETHY 49348000338 MCKESSON CORPORATION VALU-RITE yISOP ALCOHOL SOL 91% 49348000438 MCKESSON CORPORATION VALU-RITE yISOP ALCOHOL SOL 99% 49348000538 MCKESSON CORPORATION VALU-RITE yALCOHOL ISOP SOL 50% WINT 49348000738 MCKESSON CORPORATION VALU-RITE yMAGNESIUM TAB 250MG 49348000810 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 325MG 49348000910 MCKESSON CORPORATION VALU-RITE ySM CALAMINE LOT 49348001134 MCKESSON CORPORATION VALU-RITE yV-R TRIAC SYP 2-12.5/5 49348001234 MCKESSON CORPORATION VALU-RITE yV-R TRIAC SOL EXPECT 49348001334 MCKESSON CORPORATION VALU-RITE yNITE TIME LIQ COLD FLU 49348001436 MCKESSON CORPORATION VALU-RITE yNITE TIME LIQ COLD FLU 49348001492 MCKESSON CORPORATION VALU-RITE ySM CASTOR OIL 95% 49348001634 MCKESSON CORPORATION VALU-RITE yEXPECTORANT SYP DM 49348001734 MCKESSON CORPORATION VALU-RITE yEXPECTORANT SYP DM 49348001737 MCKESSON CORPORATION VALU-RITE ySM EPSOM GRA SALT 49348001863 MCKESSON CORPORATION VALU-RITE ySM EPSOM GRA SALT 49348001875 MCKESSON CORPORATION VALU-RITE ySM ANTACID SUS 49348001939 MCKESSON CORPORATION VALU-RITE ySM ANTACID SUS 49348001997 MCKESSON CORPORATION VALU-RITE ySM ANTACID/ SUS SIMETH 49348002039 MCKESSON CORPORATION VALU-RITE ySM ANTACID/ SUS SIMETH 49348002097 MCKESSON CORPORATION VALU-RITE yHYDROCORT CRE 0.5% 49348002172 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348002310 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348002312 MCKESSON CORPORATION VALU-RITE ySM SUPHEDRIN TAB 30MG 49348002404 MCKESSON CORPORATION VALU-RITE ySM ALLERGY TAB 4MG 49348002504 MCKESSON CORPORATION VALU-RITE ySM ALLERGY TAB 4MG 49348002510 MCKESSON CORPORATION VALU-RITE ySM NASAL 12H SPR 0.05% 49348002827 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SM TRIPLE OIN ANTIBIOT 49348002972 MCKESSON CORPORATION VALU-RITE yISOP ALCOHOL SOL 70% 49348003038 MCKESSON CORPORATION VALU-RITE yISOP ALCOHOL SOL 70% 49348003040 MCKESSON CORPORATION VALU-RITE yHYDROGEN PER SOL 3% 49348003134 MCKESSON CORPORATION VALU-RITE yHYDROGEN PER SOL 3% 49348003137 MCKESSON CORPORATION VALU-RITE yHYDROGEN PER SOL 3% 49348003138 MCKESSON CORPORATION VALU-RITE yNASAL DECONG TAB ANTIHIST 49348003204 MCKESSON CORPORATION VALU-RITE yV-R ASPIRIN TAB 325MG EC 49348003453 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN TAB 325MG EC 49348003482 MCKESSON CORPORATION VALU-RITE ySM ANTACID SUS W/SIM II 49348003539 MCKESSON CORPORATION VALU-RITE ySM NON-ASA ELX 160/5ML 49348003634 MCKESSON CORPORATION VALU-RITE ySM EYE DROPS SOL 0.05% OP 49348003729 MCKESSON CORPORATION VALU-RITE ySORE THROAT SPR MENTHOL 49348003836 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348004209 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348004210 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348004214 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348004219 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA TAB 500MG 49348004253 MCKESSON CORPORATION VALU-RITE ySM VALU-DRYL CAP 25MG 49348004404 MCKESSON CORPORATION VALU-RITE ySM VALU-DRYL CAP 25MG 49348004410 MCKESSON CORPORATION VALU-RITE yVALU-DRYL ELX 12.5/5ML 49348004534 MCKESSON CORPORATION VALU-RITE yNATURAL VEG POW 28.3% 49348004765 MCKESSON CORPORATION VALU-RITE yV-R VALU-TAP ELX 2-12.5/5 49348004834 MCKESSON CORPORATION VALU-RITE yV-R VALU-TAP ELX 2-12.5/5 49348004837 MCKESSON CORPORATION VALU-RITE ySM LECITHIN CAP 400MG 49348005010 MCKESSON CORPORATION VALU-RITE ySM L-LYSINE TAB 500MG 49348005310 MCKESSON CORPORATION VALU-RITE yPOT GLUCONAT TAB 2.5MEQ 49348005510 MCKESSON CORPORATION VALU-RITE ySTOOL SOFTEN CAP 100MG 49348005819 MCKESSON CORPORATION VALU-RITE ySM OYS SHL/D TAB 250MG 49348006110 MCKESSON CORPORATION VALU-RITE yOYSTER SHELL TAB 500MG 49348006243 MCKESSON CORPORATION VALU-RITE yTRAVEL SICK TAB 50MG 49348007002 MCKESSON CORPORATION VALU-RITE yPAIN MEDICIN TAB PM 49348007209 MCKESSON CORPORATION VALU-RITE yPAIN RELIEVE TAB PM 49348007309 MCKESSON CORPORATION VALU-RITE ySLEEP AID CAP 50MG 49348007403 MCKESSON CORPORATION VALU-RITE yV-R ALC PREP PAD SWABS 49348007753 MCKESSON CORPORATION VALU-RITE yVITAMIN C TAB 250MG 49348008010 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ANTI-DIARRHE TAB 2MG 49348008348 MCKESSON CORPORATION VALU-RITE yV-R EFFERVES TAB 49348008407 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348008709 MCKESSON CORPORATION VALU-RITE ySM FIBER POW 58.6% 49348009092 MCKESSON CORPORATION VALU-RITE ySTRESS B/FE TAB BIOTIN 49348009412 MCKESSON CORPORATION VALU-RITE yV-R STRESS B TAB ZN/B10 49348009512 MCKESSON CORPORATION VALU-RITE yV-R VIT E CAP 200UNIT 49348009810 MCKESSON CORPORATION VALU-RITE ySM VITAMIN E CAP 400UNIT 49348009910 MCKESSON CORPORATION VALU-RITE yVITAMIN E CAP 1000UNIT 49348010010 MCKESSON CORPORATION VALU-RITE ySM ONE DAILY TAB MULT-VIT 49348010110 MCKESSON CORPORATION VALU-RITE ySM ONE DAILY TAB MULT-VIT 49348010119 MCKESSON CORPORATION VALU-RITE ySM ONE DAILY TAB /IRON 49348010210 MCKESSON CORPORATION VALU-RITE ySM ONE DAILY TAB /IRON 49348010219 MCKESSON CORPORATION VALU-RITE yCENTRAL VITE TAB 49348010323 MCKESSON CORPORATION VALU-RITE yCENTRAL VITE TAB 49348010345 MCKESSON CORPORATION VALU-RITE ySM MULTI-VIT CHW CHILD 49348010510 MCKESSON CORPORATION VALU-RITE ySM MULT-VIT CHW /FE CHLD 49348010610 MCKESSON CORPORATION VALU-RITE ySM MULTI-VIT CHW /C CHILD 49348010810 MCKESSON CORPORATION VALU-RITE ySM CALCIUM TAB 600 +D 49348011012 MCKESSON CORPORATION VALU-RITE ySM IODINE TIN 49348013327 MCKESSON CORPORATION VALU-RITE yVITAMIN E CAP 1000UNIT 49348013609 MCKESSON CORPORATION VALU-RITE yCALCIUM 600+ TAB MINERALS 49348013912 MCKESSON CORPORATION VALU-RITE yV-R ZINC TAB 50MG 49348014110 MCKESSON CORPORATION VALU-RITE yV-R LICE RIN LIQ 1% 49348014330 MCKESSON CORPORATION VALU-RITE ySM COOL GEL 2% 49348014791 MCKESSON CORPORATION VALU-RITE ySM CAMPHOR SOL SPIRIT 49348014830 MCKESSON CORPORATION VALU-RITE yNAPROXEN SOD TAB 220MG 49348014909 MCKESSON CORPORATION VALU-RITE yNAPROXEN SOD TAB 220MG 49348015009 MCKESSON CORPORATION VALU-RITE yNAPROXEN SOD TAB 220MG 49348015110 MCKESSON CORPORATION VALU-RITE ySM NIGHT LIQ TIME 49348015336 MCKESSON CORPORATION VALU-RITE ySM NIGHT LIQ TIME 49348015349 MCKESSON CORPORATION VALU-RITE yBACITRACIN OIN 500/GM 49348015472 MCKESSON CORPORATION VALU-RITE ySM TOLNAFTAT CRE 1% 49348015529 MCKESSON CORPORATION VALU-RITE ySM ARTHRICRM LOT 10% 49348015684 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA DRO 100MG/ML 49348015729 MCKESSON CORPORATION VALU-RITE ySM GLYCERIN SUP 1.5GM 49348015805 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SM GLYCERIN SUP 3GM 49348015905 MCKESSON CORPORATION VALU-RITE ySM GLYCERIN SUP 3GM 49348015909 MCKESSON CORPORATION VALU-RITE yPED ELCTRLYT SOL GRAPE 49348016162 MCKESSON CORPORATION VALU-RITE yCLOTRIMAZOLE SOL 1% 49348016251 MCKESSON CORPORATION VALU-RITE yVITAMIN A CAP 8000UNIT 49348016310 MCKESSON CORPORATION VALU-RITE ySM SUPHEDRIN TAB 30MG 49348016434 MCKESSON CORPORATION VALU-RITE yNASAL DECON TAB ANTIHIST 49348016508 MCKESSON CORPORATION VALU-RITE yNATURAL VEG POW 48.57% 49348016665 MCKESSON CORPORATION VALU-RITE yNATURAL VEG POW 48.57% 49348016693 MCKESSON CORPORATION VALU-RITE ySM ST JOHNS TAB 300MG 49348016809 MCKESSON CORPORATION VALU-RITE ySM ANTACID CHW 500MG 49348016921 MCKESSON CORPORATION VALU-RITE ySM ANTACID CHW 500MG 49348017021 MCKESSON CORPORATION VALU-RITE ySAW PALMETTO CAP 160MG 49348017209 MCKESSON CORPORATION VALU-RITE ySM STOMACH CHW RELIEF 49348017744 MCKESSON CORPORATION VALU-RITE ySM SELENIUM TAB 200MCG 49348017810 MCKESSON CORPORATION VALU-RITE yFERROUS SULF TAB 325MG 49348018010 MCKESSON CORPORATION VALU-RITE ySM LUBRICATI GEL JELLY 49348018485 MCKESSON CORPORATION VALU-RITE yV-R VALU-TAP TAB EXT-REL 49348018804 MCKESSON CORPORATION VALU-RITE ySM ASA CHLD CHW 81MG 49348019107 MCKESSON CORPORATION VALU-RITE ySM STOMACH SUS 527/30ML 49348019237 MCKESSON CORPORATION VALU-RITE ySM STOMACH SUS 527/30ML 49348019238 MCKESSON CORPORATION VALU-RITE yV-R STOM REL SUS 527/30ML 49348019239 MCKESSON CORPORATION VALU-RITE ySM ANTACID CHW EX-STR 49348019410 MCKESSON CORPORATION VALU-RITE yULTRA ANTACD CHW 1000MG 49348019516 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348019609 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348019610 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348019619 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348019635 MCKESSON CORPORATION VALU-RITE yV-R IBUPROF TAB 200MG 49348019653 MCKESSON CORPORATION VALU-RITE ySM NOSE DROP SOL 1% 49348019727 MCKESSON CORPORATION VALU-RITE ySM NON-ASA CHW 80MG GRP 49348019944 MCKESSON CORPORATION VALU-RITE yPEDIA RELIEF DRO 7.5/0.8 49348020029 MCKESSON CORPORATION VALU-RITE yPEDIA RELIEF LIQ CGH/COLD 49348020134 MCKESSON CORPORATION VALU-RITE ySM PEDIATRIC SYP 100/5ML 49348020334 MCKESSON CORPORATION VALU-RITE ySM ALLERGY LIQ RELIEF 49348020537 MCKESSON CORPORATION VALU-RITE yV-R VALU-DRY TAB AL/SI/HE 49348020604 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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V-R NON-ASA DRO 80/0.8ML 49348020729 MCKESSON CORPORATION VALU-RITE yV-R VAGINAL CRE ITCH 49348021227 MCKESSON CORPORATION VALU-RITE ySM CLEANSING LOT 49348021538 MCKESSON CORPORATION VALU-RITE yV-R GLUCOSAM TAB 500MG 49348021812 MCKESSON CORPORATION VALU-RITE ySM LAXATIVE TAB MAX STR 49348022404 MCKESSON CORPORATION VALU-RITE ySM STRESS B TAB W/BIOTIN 49348022612 MCKESSON CORPORATION VALU-RITE yCHLD IBUPROF SUS 100/5ML 49348022834 MCKESSON CORPORATION VALU-RITE yCHLD IBUPROF SUS 100/5ML 49348022934 MCKESSON CORPORATION VALU-RITE yCHLD IBUPROF SUS 100/5ML 49348022937 MCKESSON CORPORATION VALU-RITE ySM NASAL SPR 0.05% 49348023027 MCKESSON CORPORATION VALU-RITE ySM NASAL SPR 0.05% 49348023127 MCKESSON CORPORATION VALU-RITE ySM PREGNANCY TES KIT 49348023200 MCKESSON CORPORATION VALU-RITE ySM PREGNANCY TES KIT 49348023257 MCKESSON CORPORATION VALU-RITE ySM CALCIUM TAB 600 49348023312 MCKESSON CORPORATION VALU-RITE yV-R PERSONAL GEL LUBRICAN 49348023431 MCKESSON CORPORATION VALU-RITE yV-R LICE KIT TREATMNT 49348023587 MCKESSON CORPORATION VALU-RITE ySM ONE DAILY TAB /CA/FE 49348023610 MCKESSON CORPORATION VALU-RITE ySM LICE BED AER 49348023787 MCKESSON CORPORATION VALU-RITE ySM CA/MG/ZN TAB 49348023810 MCKESSON CORPORATION VALU-RITE ySM LANCETS MIS 49348024010 MCKESSON CORPORATION VALU-RITE ySM LANCETS MIS THIN 49348024110 MCKESSON CORPORATION VALU-RITE ySM HEARTBURN TAB RELIEF 49348024644 MCKESSON CORPORATION VALU-RITE ySM VITAMIN E CAP 400UNIT 49348025810 MCKESSON CORPORATION VALU-RITE yTHERAPEUTIC TAB M 49348026045 MCKESSON CORPORATION VALU-RITE ySM TUSSIN SYP CGH/COLD 49348026134 MCKESSON CORPORATION VALU-RITE yNAT SENNA LX TAB 8.6MG 49348026210 MCKESSON CORPORATION VALU-RITE ySM GAS RELIE CAP 125MG 49348026344 MCKESSON CORPORATION VALU-RITE ySM OYST SHL TAB /D 500MG 49348026412 MCKESSON CORPORATION VALU-RITE ySM CALCIUM TAB /VITMN D 49348026443 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN SUS 160/5ML 49348026634 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN DRO 80/0.8ML 49348026827 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN DRO 80/0.8ML 49348026829 MCKESSON CORPORATION VALU-RITE yHYDROCORT OIN 0.5% 49348027172 MCKESSON CORPORATION VALU-RITE yV-R HC/ALOE OIN 0.5% 49348027176 MCKESSON CORPORATION VALU-RITE yDOUBLE ANTIB OIN 49348027472 MCKESSON CORPORATION VALU-RITE yTRIPLE ANTIB OIN PLUS 49348027569 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NASAL PUMP SPR 0.05% 49348027627 MCKESSON CORPORATION VALU-RITE yANTI-DIARRHE LIQ 1MG/5ML 49348027734 MCKESSON CORPORATION VALU-RITE yEXPECTORANT SYP 100/5ML 49348027834 MCKESSON CORPORATION VALU-RITE yEXPECTORANT SYP 100/5ML 49348027837 MCKESSON CORPORATION VALU-RITE yCLOTRIMAZOLE CRE 1% 49348027972 MCKESSON CORPORATION VALU-RITE yDOCUSATE CAL CAP 240MG 49348028010 MCKESSON CORPORATION VALU-RITE yALLERGY RELF CAP 25MG 49348028208 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN TAB 325MG EC 49348028314 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN TAB 81MG EC 49348028423 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348028609 MCKESSON CORPORATION VALU-RITE yNON-ASPIRIN TAB 500MG 49348028610 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA TAB 500MG 49348028653 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA TAB 500MG 49348028654 MCKESSON CORPORATION VALU-RITE yPEDIA RELIEF DRO INFANT 49348029069 MCKESSON CORPORATION VALU-RITE yDAIRY DIGEST TAB ULTRA 49348029106 MCKESSON CORPORATION VALU-RITE yDAIRY DIGEST TAB ULTRA 49348029112 MCKESSON CORPORATION VALU-RITE ySM NON-ASA TAB PM 49348029209 MCKESSON CORPORATION VALU-RITE ySM HEADACHE TAB EX STR 49348029309 MCKESSON CORPORATION VALU-RITE yEXPECTORANT LIQ DM 49348029598 MCKESSON CORPORATION VALU-RITE ySUPHEDRINE TAB 30MG 49348029608 MCKESSON CORPORATION VALU-RITE ySM NON ASA TAB SINUS 49348029704 MCKESSON CORPORATION VALU-RITE yGINKGO BILOB TAB 40MG 49348030207 MCKESSON CORPORATION VALU-RITE yV-R HI-POTEN TAB GARLIC 49348030344 MCKESSON CORPORATION VALU-RITE ySM CALCIUM TAB 600 +D 49348030423 MCKESSON CORPORATION VALU-RITE yV-R MEMORY TAB COMPLEX 49348030912 MCKESSON CORPORATION VALU-RITE yV-R FATIGUE TAB COMPLEX 49348031012 MCKESSON CORPORATION VALU-RITE yV-R IMMUNE TAB COMPLEX 49348031112 MCKESSON CORPORATION VALU-RITE yV-R WOMENS TAB HEALTH 49348031212 MCKESSON CORPORATION VALU-RITE yPANAX GINSEN TAB 300MG 49348031509 MCKESSON CORPORATION VALU-RITE yVITAMIN E CAP 1000UNIT 49348031709 MCKESSON CORPORATION VALU-RITE ySM VITAMIN E CAP 400UNIT 49348031810 MCKESSON CORPORATION VALU-RITE ySM B-100 TAB NATURAL 49348032109 MCKESSON CORPORATION VALU-RITE ySM B-50 TAB BALANCED 49348032209 MCKESSON CORPORATION VALU-RITE ySM OYST SHL TAB /D 500MG 49348032310 MCKESSON CORPORATION VALU-RITE yCALCIUM CIT/ TAB VIT D 49348032412 MCKESSON CORPORATION VALU-RITE yCOENZYME Q10 CAP 50MG 49348032644 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SM C/R HIPS TAB 1000MG 49348032710 MCKESSON CORPORATION VALU-RITE ySM VITAMIN E CAP 400UNIT 49348032823 MCKESSON CORPORATION VALU-RITE yVITAMIN E CAP 1000UNIT 49348032909 MCKESSON CORPORATION VALU-RITE ySM OYST SHL TAB /D 500MG 49348033019 MCKESSON CORPORATION VALU-RITE ySM ECHINACEA TAB 167MG 49348033113 MCKESSON CORPORATION VALU-RITE ySM ECHINACEA TAB 112.5-25 49348033209 MCKESSON CORPORATION VALU-RITE ySM CRANBERRY TAB 49348033413 MCKESSON CORPORATION VALU-RITE ySM COMPLETE TAB SENIOR 49348033510 MCKESSON CORPORATION VALU-RITE ySM COMPLETE TAB SENIOR 49348033523 MCKESSON CORPORATION VALU-RITE ySM CALDYPHEN LOT 49348033736 MCKESSON CORPORATION VALU-RITE ySTOMACH RELF SUS 525/15ML 49348033837 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 75MG 49348034312 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 75MG 49348034439 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 75MG 49348034444 MCKESSON CORPORATION VALU-RITE ySM HEMORRHOI SUP 49348034504 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA TAB PM X-STR 49348034854 MCKESSON CORPORATION VALU-RITE ySM NON-ASA TAB PM X-STR 49348034909 MCKESSON CORPORATION VALU-RITE ySM NON-ASA TAB PM X-STR 49348034910 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA TAB PM X-STR 49348034954 MCKESSON CORPORATION VALU-RITE yV-R LICE EGG GEL REMOVER 49348035378 MCKESSON CORPORATION VALU-RITE yNASAL SALINE SPR 0.65% 49348035625 MCKESSON CORPORATION VALU-RITE yNASAL SALINE SPR 0.65% 49348035984 MCKESSON CORPORATION VALU-RITE ySM SUPHEDRIN TAB 120MG CR 49348036101 MCKESSON CORPORATION VALU-RITE ySM ANTACID CHW 750MG XS 49348036234 MCKESSON CORPORATION VALU-RITE yMOTION SICK TAB 25MG 49348036367 MCKESSON CORPORATION VALU-RITE yURINARY PAIN TAB RELIEF 49348036444 MCKESSON CORPORATION VALU-RITE ySM FIRST AID SOL ANTISEPT 49348036534 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN TAB 100MG JR 49348037104 MCKESSON CORPORATION VALU-RITE yPAIN RELIEVE TAB COLD 49348037204 MCKESSON CORPORATION VALU-RITE yCHLD IBUPRFN DRO 40MG/ML 49348037469 MCKESSON CORPORATION VALU-RITE ySM ALLERGY TAB 25MG RLF 49348037508 MCKESSON CORPORATION VALU-RITE ySM ALLERGY TAB 25MG RLF 49348037510 MCKESSON CORPORATION VALU-RITE yV-R BANDAGES MIS 1" 49348037744 MCKESSON CORPORATION VALU-RITE ySM BANDAGES MIS ANTIBACT 49348037844 MCKESSON CORPORATION VALU-RITE y3 DAY VAGINL CRE 2% 49348037954 MCKESSON CORPORATION VALU-RITE yANTI-GAS CAP 166MG 49348038012 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SM GINKGO TAB 120MG 49348038109 MCKESSON CORPORATION VALU-RITE yV-R EXPECTOR SYP CF 49348038334 MCKESSON CORPORATION VALU-RITE yV-R EXPECTOR SYP CF 49348038337 MCKESSON CORPORATION VALU-RITE ySM COD LIVER CAP 49348038410 MCKESSON CORPORATION VALU-RITE ySM VIT C/RH TAB 500MG 49348038510 MCKESSON CORPORATION VALU-RITE yV-R VALU-TAP ELX DM 49348038634 MCKESSON CORPORATION VALU-RITE yV-R VIT C CHW 250MG 49348038710 MCKESSON CORPORATION VALU-RITE yVITAMIN C CHW 500MG 49348038810 MCKESSON CORPORATION VALU-RITE yVITAMIN C TAB 500MG CR 49348038910 MCKESSON CORPORATION VALU-RITE yVITAMIN C TAB 1000MG 49348039010 MCKESSON CORPORATION VALU-RITE ySUPER B COMP TAB VIT C 49348039110 MCKESSON CORPORATION VALU-RITE ySM VIT B-12 TAB 100MCG 49348039210 MCKESSON CORPORATION VALU-RITE ySM VIT B-6 TAB 50MG 49348039310 MCKESSON CORPORATION VALU-RITE ySM VIT B-6 TAB 100MG 49348039410 MCKESSON CORPORATION VALU-RITE ySM EAR DROPS SOL 6.5% OT 49348039529 MCKESSON CORPORATION VALU-RITE yNAPROXEN SOD TAB 220MG 49348039610 MCKESSON CORPORATION VALU-RITE ySM SORE THRT SPR CHERRY 49348039736 MCKESSON CORPORATION VALU-RITE ySM MEDICATED MIS CHST RUB 49348039896 MCKESSON CORPORATION VALU-RITE ySM FLU/COLD/ POW COUGH 49348040095 MCKESSON CORPORATION VALU-RITE yV-R SOY FORM TAB 49348040544 MCKESSON CORPORATION VALU-RITE ySM VIT B-12 TAB 1000 TR 49348040712 MCKESSON CORPORATION VALU-RITE yELASTIC BNDG MIS 3" 49348040891 MCKESSON CORPORATION VALU-RITE ySM VITAMIN E CAP 400UNIT 49348041010 MCKESSON CORPORATION VALU-RITE yELASTIC BNDG MIS 3" 49348041291 MCKESSON CORPORATION VALU-RITE yELASTIC BNDG MIS 4" 49348041393 MCKESSON CORPORATION VALU-RITE yELASTIC BNDG MIS 4" 49348041493 MCKESSON CORPORATION VALU-RITE ySM COLD/HOT OIN BALM 49348042096 MCKESSON CORPORATION VALU-RITE ySM SPORT RUB CRE 49348042584 MCKESSON CORPORATION VALU-RITE ySM CALCIUM/D TAB 400-133 49348042610 MCKESSON CORPORATION VALU-RITE ySM TUSSIN CAP CGH/COLD 49348042702 MCKESSON CORPORATION VALU-RITE yHEMORRHOIDAL CRE 49348042832 MCKESSON CORPORATION VALU-RITE ySM PAIN RELF GEL /MENTHOL 49348042984 MCKESSON CORPORATION VALU-RITE ySM VITAMIN C TAB 500MG 49348043010 MCKESSON CORPORATION VALU-RITE yNASAL ALLERG AER 4% SPRAY 49348043248 MCKESSON CORPORATION VALU-RITE yNASAL ALLERG AER 4% SPRAY 49348043253 MCKESSON CORPORATION VALU-RITE yLICE KILLING SHA 49348043437 MCKESSON CORPORATION VALU-RITE y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETA CAROTEN CAP 25000UNT 49348043810 MCKESSON CORPORATION VALU-RITE yHAIR REGROWT SOL 5% 49348044030 MCKESSON CORPORATION VALU-RITE ySM HYDROCORT CRE PLUS 49348044172 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 10MG 49348044212 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 10MG 49348044244 MCKESSON CORPORATION VALU-RITE yLICE KILLING LIQ 49348044330 MCKESSON CORPORATION VALU-RITE yLICE KILLING LIQ 49348044334 MCKESSON CORPORATION VALU-RITE yTRIACING ORA SYP 1-15MG/5 49348044434 MCKESSON CORPORATION VALU-RITE yTRIACING CLD LIQ MULTISYM 49348044534 MCKESSON CORPORATION VALU-RITE ySM PAIN RELF GEL /MENTHOL 49348044685 MCKESSON CORPORATION VALU-RITE yV-R HYGIENIC PAD CLEANSNG 49348044710 MCKESSON CORPORATION VALU-RITE ySM TUSSIN CF LIQ 49348045134 MCKESSON CORPORATION VALU-RITE ySM TUSSIN CF LIQ 49348045237 MCKESSON CORPORATION VALU-RITE yCOLD/ALLERGY ELX CHILDREN 49348045634 MCKESSON CORPORATION VALU-RITE yCOLD/ALLERGY ELX CHILDREN 49348045637 MCKESSON CORPORATION VALU-RITE yCOLD/COUGH ELX CHILDREN 49348045722 MCKESSON CORPORATION VALU-RITE ySM PERMETHRI LOT LICE 49348046030 MCKESSON CORPORATION VALU-RITE ySM PERMETHRI LOT LICE 49348046034 MCKESSON CORPORATION VALU-RITE yWOMENS MENST TAB RELIEF 49348046104 MCKESSON CORPORATION VALU-RITE yCALCIUM SOFT CHW MLK CHOC 49348046312 MCKESSON CORPORATION VALU-RITE yV-R THROAT L LOZ CHERRY 49348046803 MCKESSON CORPORATION VALU-RITE yV-R THROAT L LOZ CITRUS 49348046903 MCKESSON CORPORATION VALU-RITE ySM 12-HOUR SPR 0.05% 49348047227 MCKESSON CORPORATION VALU-RITE yINFANTS PAIN DRO RLVR CLD 49348048629 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN CHW 81MG 49348049807 MCKESSON CORPORATION VALU-RITE yCHLD IBUPROF SUS 100/5ML 49348049934 MCKESSON CORPORATION VALU-RITE yCHLD IBUPROF SUS 100/5ML 49348050034 MCKESSON CORPORATION VALU-RITE ySM ALLERGY CRE 2% 49348050272 MCKESSON CORPORATION VALU-RITE yMAGN CITRATE SOL 49348050449 MCKESSON CORPORATION VALU-RITE ySM DRY SKIN LOT THERAPY 49348050538 MCKESSON CORPORATION VALU-RITE yGAS RELIEF CHW 80MG 49348050907 MCKESSON CORPORATION VALU-RITE ySTOMACH RELF TAB 262MG 49348051159 MCKESSON CORPORATION VALU-RITE yFOAM ANTACID CHW 80-20MG 49348051210 MCKESSON CORPORATION VALU-RITE yGLUCOS/CHOND TAB 750-600 49348051339 MCKESSON CORPORATION VALU-RITE ySM NON-DROWS TAB SINUS 49348051404 MCKESSON CORPORATION VALU-RITE ySM LANCETS MIS THIN 49348051610 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SM NIACIN TAB 250MG CR 49348051710 MCKESSON CORPORATION VALU-RITE ySM HYDROCORT CRE 1% 49348052172 MCKESSON CORPORATION VALU-RITE yV-R HYDROCOR CRE 1% 49348052176 MCKESSON CORPORATION VALU-RITE ySM HYDROCORT OIN 1% 49348052272 MCKESSON CORPORATION VALU-RITE ySM ENEMA ENE 49348052720 MCKESSON CORPORATION VALU-RITE yV-R ENEMA ENE RTU 49348052757 MCKESSON CORPORATION VALU-RITE yANTI-DIARRHE TAB 2MG 49348052902 MCKESSON CORPORATION VALU-RITE yANTI-DIARRHE TAB 2MG 49348052908 MCKESSON CORPORATION VALU-RITE yMICONAZOLE 7 CRE 2% VAGIN 49348053077 MCKESSON CORPORATION VALU-RITE ySM SENNA-S TAB 8.6-50MG 49348053212 MCKESSON CORPORATION VALU-RITE ySM NITE TIME CAP COLD/FLU 49348053302 MCKESSON CORPORATION VALU-RITE ySM NITE TIME CAP COLD/FLU 49348053347 MCKESSON CORPORATION VALU-RITE ySM BANDAGES MIS FABRIC 49348053644 MCKESSON CORPORATION VALU-RITE ySM ADHESIVE PAD 2"X3" 49348053701 MCKESSON CORPORATION VALU-RITE ySM BANDAGES MIS FOAM 49348053844 MCKESSON CORPORATION VALU-RITE yNASAL DECONG TAB 12HR 49348053947 MCKESSON CORPORATION VALU-RITE yLORATADINE TAB 10MG 49348054201 MCKESSON CORPORATION VALU-RITE yLORATADINE TAB 10MG 49348054212 MCKESSON CORPORATION VALU-RITE yLORATADINE TAB 10MG 49348054213 MCKESSON CORPORATION VALU-RITE yLORATADINE TAB 10MG 49348054244 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10-240MG 49348054301 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10-240MG 49348054337 MCKESSON CORPORATION VALU-RITE ySTOOL SOFTEN TAB 8.6-50MG 49348054410 MCKESSON CORPORATION VALU-RITE ySTOOL SOFTEN TAB 8.6-50MG 49348054419 MCKESSON CORPORATION VALU-RITE yORAL SALINE SOL LAXATIVE 49348054584 MCKESSON CORPORATION VALU-RITE ySM OPTI-VITA TAB 49348054912 MCKESSON CORPORATION VALU-RITE ySM PRENATAL TAB 49348055610 MCKESSON CORPORATION VALU-RITE ySM ANTACID CHW 750MG XS 49348056134 MCKESSON CORPORATION VALU-RITE ySM LANCETS MIS 49348056322 MCKESSON CORPORATION VALU-RITE ySM ALLERGY TAB 25MG RLF 49348056404 MCKESSON CORPORATION VALU-RITE yV-R VALU-DRY TAB 25MG 49348056407 MCKESSON CORPORATION VALU-RITE yGLUCOSAMINE TAB 1000MG 49348056553 MCKESSON CORPORATION VALU-RITE ySM FLAX SEED CAP 1000MG 49348056610 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN CAP 200MG 49348056839 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN CAP 200MG 49348056859 MCKESSON CORPORATION VALU-RITE yPED ELCTRLYT SOL FRUIT 49348057041 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PED ELCTRLYT SOL UNFLAVRD 49348057141 MCKESSON CORPORATION VALU-RITE yNICOTINE POL GUM 4MG 49348057208 MCKESSON CORPORATION VALU-RITE yNICOTINE POL GUM 4MG 49348057236 MCKESSON CORPORATION VALU-RITE yNICOTINE POL GUM 2MG 49348057308 MCKESSON CORPORATION VALU-RITE yNICOTINE POL GUM 2MG 49348057336 MCKESSON CORPORATION VALU-RITE ySM SLEEP AID TAB 25MG 49348057406 MCKESSON CORPORATION VALU-RITE ySM NAUSEA SOL CONTROL 49348057627 MCKESSON CORPORATION VALU-RITE yV-R GAS RELI DRO 40/0.6ML 49348057734 MCKESSON CORPORATION VALU-RITE ySM LAXATIVE SUP 10MG 49348059867 MCKESSON CORPORATION VALU-RITE ySM LAXATIVE TAB 5MG EC 49348059905 MCKESSON CORPORATION VALU-RITE ySM TRI ANTIB OIN /LIDOCAI 49348060072 MCKESSON CORPORATION VALU-RITE ySM CALDYPHEN LOT CLEAR 49348061036 MCKESSON CORPORATION VALU-RITE yNUTRITIONAL LIQ CHOCOLAT 49348061437 MCKESSON CORPORATION VALU-RITE yNUTRITIONAL LIQ VANILLA 49348061537 MCKESSON CORPORATION VALU-RITE ySTOOL SOFTEN CAP 100MG 49348061610 MCKESSON CORPORATION VALU-RITE yV-R EAR DROP SOL 6.5% OT 49348061829 MCKESSON CORPORATION VALU-RITE yNUTRITIONAL LIQ PLUS CHO 49348062037 MCKESSON CORPORATION VALU-RITE yNUTRITIONAL LIQ PLUS VAN 49348062137 MCKESSON CORPORATION VALU-RITE ySM POVID-IOD SOL 10% 49348062237 MCKESSON CORPORATION VALU-RITE ySM POVID-IOD SOL 10% 49348062238 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10MG 49348063401 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10MG 49348063501 MCKESSON CORPORATION VALU-RITE ySM LORATADIN SYP 5MG/5ML 49348063634 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10MG 49348063702 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10MG 49348063704 MCKESSON CORPORATION VALU-RITE yALLERGY RELF TAB 10MG 49348063804 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN CHW 100MG 49348063904 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN SUS COLD 49348064034 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN SUS INFANTS 49348064227 MCKESSON CORPORATION VALU-RITE yINSULIN SYRG MIS 0.3/31G 49348065510 MCKESSON CORPORATION VALU-RITE yINSULIN SYRG MIS 0.5/31G 49348065610 MCKESSON CORPORATION VALU-RITE yINSULIN SYRG MIS 1ML/31G 49348065710 MCKESSON CORPORATION VALU-RITE yV-R DAILYHST TAB 1.34MG 49348068603 MCKESSON CORPORATION VALU-RITE ySM MILK MAGN SUS ORIGINAL 49348068739 MCKESSON CORPORATION VALU-RITE ySM MILK MAGN SUS ORIGINAL 49348068744 MCKESSON CORPORATION VALU-RITE ySM MILK MAGN SUS MINT 49348068839 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SM MILK MAGN SUS MINT 49348068844 MCKESSON CORPORATION VALU-RITE ySM MICONAZOL CRE 2% 49348068972 MCKESSON CORPORATION VALU-RITE yNICOTINE POL GUM 4MG 49348069236 MCKESSON CORPORATION VALU-RITE yNASAL DECON LIQ 15MG/5ML 49348069534 MCKESSON CORPORATION VALU-RITE yMAGN CITRATE SOL 49348069649 MCKESSON CORPORATION VALU-RITE ySM EYE ALLER SOL RELIEF 49348069729 MCKESSON CORPORATION VALU-RITE ySM ARTIFICIA SOL TEARS 49348069929 MCKESSON CORPORATION VALU-RITE ySM ARTHRITIS TAB 650MG 49348070409 MCKESSON CORPORATION VALU-RITE ySM ARTHRITIS TAB 650MG 49348070410 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348070604 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348070609 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348070610 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348070614 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348070619 MCKESSON CORPORATION VALU-RITE yV-R IBUPROF TAB 200MG 49348070653 MCKESSON CORPORATION VALU-RITE yV-R IBUPROF TAB 200MG 49348070654 MCKESSON CORPORATION VALU-RITE yHEMORRHOIDAL OIN 49348072027 MCKESSON CORPORATION VALU-RITE ySM HEADACHE TAB ADD STR 49348072210 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN TAB 200MG 49348072610 MCKESSON CORPORATION VALU-RITE ySM IBUPROFEN TAB 200MG 49348072710 MCKESSON CORPORATION VALU-RITE yCHEST CONGES TAB RELIEF 49348072809 MCKESSON CORPORATION VALU-RITE yCHEST CONGES TAB RELIEF 49348072909 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 75MG 49348073312 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 75MG 49348073339 MCKESSON CORPORATION VALU-RITE yACID REDUCER TAB 75MG 49348073344 MCKESSON CORPORATION VALU-RITE yORAL MEDICIN MIS SYRINGE 49348073401 MCKESSON CORPORATION VALU-RITE yV-R BRONCHIA AER 0.22MG/A 49348075129 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN TAB 81MG EC 49348075615 MCKESSON CORPORATION VALU-RITE ySM ASPIRIN TAB 81MG EC 49348075653 MCKESSON CORPORATION VALU-RITE ySM ASA CHLD CHW 81MG 49348075707 MCKESSON CORPORATION VALU-RITE ySM FIBER TAB LAXATIVE 49348075913 MCKESSON CORPORATION VALU-RITE ySTAY AWAKE TAB 200MG 49348077103 MCKESSON CORPORATION VALU-RITE ySM DAY TIME CAP COLD/FLU 49348077202 MCKESSON CORPORATION VALU-RITE ySM DAY TIME CAP COLD/FLU 49348077247 MCKESSON CORPORATION VALU-RITE ySM COLD/CGH ELX DM 49348077534 MCKESSON CORPORATION VALU-RITE ySM EYE WASH SOL OP 49348078334 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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V-R ASPIRIN TAB 500MG EC 49348078412 MCKESSON CORPORATION VALU-RITE ySM NON-ASA TAB JR 160MG 49348079204 MCKESSON CORPORATION VALU-RITE yCLOTRIMAZOLE CRE 1% VAG 49348079376 MCKESSON CORPORATION VALU-RITE ySM SINUS TAB ALLERGY 49348079504 MCKESSON CORPORATION VALU-RITE ySM SINUS TAB ALLERGY 49348079508 MCKESSON CORPORATION VALU-RITE ySM NON-ASA SUS CHILDREN 49348079734 MCKESSON CORPORATION VALU-RITE yV-R NON-ASA DRO 80/0.8ML 49348079829 MCKESSON CORPORATION VALU-RITE ySM BENZOIN TIN 49348080130 MCKESSON CORPORATION VALU-RITE ySM CALAMINE LOT PHENOLAT 49348080234 MCKESSON CORPORATION VALU-RITE yV-R IPECAC SYP 49348080327 MCKESSON CORPORATION VALU-RITE ySM MINERAL OIL 49348080438 MCKESSON CORPORATION VALU-RITE yWITCH HAZEL LIQ 49348080538 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348080810 MCKESSON CORPORATION VALU-RITE yV-R IBU-PROF TAB 200MG 49348080853 MCKESSON CORPORATION VALU-RITE yIBUPROFEN TAB 200MG 49348080910 MCKESSON CORPORATION VALU-RITE ySM VIT B-12 TAB 500MCG 49348082110 MCKESSON CORPORATION VALU-RITE ySM FOLIC ACD TAB 400MCG 49348082519 MCKESSON CORPORATION VALU-RITE ySM CHROM PIC TAB 200MCG 49348082610 MCKESSON CORPORATION VALU-RITE yCLOTRIMAZOLE CRE 1% 49348082769 MCKESSON CORPORATION VALU-RITE ySM MICON 7 SUP 100MG 49348083361 MCKESSON CORPORATION VALU-RITE ySM MEDICATED POW BODY 49348083492 MCKESSON CORPORATION VALU-RITE ySM DAY TIME LIQ 49348083736 MCKESSON CORPORATION VALU-RITE ySM GLYCERIN LIQ 49348083934 MCKESSON CORPORATION VALU-RITE yV-R NALPHEN SYP DX CHILD 49348085634 MCKESSON CORPORATION VALU-RITE yV-R NALPHEN SOL DX PEDIA 49348085727 MCKESSON CORPORATION VALU-RITE ySM SINUS TAB HEADACHE 49348085804 MCKESSON CORPORATION VALU-RITE ySM COUGH/COL CAP MULTISYM 49348085901 MCKESSON CORPORATION VALU-RITE ySM NON-ASA TAB SINUS 49348086004 MCKESSON CORPORATION VALU-RITE ySM TUSSIN SYP DM CLEAR 49348086134 MCKESSON CORPORATION VALU-RITE ySM TUSSIN SYP DM CLEAR 49348086137 MCKESSON CORPORATION VALU-RITE ySM ANTACID CHW 750MG XS 49348086513 MCKESSON CORPORATION VALU-RITE ySM PREGNANCY TES KIT 49348087000 MCKESSON CORPORATION VALU-RITE yPAIN RELIEVE TAB 500MG 49348087110 MCKESSON CORPORATION VALU-RITE yMICONAZOLE 7 CRE 2% VAGIN 49348087277 MCKESSON CORPORATION VALU-RITE yPED ELCTRLYT SOL BUBBLGUM 49348088062 MCKESSON CORPORATION VALU-RITE yV-R DAILYHIS TAB -D 49348088103 MCKESSON CORPORATION VALU-RITE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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V-R NON-ASA SUS CHILDREN 49348088834 MCKESSON CORPORATION VALU-RITE ySM LANCETS MIS THIN 49348091122 MCKESSON CORPORATION VALU-RITE ySM LANCETS MIS 49348091222 MCKESSON CORPORATION VALU-RITE ySM GLUCOSE CHW 4GM 49348091301 MCKESSON CORPORATION VALU-RITE ySM GLUCOSE CHW 4GM 49348091409 MCKESSON CORPORATION VALU-RITE ySM GLUCOSE CHW 4GM 49348091501 MCKESSON CORPORATION VALU-RITE ySM GLUCOSE CHW 4GM 49348091609 MCKESSON CORPORATION VALU-RITE yACETAMIN TAB 500MG ES 63739000101 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 500MG ES 63739000103 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 500MG ES 63739000115 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 325MG 63739000201 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 325MG 63739000203 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 325MG 63739000211 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 325MG 63739000213 MCKESSON PACKAGING SERVICE, A DIVISION yACETAMIN TAB 325MG 63739000215 MCKESSON PACKAGING SERVICE, A DIVISION yAPAP/CODEINE TAB 300-30MG 63739000401 MCKESSON PACKAGING SERVICE, A DIVISION yAPAP/CODEINE TAB 300-30MG 63739000403 MCKESSON PACKAGING SERVICE, A DIVISION yAPAP/CODEINE TAB 300-30MG 63739000415 MCKESSON PACKAGING SERVICE, A DIVISION yALPRAZOLAM TAB 0.25MG 63739001015 MCKESSON PACKAGING SERVICE, A DIVISION yALPRAZOLAM TAB 0.5MG 63739001115 MCKESSON PACKAGING SERVICE, A DIVISION yALPRAZOLAM TAB 1MG 63739001215 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 2MG 63739002101 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 2MG 63739002103 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 2MG 63739002115 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 325MG EC 63739002301 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 325MG EC 63739002303 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 325MG 63739002401 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 325MG 63739002403 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 325MG 63739002415 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN CHW 81MG 63739002501 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN CHW 81MG 63739002503 MCKESSON PACKAGING SERVICE, A DIVISION yATENOLOL TAB 25MG 63739002701 MCKESSON PACKAGING SERVICE, A DIVISION yATENOLOL TAB 25MG 63739002703 MCKESSON PACKAGING SERVICE, A DIVISION yATENOLOL TAB 25MG 63739002715 MCKESSON PACKAGING SERVICE, A DIVISION yATENOLOL TAB 50MG 63739002801 MCKESSON PACKAGING SERVICE, A DIVISION yATENOLOL TAB 50MG 63739002803 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ATENOLOL TAB 50MG 63739002815 MCKESSON PACKAGING SERVICE, A DIVISION yBACLOFEN TAB 10MG 63739003101 MCKESSON PACKAGING SERVICE, A DIVISION yBACLOFEN TAB 10MG 63739003103 MCKESSON PACKAGING SERVICE, A DIVISION yBACLOFEN TAB 10MG 63739003115 MCKESSON PACKAGING SERVICE, A DIVISION yBACLOFEN TAB 20MG 63739003201 MCKESSON PACKAGING SERVICE, A DIVISION yBACLOFEN TAB 20MG 63739003203 MCKESSON PACKAGING SERVICE, A DIVISION yBACLOFEN TAB 20MG 63739003215 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 0.5MG 63739003301 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 0.5MG 63739003303 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 0.5MG 63739003315 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 1MG 63739003401 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 1MG 63739003403 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 1MG 63739003415 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 2MG 63739003501 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 2MG 63739003503 MCKESSON PACKAGING SERVICE, A DIVISION yBENZTROPINE TAB 2MG 63739003515 MCKESSON PACKAGING SERVICE, A DIVISION yCALCIUM/D TAB 250MG 63739004101 MCKESSON PACKAGING SERVICE, A DIVISION yCALCIUM/D TAB 250MG 63739004103 MCKESSON PACKAGING SERVICE, A DIVISION yCAPTOPRIL TAB 12.5MG 63739004201 MCKESSON PACKAGING SERVICE, A DIVISION yCAPTOPRIL TAB 12.5MG 63739004203 MCKESSON PACKAGING SERVICE, A DIVISION yCAPTOPRIL TAB 12.5MG 63739004215 MCKESSON PACKAGING SERVICE, A DIVISION yCAPTOPRIL TAB 25MG 63739004301 MCKESSON PACKAGING SERVICE, A DIVISION yCAPTOPRIL TAB 25MG 63739004303 MCKESSON PACKAGING SERVICE, A DIVISION yCAPTOPRIL TAB 25MG 63739004315 MCKESSON PACKAGING SERVICE, A DIVISION yCARBAMAZEPIN TAB 200MG 63739004501 MCKESSON PACKAGING SERVICE, A DIVISION yCARBAMAZEPIN TAB 200MG 63739004503 MCKESSON PACKAGING SERVICE, A DIVISION yCARBAMAZEPIN TAB 200MG 63739004515 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 10-100MG 63739004601 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 10-100MG 63739004603 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 10-100MG 63739004615 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 25-100MG 63739004701 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 25-100MG 63739004703 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 25-100MG 63739004715 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 25-250MG 63739004801 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 25-250MG 63739004803 MCKESSON PACKAGING SERVICE, A DIVISION yCARB/LEVO TAB 25-250MG 63739004815 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARISOPRODOL TAB 350MG 63739004915 MCKESSON PACKAGING SERVICE, A DIVISION yCLONIDINE TAB 0.1MG 63739006015 MCKESSON PACKAGING SERVICE, A DIVISION yCLONIDINE TAB 0.2MG 63739006115 MCKESSON PACKAGING SERVICE, A DIVISION yCLONIDINE TAB 0.3MG 63739006215 MCKESSON PACKAGING SERVICE, A DIVISION yCYCLOBENZAPR TAB 10MG 63739006615 MCKESSON PACKAGING SERVICE, A DIVISION yDIAZEPAM TAB 5MG 63739007310 MCKESSON PACKAGING SERVICE, A DIVISION yDILTIAZEM TAB 30MG 63739007915 MCKESSON PACKAGING SERVICE, A DIVISION yDILTIAZEM TAB 60MG 63739008015 MCKESSON PACKAGING SERVICE, A DIVISION yDOCUSATE CAL CAP 240MG 63739008801 MCKESSON PACKAGING SERVICE, A DIVISION yDOCUSATE CAL CAP 240MG 63739008803 MCKESSON PACKAGING SERVICE, A DIVISION yDOCUSATE SOD CAP 100MG 63739008901 MCKESSON PACKAGING SERVICE, A DIVISION yDOCUSATE SOD CAP 100MG 63739008903 MCKESSON PACKAGING SERVICE, A DIVISION yDOCUSATE SOD CAP 100MG 63739008915 MCKESSON PACKAGING SERVICE, A DIVISION yFOLIC ACID TAB 1MG 63739011001 MCKESSON PACKAGING SERVICE, A DIVISION yFOLIC ACID TAB 1MG 63739011003 MCKESSON PACKAGING SERVICE, A DIVISION yFOLIC ACID TAB 1MG 63739011015 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 20MG 63739011101 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 20MG 63739011103 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 20MG 63739011115 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 40MG 63739011201 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 40MG 63739011203 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 40MG 63739011215 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 80MG 63739011301 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 80MG 63739011303 MCKESSON PACKAGING SERVICE, A DIVISION yFUROSEMIDE TAB 80MG 63739011315 MCKESSON PACKAGING SERVICE, A DIVISION yGLIPIZIDE TAB 5MG 63739011615 MCKESSON PACKAGING SERVICE, A DIVISION yGLIPIZIDE TAB 10MG 63739011715 MCKESSON PACKAGING SERVICE, A DIVISION yGLYBURIDE TAB 2.5MG 63739011815 MCKESSON PACKAGING SERVICE, A DIVISION yGLYBURIDE TAB 5MG 63739011915 MCKESSON PACKAGING SERVICE, A DIVISION yHALOPERIDOL TAB 0.5MG 63739012015 MCKESSON PACKAGING SERVICE, A DIVISION yHALOPERIDOL TAB 1MG 63739012115 MCKESSON PACKAGING SERVICE, A DIVISION yHALOPERIDOL TAB 2MG 63739012215 MCKESSON PACKAGING SERVICE, A DIVISION yHALOPERIDOL TAB 5MG 63739012315 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCHLOROT TAB 25MG 63739012815 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCHLOROT TAB 50MG 63739012915 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 5-500MG 63739013001 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCO/APAP TAB 5-500MG 63739013003 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 5-500MG 63739013015 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 7.5-750 63739013101 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 7.5-750 63739013103 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 7.5-750 63739013115 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 200MG 63739013401 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 200MG 63739013403 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 200MG 63739013415 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 400MG 63739013501 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 400MG 63739013503 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 400MG 63739013515 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 600MG 63739013601 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 600MG 63739013603 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 600MG 63739013615 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 800MG 63739013701 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 800MG 63739013703 MCKESSON PACKAGING SERVICE, A DIVISION yIBUPROFEN TAB 800MG 63739013715 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 7.5-500 63739014101 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 7.5-500 63739014103 MCKESSON PACKAGING SERVICE, A DIVISION yHYDROCO/APAP TAB 7.5-500 63739014115 MCKESSON PACKAGING SERVICE, A DIVISION yISOSORB DIN TAB 10MG 63739014801 MCKESSON PACKAGING SERVICE, A DIVISION yISOSORB DIN TAB 10MG 63739014803 MCKESSON PACKAGING SERVICE, A DIVISION yISOSORB DIN TAB 10MG 63739014815 MCKESSON PACKAGING SERVICE, A DIVISION yISOSORB DIN TAB 20MG 63739014901 MCKESSON PACKAGING SERVICE, A DIVISION yISOSORB DIN TAB 20MG 63739014903 MCKESSON PACKAGING SERVICE, A DIVISION yISOSORB DIN TAB 20MG 63739014915 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 0.5MG 63739015401 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 0.5MG 63739015403 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 0.5MG 63739015415 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 1MG 63739015501 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 1MG 63739015503 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 1MG 63739015515 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 2MG 63739015601 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 2MG 63739015603 MCKESSON PACKAGING SERVICE, A DIVISION yLORAZEPAM TAB 2MG 63739015615 MCKESSON PACKAGING SERVICE, A DIVISION yMETHYLPRED TAB 4MG 63739016115 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MECLIZINE TAB 12.5MG 63739016215 MCKESSON PACKAGING SERVICE, A DIVISION yMECLIZINE TAB 25MG 63739016315 MCKESSON PACKAGING SERVICE, A DIVISION yMEGESTROL AC TAB 40MG 63739016515 MCKESSON PACKAGING SERVICE, A DIVISION yMETHOCARBAM TAB 500MG 63739016615 MCKESSON PACKAGING SERVICE, A DIVISION yMETHOCARBAM TAB 750MG 63739016715 MCKESSON PACKAGING SERVICE, A DIVISION yMETOCLOPRAM TAB 5MG 63739017101 MCKESSON PACKAGING SERVICE, A DIVISION yMETOCLOPRAM TAB 5MG 63739017103 MCKESSON PACKAGING SERVICE, A DIVISION yMETOCLOPRAM TAB 5MG 63739017115 MCKESSON PACKAGING SERVICE, A DIVISION yMETOCLOPRAM TAB 10MG 63739017201 MCKESSON PACKAGING SERVICE, A DIVISION yMETOCLOPRAM TAB 10MG 63739017203 MCKESSON PACKAGING SERVICE, A DIVISION yMETOCLOPRAM TAB 10MG 63739017215 MCKESSON PACKAGING SERVICE, A DIVISION yMETOPROLOL TAB 50MG 63739017301 MCKESSON PACKAGING SERVICE, A DIVISION yMETOPROLOL TAB 50MG 63739017303 MCKESSON PACKAGING SERVICE, A DIVISION yMETOPROLOL TAB 50MG 63739017315 MCKESSON PACKAGING SERVICE, A DIVISION yNAPROXEN TAB 250MG 63739018015 MCKESSON PACKAGING SERVICE, A DIVISION yNAPROXEN TAB 500MG 63739018215 MCKESSON PACKAGING SERVICE, A DIVISION yNORTRIPTYLIN CAP 10MG 63739018915 MCKESSON PACKAGING SERVICE, A DIVISION yNORTRIPTYLIN CAP 25MG 63739019015 MCKESSON PACKAGING SERVICE, A DIVISION yOXYBUTYNIN TAB 5MG 63739019501 MCKESSON PACKAGING SERVICE, A DIVISION yOXYBUTYNIN TAB 5MG 63739019503 MCKESSON PACKAGING SERVICE, A DIVISION yOXYBUTYNIN TAB 5MG 63739019515 MCKESSON PACKAGING SERVICE, A DIVISION yPHENOBARB TAB 16.2MG 63739020001 MCKESSON PACKAGING SERVICE, A DIVISION yPHENOBARB TAB 16.2MG 63739020003 MCKESSON PACKAGING SERVICE, A DIVISION yPHENOBARB TAB 16.2MG 63739020015 MCKESSON PACKAGING SERVICE, A DIVISION yPHENOBARB TAB 32.4MG 63739020101 MCKESSON PACKAGING SERVICE, A DIVISION yPHENOBARB TAB 32.4MG 63739020103 MCKESSON PACKAGING SERVICE, A DIVISION yPHENOBARB TAB 32.4MG 63739020115 MCKESSON PACKAGING SERVICE, A DIVISION yPREDNISONE TAB 5MG 63739020715 MCKESSON PACKAGING SERVICE, A DIVISION yPREDNISONE TAB 10MG 63739020815 MCKESSON PACKAGING SERVICE, A DIVISION yPREDNISONE TAB 20MG 63739020915 MCKESSON PACKAGING SERVICE, A DIVISION yPROMETHAZINE TAB 25MG 63739021315 MCKESSON PACKAGING SERVICE, A DIVISION yPROPO-N/APAP TAB 100-650 63739021501 MCKESSON PACKAGING SERVICE, A DIVISION yPROPO-N/APAP TAB 100-650 63739021503 MCKESSON PACKAGING SERVICE, A DIVISION yPROPO-N/APAP TAB 100-650 63739021515 MCKESSON PACKAGING SERVICE, A DIVISION ySIMETHICONE CHW 80MG 63739022515 MCKESSON PACKAGING SERVICE, A DIVISION ySPIRONOLACT TAB 25MG 63739022615 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TEMAZEPAM CAP 15MG 63739023115 MCKESSON PACKAGING SERVICE, A DIVISION yTEMAZEPAM CAP 30MG 63739023215 MCKESSON PACKAGING SERVICE, A DIVISION yTRAZODONE TAB 50MG 63739024501 MCKESSON PACKAGING SERVICE, A DIVISION yTRAZODONE TAB 50MG 63739024503 MCKESSON PACKAGING SERVICE, A DIVISION yTRAZODONE TAB 50MG 63739024515 MCKESSON PACKAGING SERVICE, A DIVISION yTRAZODONE TAB 100MG 63739024601 MCKESSON PACKAGING SERVICE, A DIVISION yTRAZODONE TAB 100MG 63739024603 MCKESSON PACKAGING SERVICE, A DIVISION yTRAZODONE TAB 100MG 63739024615 MCKESSON PACKAGING SERVICE, A DIVISION yVALPROIC ACD CAP 250MG 63739025101 MCKESSON PACKAGING SERVICE, A DIVISION yVALPROIC ACD CAP 250MG 63739025103 MCKESSON PACKAGING SERVICE, A DIVISION yVALPROIC ACD CAP 250MG 63739025115 MCKESSON PACKAGING SERVICE, A DIVISION yPENTOXIFYLLI TAB 400MG ER 63739026015 MCKESSON PACKAGING SERVICE, A DIVISION ySUCRALFATE TAB 1GM 63739026101 MCKESSON PACKAGING SERVICE, A DIVISION ySUCRALFATE TAB 1GM 63739026103 MCKESSON PACKAGING SERVICE, A DIVISION ySUCRALFATE TAB 1GM 63739026115 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 0.5MG 63739026301 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 0.5MG 63739026303 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 0.5MG 63739026315 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 1MG 63739026401 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 1MG 63739026403 MCKESSON PACKAGING SERVICE, A DIVISION yCLONAZEPAM TAB 1MG 63739026415 MCKESSON PACKAGING SERVICE, A DIVISION yLITHIUM CARB CAP 300MG 63739026501 MCKESSON PACKAGING SERVICE, A DIVISION yLITHIUM CARB CAP 300MG 63739026503 MCKESSON PACKAGING SERVICE, A DIVISION yLITHIUM CARB CAP 300MG 63739026515 MCKESSON PACKAGING SERVICE, A DIVISION yRANITIDINE TAB 150MG 63739026601 MCKESSON PACKAGING SERVICE, A DIVISION yRANITIDINE TAB 150MG 63739026603 MCKESSON PACKAGING SERVICE, A DIVISION yRANITIDINE TAB 150MG 63739026615 MCKESSON PACKAGING SERVICE, A DIVISION ySENNA TAB 8.6MG 63739026801 MCKESSON PACKAGING SERVICE, A DIVISION ySENNA TAB 8.6MG 63739026803 MCKESSON PACKAGING SERVICE, A DIVISION ySENNA TAB 8.6MG 63739026815 MCKESSON PACKAGING SERVICE, A DIVISION yTAMOXIFEN TAB 10MG 63739026915 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 81MG EC 63739027201 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 81MG EC 63739027203 MCKESSON PACKAGING SERVICE, A DIVISION yASPIRIN TAB 81MG EC 63739027215 MCKESSON PACKAGING SERVICE, A DIVISION yLOVASTATIN TAB 10MG 63739028015 MCKESSON PACKAGING SERVICE, A DIVISION yLOVASTATIN TAB 20MG 63739028103 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LOVASTATIN TAB 20MG 63739028115 MCKESSON PACKAGING SERVICE, A DIVISION yLOVASTATIN TAB 40MG 63739028203 MCKESSON PACKAGING SERVICE, A DIVISION yDILTIAZEM CAP 120MG ER 63739028315 MCKESSON PACKAGING SERVICE, A DIVISION yDILTIAZEM CAP 180MG ER 63739028415 MCKESSON PACKAGING SERVICE, A DIVISION yDILTIAZEM CAP 240MG ER 63739028515 MCKESSON PACKAGING SERVICE, A DIVISION yDILTIAZEM CAP 300MG ER 63739028615 MCKESSON PACKAGING SERVICE, A DIVISION yTERAZOSIN CAP 1MG 63739028715 MCKESSON PACKAGING SERVICE, A DIVISION yTERAZOSIN CAP 2MG 63739028815 MCKESSON PACKAGING SERVICE, A DIVISION yTERAZOSIN CAP 5MG 63739028915 MCKESSON PACKAGING SERVICE, A DIVISION yCALCIUM/D TAB 500/200 63739029101 MCKESSON PACKAGING SERVICE, A DIVISION yCALCIUM/D TAB 500/200 63739029103 MCKESSON PACKAGING SERVICE, A DIVISION yFLUOXETINE CAP 10MG 63739029515 MCKESSON PACKAGING SERVICE, A DIVISION yFLUOXETINE CAP 20MG 63739029615 MCKESSON PACKAGING SERVICE, A DIVISION yENALAPRIL TAB 10MG 63739030215 MCKESSON PACKAGING SERVICE, A DIVISION yPOT CHLORIDE TAB 10MEQ CR 63739030501 MCKESSON PACKAGING SERVICE, A DIVISION yPOT CHLORIDE TAB 10MEQ CR 63739030503 MCKESSON PACKAGING SERVICE, A DIVISION yPOT CHLORIDE TAB 10MEQ CR 63739030515 MCKESSON PACKAGING SERVICE, A DIVISION yPOT CHLORIDE TAB 20MEQ CR 63739030601 MCKESSON PACKAGING SERVICE, A DIVISION yPOT CHLORIDE TAB 20MEQ CR 63739030603 MCKESSON PACKAGING SERVICE, A DIVISION yPOT CHLORIDE TAB 20MEQ CR 63739030615 MCKESSON PACKAGING SERVICE, A DIVISION yPHENAZOPYRID TAB 100MG 63739030915 MCKESSON PACKAGING SERVICE, A DIVISION yPHENAZOPYRID TAB 200MG 63739031015 MCKESSON PACKAGING SERVICE, A DIVISION ySENNA/DSS TAB 8.6-50MG 63739031101 MCKESSON PACKAGING SERVICE, A DIVISION ySENNA/DSS TAB 8.6-50MG 63739031103 MCKESSON PACKAGING SERVICE, A DIVISION ySENNA/DSS TAB 8.6-50MG 63739031115 MCKESSON PACKAGING SERVICE, A DIVISION yACYCLOVIR CAP 200MG 63739031415 MCKESSON PACKAGING SERVICE, A DIVISION yACYCLOVIR TAB 400MG 63739031515 MCKESSON PACKAGING SERVICE, A DIVISION yACYCLOVIR TAB 800MG 63739031615 MCKESSON PACKAGING SERVICE, A DIVISION yBUPROPION TAB 75MG 63739031715 MCKESSON PACKAGING SERVICE, A DIVISION yBUPROPION TAB 100MG 63739031815 MCKESSON PACKAGING SERVICE, A DIVISION yBUSPIRONE TAB 5MG 63739031901 MCKESSON PACKAGING SERVICE, A DIVISION yBUSPIRONE TAB 5MG 63739031903 MCKESSON PACKAGING SERVICE, A DIVISION yBUSPIRONE TAB 5MG 63739031915 MCKESSON PACKAGING SERVICE, A DIVISION yBUSPIRONE TAB 10MG 63739032001 MCKESSON PACKAGING SERVICE, A DIVISION yBUSPIRONE TAB 10MG 63739032003 MCKESSON PACKAGING SERVICE, A DIVISION yBUSPIRONE TAB 10MG 63739032015 MCKESSON PACKAGING SERVICE, A DIVISION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRIL TAB 2.5MG 63739032215 MCKESSON PACKAGING SERVICE, A DIVISION yENALAPRIL TAB 5MG 63739032315 MCKESSON PACKAGING SERVICE, A DIVISION yFAMOTIDINE TAB 20MG 63739032515 MCKESSON PACKAGING SERVICE, A DIVISION yTORSEMIDE TAB 10MG 63739033015 MCKESSON PACKAGING SERVICE, A DIVISION yTORSEMIDE TAB 20MG 63739033115 MCKESSON PACKAGING SERVICE, A DIVISION yNIZATIDINE CAP 150MG 63739033915 MCKESSON PACKAGING SERVICE, A DIVISION yTIZANIDINE TAB 4MG 63739034615 MCKESSON PACKAGING SERVICE, A DIVISION yLISINOPRIL TAB 5MG 63739034815 MCKESSON PACKAGING SERVICE, A DIVISION yLISINOPRIL TAB 10MG 63739034915 MCKESSON PACKAGING SERVICE, A DIVISION yLISINOPRIL TAB 20MG 63739035015 MCKESSON PACKAGING SERVICE, A DIVISION yMAG OXIDE TAB 400MG 63739035401 MCKESSON PACKAGING SERVICE, A DIVISION yMAG OXIDE TAB 400MG 63739035403 MCKESSON PACKAGING SERVICE, A DIVISION yMAG OXIDE TAB 400MG 63739035415 MCKESSON PACKAGING SERVICE, A DIVISION yMIRTAZAPINE TAB 15MG 63739035515 MCKESSON PACKAGING SERVICE, A DIVISION yMIRTAZAPINE TAB 30MG 63739035615 MCKESSON PACKAGING SERVICE, A DIVISION yWARFARIN TAB 2.5MG 63739036115 MCKESSON PACKAGING SERVICE, A DIVISION yWARFARIN TAB 3MG 63739036215 MCKESSON PACKAGING SERVICE, A DIVISION yWARFARIN TAB 4MG 63739036315 MCKESSON PACKAGING SERVICE, A DIVISION yWARFARIN TAB 5MG 63739036415 MCKESSON PACKAGING SERVICE, A DIVISION yGABAPENTIN CAP 100MG 63739037415 MCKESSON PACKAGING SERVICE, A DIVISION yGABAPENTIN CAP 300MG 63739037515 MCKESSON PACKAGING SERVICE, A DIVISION yGABAPENTIN CAP 400MG 63739037615 MCKESSON PACKAGING SERVICE, A DIVISION yFAMOTIDINE TAB 40MG 63739038815 MCKESSON PACKAGING SERVICE, A DIVISION yGABAPENTIN TAB 600MG 63739039115 MCKESSON PACKAGING SERVICE, A DIVISION yGABAPENTIN TAB 800MG 63739039215 MCKESSON PACKAGING SERVICE, A DIVISION yMETOLAZONE TAB 5MG 63739040410 MCKESSON PACKAGING SERVICE, A DIVISION yRIFAMPIN CAP 300MG 63739041510 MCKESSON PACKAGING SERVICE, A DIVISION yTYLENOL SINU MIS DAY/NITE 50580007224 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU MIS DAY/NITE 50580007248 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD MIS DAY/NITE 50580007324 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD MIS DAY/NITE 50580007348 MCNEIL CONSUMER HEALTHCARE yCHLRNS MOTRN DRO BERRY 50580010015 MCNEIL CONSUMER HEALTHCARE yCHLRNS MOTRN DRO BERRY 50580010020 MCNEIL CONSUMER HEALTHCARE yTYLENOL JR CHW 160MG 50580010124 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD CHW 80MG 50580010232 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD CHW 80MG 50580010248 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TYLENOL CHLD CHW 80MG 50580010250 MCNEIL CONSUMER HEALTHCARE yTYLENOL JR CHW 160MG 50580010324 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD CHW 80MG 50580010430 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD CHW 80MG 50580010532 MCNEIL CONSUMER HEALTHCARE yCHLD TYLENOL LIQ COLD 50580010604 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD LIQ SINUS 50580010704 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580010902 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580010903 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580010904 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580010908 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580010911 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011001 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011002 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011003 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011004 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011009 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011011 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011013 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011016 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011019 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011029 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011037 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011051 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011052 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011056 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011060 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580011073 MCNEIL CONSUMER HEALTHCARE yTYLENOL LIQ 1000/30 50580011108 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011204 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011206 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011210 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011212 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011215 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011221 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011222 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011224 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TYLENOL ARTH TAB 650MG 50580011225 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011229 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011250 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580011270 MCNEIL CONSUMER HEALTHCARE yMOTRIN MIGRA TAB 200MG 50580011910 MCNEIL CONSUMER HEALTHCARE yMOTRIN MIGRA TAB 200MG 50580011920 MCNEIL CONSUMER HEALTHCARE yMOTRIN MIGRA TAB 200MG 50580011924 MCNEIL CONSUMER HEALTHCARE yMOTRIN MIGRA TAB 200MG 50580011950 MCNEIL CONSUMER HEALTHCARE yMOTRIN MIGRA TAB 200MG 50580011974 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580012201 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580012215 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580012302 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580012303 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580012304 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580012308 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580012410 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580012415 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580012424 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580012432 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580012440 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580012450 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012603 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012610 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012614 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012618 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012619 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012620 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012636 MCNEIL CONSUMER HEALTHCARE yST JOSEPH TAB ASPIRIN 50580012639 MCNEIL CONSUMER HEALTHCARE yGASAID CAP 125MG 50580012712 MCNEIL CONSUMER HEALTHCARE yGASAID CAP 125MG 50580012724 MCNEIL CONSUMER HEALTHCARE yGASAID CAP 125MG 50580012748 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D LIQ MINT 50580013401 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D LIQ MINT 50580013404 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D LIQ MINT 50580013408 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D LIQ MINT 50580013412 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IMODIUM A-D LIQ MINT 50580013444 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580014315 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580014330 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580014401 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580014415 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580014418 MCNEIL CONSUMER HEALTHCARE yTYLENOL NITE LIQ COLD/FLU 50580014508 MCNEIL CONSUMER HEALTHCARE yMOTRIN COLD TAB & SINUS 50580014620 MCNEIL CONSUMER HEALTHCARE yMOTRIN COLD TAB & SINUS 50580014641 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580014724 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580014725 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580014748 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580014750 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580014760 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580016604 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580016701 MCNEIL CONSUMER HEALTHCARE yST JOSEPH AS CHW 81MG 50580017306 MCNEIL CONSUMER HEALTHCARE yST JOSEPH AS CHW 81MG 50580017308 MCNEIL CONSUMER HEALTHCARE yST JOSEPH AS CHW 81MG 50580017325 MCNEIL CONSUMER HEALTHCARE yST JOSEPH AS CHW 81MG 50580017336 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU TAB NIGHTIME 50580017424 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU TAB NIGHTIME 50580017450 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017601 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017610 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017612 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017614 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017615 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017618 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017624 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017640 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017650 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580017670 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580018210 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580018220 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580018240 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580018252 MCNEIL CONSUMER HEALTHCARE y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHILD MOTRIN SUS 100/5ML 50580018404 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580018607 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580018615 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO 80/0.8ML 50580018630 MCNEIL CONSUMER HEALTHCARE ySIMPLY STUFF LIQ 15MG/5ML 50580019304 MCNEIL CONSUMER HEALTHCARE ySIMPLY COUGH SYP 5MG/5ML 50580019504 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS COLD 50580019604 MCNEIL CONSUMER HEALTHCARE yMOTRIN DRO 40MG/ML 50580019801 MCNEIL CONSUMER HEALTHCARE yMOTRIN DRO 40MG/ML 50580019815 MCNEIL CONSUMER HEALTHCARE yMOTRIN SINUS TAB HEADACHE 50580020120 MCNEIL CONSUMER HEALTHCARE yMOTRIN SINUS TAB HEADACHE 50580020141 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU LIQ CHLDRN'S 50580020204 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SYP COLD/CGH 50580020304 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SYP COLD/CGH 50580020310 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN CHW 50MG 50580020524 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN CHW JR 100MG 50580020724 MCNEIL CONSUMER HEALTHCARE yTYLENOL SEVE TAB ALLERGY 50580021136 MCNEIL CONSUMER HEALTHCARE yTYLENOL SEVE TAB ALLERGY 50580021148 MCNEIL CONSUMER HEALTHCARE yTYLENOL SEVE TAB ALLERGY 50580021172 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580021424 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580021425 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580021447 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580021448 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580021450 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB SEV CONG 50580021460 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580021504 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB RELIEF 50580023324 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB RELIEF 50580023348 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB RELIEF 50580023424 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD LIQ RELIEF 50580025208 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD LIQ MULTI-S 50580025708 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD LIQ MULTI-SY 50580025808 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHES TAB CONGEST 50580025924 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHES TAB CONGEST 50580025949 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB HEAD CON 50580026150 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB CNG/PAIN 50580026248 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TYLENOL SINU TAB CNG/PAIN 50580026250 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB MULTI-S 50580026324 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB CNG/PAIN 50580026424 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD PAK MULTI-S 50580026524 MCNEIL CONSUMER HEALTHCARE yTYLENOL CGH PAK SORE THR 50580026716 MCNEIL CONSUMER HEALTHCARE yTYLENOL CGH PAK SORE THR 50580026724 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD LIQ MULTI-S 50580026908 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB MULTI-S 50580027124 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB MULTI-S 50580027224 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB MULTI-SY 50580027348 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB MULTI-SY 50580027350 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB MULTI-SY 50580027424 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB CNG/PAIN 50580027548 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB CNG/PAIN 50580027624 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB HEAD CON 50580027724 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB HEAD CON 50580027824 MCNEIL CONSUMER HEALTHCARE yFLEXERIL TAB 5MG 50580028010 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD PAK HEAD CON 50580028224 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB 50580028512 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB 50580028524 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB 50580028527 MCNEIL CONSUMER HEALTHCARE yCHLD TYLENOL CHW COLD 50580028742 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD LIQ & FLU 50580028808 MCNEIL CONSUMER HEALTHCARE yTYLENOL CGH LIQ SORE THR 50580028908 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580029024 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580029048 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580029055 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580029220 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580029240 MCNEIL CONSUMER HEALTHCARE yTYLENOL ARTH TAB 650MG 50580029280 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D LIQ 1MG/5ML 50580029302 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D LIQ 1MG/5ML 50580029304 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV CHW 2-125MG 50580029406 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV CHW 2-125MG 50580029412 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV CHW 2-125MG 50580029418 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV CHW 2-125MG 50580029425 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IMODIUM ADV CHW 2-125MG 50580029430 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029506 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029507 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029512 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029514 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029518 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029524 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029525 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029548 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029550 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029555 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029572 MCNEIL CONSUMER HEALTHCARE yIMODIUM A-D TAB 2MG 50580029584 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580029604 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029705 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029710 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029715 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029720 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029724 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029734 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580029750 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE PAK DAY/NIGH 50580037924 MCNEIL CONSUMER HEALTHCARE yNIZORAL SHA 2% 50580038008 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038520 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038524 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038525 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038534 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038548 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038552 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580038584 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS PLUS C/A 50580039004 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS PLUS MS 50580039104 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO COLD/CGH 50580039215 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO PLUS CLD 50580039315 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580040704 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD CHW + COUGH 50580040842 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TYLENOL GO CHW EXTRA ST 50580041006 MCNEIL CONSUMER HEALTHCARE yTYLENOL GO CHW EXTRA ST 50580041012 MCNEIL CONSUMER HEALTHCARE yTYLENOL GO CHW EXTRA ST 50580041018 MCNEIL CONSUMER HEALTHCARE yTYLENOL GO CHW EXTRA ST 50580041036 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG EZ 50580042210 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG EZ 50580042215 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG EZ 50580042224 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG EZ 50580042225 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG EZ 50580042250 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580042606 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580042610 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580042622 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580042624 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM LIQ EX STR 50580042708 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM LIQ EX STR 50580042716 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580043205 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580043224 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580043272 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU PAK DAY/NIGH 50580044112 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB SEV CONG 50580044202 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB SEV CONG 50580044212 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB SEV CONG 50580044224 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB SEV CONG 50580044248 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB SEV CONG 50580044272 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB MAX-STR 50580044302 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB MAX-STR 50580044322 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB MAX-STR 50580044324 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044900 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044902 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044905 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044907 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044909 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044910 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044912 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044913 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044915 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

413 of 774

TYLENOL TAB 500MG 50580044916 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044923 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044930 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044932 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044940 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044953 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044959 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044970 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044980 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044981 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580044983 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580045103 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580045150 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580045170 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB NO-DROW 50580045912 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB NO-DROW 50580045924 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB NO-DROW 50580045927 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB SINUS 50580046124 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB SINUS 50580046148 MCNEIL CONSUMER HEALTHCARE yTYLENOL ALLE TAB SINUS 50580046172 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046302 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046303 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046304 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046308 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046311 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046314 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046320 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046324 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046360 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580046374 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046800 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046801 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046813 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046821 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046824 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046850 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

414 of 774

TYLENOL TAB 500MG 50580046861 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046864 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046865 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046867 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046868 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046870 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046872 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580046884 MCNEIL CONSUMER HEALTHCARE yTYLENOL CGH LIQ SORE THR 50580047108 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580048020 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB SINUS MS 50580048048 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048100 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048101 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048102 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048103 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048104 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048109 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048111 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048113 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048116 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048119 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048124 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048127 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048129 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048132 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048137 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048138 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048152 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048160 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580048174 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048209 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048210 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048213 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048215 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048216 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048217 MCNEIL CONSUMER HEALTHCARE y

Page 415: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

415 of 774

TYLENOL PM TAB EX STR 50580048223 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048224 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048235 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048240 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048250 MCNEIL CONSUMER HEALTHCARE yTYLENOL PM TAB EX STR 50580048270 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048808 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048810 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048815 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048824 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048825 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048829 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048834 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG/RR 50580048850 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580049304 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD SUS 160/5ML 50580049310 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 325MG 50580049660 MCNEIL CONSUMER HEALTHCARE yMOTRIN JR TAB 100MG 50580049824 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580049932 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580049960 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580049968 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580049970 MCNEIL CONSUMER HEALTHCARE yTYLENOL LIQ 167MG/5 50580050008 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 325MG 50580050130 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 325MG 50580050150 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 325MG 50580050180 MCNEIL CONSUMER HEALTHCARE yINFAN TYLEN DRO DCON/FVR 50580050315 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580050412 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580050424 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580050448 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580050484 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580050520 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580050540 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580050580 MCNEIL CONSUMER HEALTHCARE yTYLENOL 8 HR TAB 650MG 50580050588 MCNEIL CONSUMER HEALTHCARE ySIMPLY STUFF TAB 30MG 50580050624 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SIMPLY STUFF TAB 30MG 50580050648 MCNEIL CONSUMER HEALTHCARE yTYLENOL JR TAB 160MG 50580051324 MCNEIL CONSUMER HEALTHCARE yTYLENOL JR TAB 160MG 50580051424 MCNEIL CONSUMER HEALTHCARE yTYLENOL JR TAB 160MG 50580051448 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051630 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051830 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051904 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051908 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051930 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051948 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD TAB 80MG 50580051990 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD MIS & FLU 50580053080 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060102 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060104 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060108 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060140 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060150 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060304 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS 100/5ML 50580060404 MCNEIL CONSUMER HEALTHCARE yTYLENOL COLD TAB NO-DROW 50580061620 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580071008 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580071024 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580071053 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580071055 MCNEIL CONSUMER HEALTHCARE yTYLENOL TAB 500MG 50580071065 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO PLUS CLD 50580071215 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO COLD/CGH 50580071302 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO COLD/CGH 50580071315 MCNEIL CONSUMER HEALTHCARE yTYLENOL INF DRO COLD/CGH 50580071330 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580075124 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580075127 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580075141 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580075142 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580075148 MCNEIL CONSUMER HEALTHCARE yTYL ALLERGY/ TAB COMPLETE 50580075172 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580077002 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MOTRIN IB TAB 200MG 50580077004 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580077006 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580077010 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580077020 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580077052 MCNEIL CONSUMER HEALTHCARE yMOTRIN IB TAB 200MG 50580077074 MCNEIL CONSUMER HEALTHCARE yTYLENOL SORE LIQ THROAT 50580081308 MCNEIL CONSUMER HEALTHCARE yTYLENOL SORE LIQ THROAT 50580081408 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD LIQ ALLERGY 50580081502 MCNEIL CONSUMER HEALTHCARE yTYLENOL CHLD LIQ ALLERGY 50580081504 MCNEIL CONSUMER HEALTHCARE yINF TYLENOL DRO COLD/CGH 50580082902 MCNEIL CONSUMER HEALTHCARE yINF TYLENOL DRO COLD/CGH 50580082915 MCNEIL CONSUMER HEALTHCARE yINF TYLENOL DRO COLD/CGH 50580082930 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU LIQ NIGHTIME 50580083008 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB NIGHTIME 50580083624 MCNEIL CONSUMER HEALTHCARE yTYLENOL SINU TAB NIGHTIME 50580083627 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU TAB NO-DROW 50580084112 MCNEIL CONSUMER HEALTHCARE yTYLENOL FLU TAB NO-DROW 50580084124 MCNEIL CONSUMER HEALTHCARE ySIMPLY SLEEP TAB 25MG 50580084310 MCNEIL CONSUMER HEALTHCARE ySIMPLY SLEEP TAB 25MG 50580084313 MCNEIL CONSUMER HEALTHCARE ySIMPLY SLEEP TAB 25MG 50580084324 MCNEIL CONSUMER HEALTHCARE ySIMPLY SLEEP TAB 25MG 50580084325 MCNEIL CONSUMER HEALTHCARE ySIMPLY SLEEP TAB 25MG 50580084348 MCNEIL CONSUMER HEALTHCARE ySIMPLY SLEEP TAB 25MG 50580084372 MCNEIL CONSUMER HEALTHCARE yFLEXERIL TAB 10MG 50580087411 MCNEIL CONSUMER HEALTHCARE yNIZORAL A-D SHA 1% 50580089504 MCNEIL CONSUMER HEALTHCARE yNIZORAL A-D SHA 1% 50580089507 MCNEIL CONSUMER HEALTHCARE yNIZORAL A-D SHA 1% 50580089514 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS COLD 50580090204 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS COLD 50580090210 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN SUS COLD 50580090304 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN CHW 50MG 50580090724 MCNEIL CONSUMER HEALTHCARE yCHILD MOTRIN CHW JR 100MG 50580090924 MCNEIL CONSUMER HEALTHCARE yTYLENOL SORE LIQ THROAT 50580091308 MCNEIL CONSUMER HEALTHCARE yTYLENOL SORE LIQ THROAT 50580091408 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV TAB 50580092212 MCNEIL CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IMODIUM ADV TAB 50580092230 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV TAB 50580092242 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV TAB 50580092250 MCNEIL CONSUMER HEALTHCARE yIMODIUM ADV TAB 50580092261 MCNEIL CONSUMER HEALTHCARE yWMN'S TYLENL TAB 500-25MG 50580092824 MCNEIL CONSUMER HEALTHCARE yWMN'S TYLENL TAB 500-25MG 50580092840 MCNEIL CONSUMER HEALTHCARE yPANCREASE CAP EC 00045009560 MCNEIL PHARMACEUTICALS yIMODIUM A-D TAB 2MG 00045029529 MCNEIL PHARMACEUTICALS yPANCREASE MT CAP 4 00045034160 MCNEIL PHARMACEUTICALS yPANCREASE MT CAP 10 00045034260 MCNEIL PHARMACEUTICALS yPANCREASE MT CAP 16 00045034360 MCNEIL PHARMACEUTICALS yPANCREASE MT CAP 20 00045034660 MCNEIL PHARMACEUTICALS yTYLENOL TAB 500MG 00045044921 MCNEIL PHARMACEUTICALS yTYLENOL TAB 500MG 00045045150 MCNEIL PHARMACEUTICALS yULTRAM TAB 50MG 00045065910 MCNEIL PHARMACEUTICALS yULTRAM TAB 50MG 00045065960 MCNEIL PHARMACEUTICALS yREGRANEX GEL 0.01% 00045081015 MCNEIL PHARMACEUTICALS yLEVAQUIN SOL 25MG/ML 00045151501 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB 250MG 00045152010 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB 250MG 00045152050 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB 500MG 00045152510 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB 500MG 00045152550 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB LEVA-PAK 00045153005 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB 750MG 00045153010 MCNEIL PHARMACEUTICALS yLEVAQUIN TAB 750MG 00045153020 MCNEIL PHARMACEUTICALS yMONISTAT 1 OIN 6.5% 08004541001 MCNEIL-PPC, INC. yMONISTAT 1 KIT 1200MG2% 08004541100 MCNEIL-PPC, INC. yMAXIFED DMX TAB 58605051501 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXIFED TAB 80-700CR 58605052001 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXI-TUSS DM LIQ 58605052201 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXI-TUSS HC SYP 58605052301 MCR-AMERICAN PHARMACEUTICALS, INC. yPROMACET TAB 58605052401 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXIFED DM TAB 58605052601 MCR-AMERICAN PHARMACEUTICALS, INC. yALLFEN JR TAB 400MG 58605053001 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXI-TUSS LIQ HCX 58605053401 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXI-TUSS LIQ HCG 58605053601 MCR-AMERICAN PHARMACEUTICALS, INC. y

Page 419: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

419 of 774

ALLFEN TAB 58605061301 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXIFED-G TAB 60-580CR 58605061401 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXIFED DMX TAB 58605061501 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXIFED TAB 80-780MG 58605062001 MCR-AMERICAN PHARMACEUTICALS, INC. yALLFEN-DM TAB 55-1000 58605062101 MCR-AMERICAN PHARMACEUTICALS, INC. yMAXIFED DM TAB 58605062601 MCR-AMERICAN PHARMACEUTICALS, INC. yALLFEN C TAB 5-1000MG 58605071301 MCR-AMERICAN PHARMACEUTICALS, INC. yALLFEN CX TAB 58605072101 MCR-AMERICAN PHARMACEUTICALS, INC. yCYTOXAN INJ 500MG 00015050241 MEAD JOHNSON AND COMPANY yCYTOXAN TAB 50MG 00015050301 MEAD JOHNSON AND COMPANY yCYTOXAN TAB 25MG 00015050401 MEAD JOHNSON AND COMPANY yCYTOXAN INJ 1GM 00015050541 MEAD JOHNSON AND COMPANY yCYTOXAN INJ 2GM 00015050641 MEAD JOHNSON AND COMPANY yMEGACE ORAL SUS 40MG/ML 00015050842 MEAD JOHNSON AND COMPANY yIFEX INJ 1GM 00015055605 MEAD JOHNSON AND COMPANY yIFEX INJ 1GM 00015055641 MEAD JOHNSON AND COMPANY yIFEX INJ 3GM 00015055741 MEAD JOHNSON AND COMPANY yQUESTRAN POW 4GM 00015058011 MEAD JOHNSON AND COMPANY yTEQUIN TAB 200MG 00015111750 MEAD JOHNSON AND COMPANY yTEQUIN TAB 200MG 00015111780 MEAD JOHNSON AND COMPANY yTEQUIN TAB 400MG 00015117760 MEAD JOHNSON AND COMPANY yTEQUIN TAB 400MG 00015117780 MEAD JOHNSON AND COMPANY yTEQUIN INJ 10MG/ML 00015117980 MEAD JOHNSON AND COMPANY yTEQUIN INJ 2MG/ML 00015118078 MEAD JOHNSON AND COMPANY yTEQUIN INJ 2MG/ML 00015118079 MEAD JOHNSON AND COMPANY yTEQUIN INJ 2MG/ML 00015118178 MEAD JOHNSON AND COMPANY yTEQUIN INJ 2MG/ML 00015118179 MEAD JOHNSON AND COMPANY yMUTAMYCIN INJ 5MG 00015300120 MEAD JOHNSON AND COMPANY yMUTAMYCIN INJ 20MG 00015300220 MEAD JOHNSON AND COMPANY yBLENOXANE INJ 15UNIT 00015301020 MEAD JOHNSON AND COMPANY yBICNU INJ 100MG 00015301238 MEAD JOHNSON AND COMPANY yCEENU CAP 10MG 00015303020 MEAD JOHNSON AND COMPANY yCEENU CAP 40MG 00015303120 MEAD JOHNSON AND COMPANY yCEENU CAP 100MG 00015303220 MEAD JOHNSON AND COMPANY yCEENU PAK DOSEPACK 00015303410 MEAD JOHNSON AND COMPANY yMUTAMYCIN INJ 40MG 00015305920 MEAD JOHNSON AND COMPANY y

Page 420: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BLENOXANE INJ 30UNIT 00015306301 MEAD JOHNSON AND COMPANY yVUMON INJ 50MG/5ML 00015307519 MEAD JOHNSON AND COMPANY yLYSODREN TAB 500MG 00015308060 MEAD JOHNSON AND COMPANY yVEPESID CAP 50MG 00015309145 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 50MG/5ML 00015321030 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 50MG/5ML 00015321076 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 150/15ML 00015321130 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 150/15ML 00015321176 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 50MG 00015321330 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 150MG 00015321430 MEAD JOHNSON AND COMPANY yPARAPLATIN INJ 450MG 00015321530 MEAD JOHNSON AND COMPANY yETOPOPHOS INJ 100MG 00015340420 MEAD JOHNSON AND COMPANY yTAXOL INJ 30MG/5ML 00015347530 MEAD JOHNSON AND COMPANY yTAXOL INJ 100/17ML 00015347630 MEAD JOHNSON AND COMPANY yTAXOL INJ 6MG/ML 00015347911 MEAD JOHNSON AND COMPANY yIFEX/MESNEX KIT 00015355427 MEAD JOHNSON AND COMPANY yIFEX/MESNEX KIT 00015355626 MEAD JOHNSON AND COMPANY yMESNEX INJ 1GM 00015356302 MEAD JOHNSON AND COMPANY yMESNEX INJ 1GM 00015356303 MEAD JOHNSON AND COMPANY yIFEX/MESNEX KIT 00015356415 MEAD JOHNSON AND COMPANY ySTADOL INJ 2MG/ML 00015564433 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 10GM 00015710128 MEAD JOHNSON AND COMPANY yOXACILLIN INJ 10GM 00015710328 MEAD JOHNSON AND COMPANY yOXACILLIN INJ 10GM 00015710398 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 1GM 00015722518 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 1GM 00015722520 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 1GM PBK 00015722521 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 1GM 00015722522 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 2GM 00015722620 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 2GM PBK 00015722621 MEAD JOHNSON AND COMPANY yNAFCILLIN INJ 2GM 00015722622 MEAD JOHNSON AND COMPANY yULTRACEF SUS 125/5ML 00015728325 MEAD JOHNSON AND COMPANY yULTRACEF TAB 1GM 00015728630 MEAD JOHNSON AND COMPANY yULTRACEF TAB 1GM 00015728666 MEAD JOHNSON AND COMPANY yCEFAZOLIN INJ 500MG 00015733812 MEAD JOHNSON AND COMPANY yCEFAZOLIN INJ 1GM 00015733912 MEAD JOHNSON AND COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CEFAZOLIN INJ 10GM 00015734639 MEAD JOHNSON AND COMPANY yAMPICILLIN INJ 500MG 00015740320 MEAD JOHNSON AND COMPANY yAMPICILLIN INJ 500MG 00015740330 MEAD JOHNSON AND COMPANY yAMPICILLIN INJ 500MG 00015740331 MEAD JOHNSON AND COMPANY yAMPICILLIN INJ 500MG 00015740399 MEAD JOHNSON AND COMPANY yOXACILLIN INJ 1GM 00015798118 MEAD JOHNSON AND COMPANY yOXACILLIN INJ 1GM 00015798120 MEAD JOHNSON AND COMPANY yPROSTAPHLIN INJ 1GM 00015798122 MEAD JOHNSON AND COMPANY yOXACILLIN INJ 1GM 00015798128 MEAD JOHNSON AND COMPANY yOXACILLIN INJ 1GM 00015798189 MEAD JOHNSON AND COMPANY yPOLYCILLIN SUS 250/5ML 00015799835 MEAD JOHNSON AND COMPANY yQUESTRAN POW 4GM LITE 00015944214 MEAD JOHNSON AND COMPANY yNASAL SPR 0.05% 49614006510 MEDICINE SHOPPE INTERNATIONAL, INC. yTRAVEL-EASE TAB 50MG 49614010153 MEDICINE SHOPPE INTERNATIONAL, INC. yFEM-LAX TAB 100-65MG 49614010265 MEDICINE SHOPPE INTERNATIONAL, INC. yPEDIA RELIEF LIQ CGH/COLD 49614010326 MEDICINE SHOPPE INTERNATIONAL, INC. ySIMETHICONE CHW 80MG 49614010378 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-GESIC TAB 30-325MG 49614010475 MEDICINE SHOPPE INTERNATIONAL, INC. yPEDIA RELIEF LIQ CGH/COLD 49614010626 MEDICINE SHOPPE INTERNATIONAL, INC. yADULT PAIN TAB 400-32MG 49614010878 MEDICINE SHOPPE INTERNATIONAL, INC. yASPIRIN TAB 325MG EC 49614011378 MEDICINE SHOPPE INTERNATIONAL, INC. yASPIRIN TAB 325MG EC 49614011385 MEDICINE SHOPPE INTERNATIONAL, INC. yHEADACHE REL TAB ADD STR 49614011471 MEDICINE SHOPPE INTERNATIONAL, INC. yHEADACHE REL TAB ADD STR 49614011478 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614011571 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614011671 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614011678 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614011685 MEDICINE SHOPPE INTERNATIONAL, INC. yCHLD MEDITAB CHW 80MG 49614011765 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 325MG 49614011878 MEDICINE SHOPPE INTERNATIONAL, INC. yCIMETIDINE TAB 200MG 49614011965 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614012172 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614012178 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614012278 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614012371 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614012378 MEDICINE SHOPPE INTERNATIONAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MEDI-TABS TAB 500MG 49614012390 MEDICINE SHOPPE INTERNATIONAL, INC. yMINOXIDIL SOL 5% 49614012416 MEDICINE SHOPPE INTERNATIONAL, INC. ySIMETHICONE CHW 80MG 49614012778 MEDICINE SHOPPE INTERNATIONAL, INC. yMAG CITRATE SOL CHERRY 49614013042 MEDICINE SHOPPE INTERNATIONAL, INC. ySTOOL SOFTEN CAP 100MG 49614013078 MEDICINE SHOPPE INTERNATIONAL, INC. yGENTLE LAXAT TAB 5MG EC 49614013163 MEDICINE SHOPPE INTERNATIONAL, INC. yNIGHT TIME TAB 25MG 49614013262 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-SLEEP TAB 25MG 49614013266 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-NATURAL TAB W/SOFTNR 49614013272 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-NATURAL TAB W/SOFTNR 49614013278 MEDICINE SHOPPE INTERNATIONAL, INC. yLAXATIVE SUP 10MG 49614013335 MEDICINE SHOPPE INTERNATIONAL, INC. yMAG CITRATE SOL LEMON 49614013442 MEDICINE SHOPPE INTERNATIONAL, INC. yMAGN CITRATE SOL 49614013542 MEDICINE SHOPPE INTERNATIONAL, INC. yFAMOTIDINE TAB 10MG 49614013765 MEDICINE SHOPPE INTERNATIONAL, INC. yFAMOTIDINE TAB 10MG 49614013772 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614013971 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614013978 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-LAX TAB 49614014065 MEDICINE SHOPPE INTERNATIONAL, INC. yNAPROXEN SOD TAB 220MG 49614014271 MEDICINE SHOPPE INTERNATIONAL, INC. yNAPROXEN SOD TAB 220MG 49614014278 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-SLEEP TAB 25MG 49614014366 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB COLD 49614014462 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-NATURAL TAB 8.6-50MG 49614014572 MEDICINE SHOPPE INTERNATIONAL, INC. yNIGHTTIME SL TAB 25MG 49614014662 MEDICINE SHOPPE INTERNATIONAL, INC. yEAR WAX REMO SOL 6.5% OT 49614014805 MEDICINE SHOPPE INTERNATIONAL, INC. ySOLUBLE FIB POW 49614015065 MEDICINE SHOPPE INTERNATIONAL, INC. yLAXATIVE TAB W/SENNA 49614015162 MEDICINE SHOPPE INTERNATIONAL, INC. ySTOOL SOFTEN TAB LAXATIVE 49614015478 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB ALRG/SIN 49614015662 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY RELF TAB 10MG 49614017052 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY RELF TAB 10MG 49614017060 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY RELF TAB 10MG 49614017065 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY RELF TAB 10MG 49614017072 MEDICINE SHOPPE INTERNATIONAL, INC. yLORATADINE TAB D-12 49614017152 MEDICINE SHOPPE INTERNATIONAL, INC. yLORATADINE TAB D-12 49614017160 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY RELF TAB D-24 49614017213 MEDICINE SHOPPE INTERNATIONAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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ALLERGY RELF TAB D-24 49614017252 MEDICINE SHOPPE INTERNATIONAL, INC. yAZO-TABS TAB 95MG 49614017366 MEDICINE SHOPPE INTERNATIONAL, INC. yLORATADINE SYP ALLG REL 49614017426 MEDICINE SHOPPE INTERNATIONAL, INC. yCHLD MEDITAB SUS 80/2.5ML 49614017526 MEDICINE SHOPPE INTERNATIONAL, INC. yLORATADINE TAB ALLG REL 49614017652 MEDICINE SHOPPE INTERNATIONAL, INC. yLORATADINE TAB ALLG REL 49614017653 MEDICINE SHOPPE INTERNATIONAL, INC. yANTACID CHW 750MG 49614017880 MEDICINE SHOPPE INTERNATIONAL, INC. yCAL ANTACID CHW 750MG XS 49614017980 MEDICINE SHOPPE INTERNATIONAL, INC. yLAXATIVE SOL SALINE 49614018221 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614018871 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB 500MG 49614018878 MEDICINE SHOPPE INTERNATIONAL, INC. yCOLD/HOT PAD 5% 49614019013 MEDICINE SHOPPE INTERNATIONAL, INC. yNITE-TIME CAP 49614019453 MEDICINE SHOPPE INTERNATIONAL, INC. yMINERAL OIL 49614020243 MEDICINE SHOPPE INTERNATIONAL, INC. yIPECAC SYP 49614020310 MEDICINE SHOPPE INTERNATIONAL, INC. yDAY TIME CAP 49614020353 MEDICINE SHOPPE INTERNATIONAL, INC. yDAY-TIME CAP COLD/FLU 49614020653 MEDICINE SHOPPE INTERNATIONAL, INC. yACID REDUCER TAB 75MG 49614022065 MEDICINE SHOPPE INTERNATIONAL, INC. yPED ELECTROL SOL FRUIT 49614022208 MEDICINE SHOPPE INTERNATIONAL, INC. yPED ELECTROL SOL GRAPE 49614022308 MEDICINE SHOPPE INTERNATIONAL, INC. yK-PEC SUS 262/15ML 49614027940 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERHIST-1 TAB 1.34MG 49614028273 MEDICINE SHOPPE INTERNATIONAL, INC. yEYE DROPS SOL 0.05% OP 49614029705 MEDICINE SHOPPE INTERNATIONAL, INC. yEYE DROPS SOL 0.05% OP 49614030105 MEDICINE SHOPPE INTERNATIONAL, INC. yNATURAL VEG POW 48.57% 49614030155 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-BISMUTH SUS 262/15ML 49614030234 MEDICINE SHOPPE INTERNATIONAL, INC. yINTENSE COUG LIQ RELIEVER 49614030726 MEDICINE SHOPPE INTERNATIONAL, INC. yARTIFI TEARS OIN OP 49614030808 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TUSSIN SYP 100/5ML 49614031034 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TUSSIN SYP DM 49614031134 MEDICINE SHOPPE INTERNATIONAL, INC. ySALINE NASAL SPR 0.65% 49614031213 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS DRO 80/0.8ML 49614031310 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614031478 MEDICINE SHOPPE INTERNATIONAL, INC. yHEMORRHOIDAL SUP 49614031553 MEDICINE SHOPPE INTERNATIONAL, INC. y12 HR NASAL SPR 0.05% 49614031610 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TUSSIN LIQ 49614031934 MEDICINE SHOPPE INTERNATIONAL, INC. y

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GLYCERIN SUP 3GM 49614032063 MEDICINE SHOPPE INTERNATIONAL, INC. yNITE TIME LIQ CHERRY 49614032238 MEDICINE SHOPPE INTERNATIONAL, INC. ySORE THROAT SPR CHERRY 49614032830 MEDICINE SHOPPE INTERNATIONAL, INC. yENEMA ENE SINGLE 49614033127 MEDICINE SHOPPE INTERNATIONAL, INC. yENEMA ENE SINGLE 49614033128 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-MILK OF SUS MAGNESIA 49614033140 MEDICINE SHOPPE INTERNATIONAL, INC. yMILK OF MAGN SUS 400/5ML 49614033240 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB COLD/SIN 49614033660 MEDICINE SHOPPE INTERNATIONAL, INC. yANTACID/SIME SUS DS 49614034040 MEDICINE SHOPPE INTERNATIONAL, INC. yNATURAL VEG POW 30.9% 49614034737 MEDICINE SHOPPE INTERNATIONAL, INC. yNATURAL VEG POW 30.9% 49614034755 MEDICINE SHOPPE INTERNATIONAL, INC. yFIBER TAB 625MG 49614035075 MEDICINE SHOPPE INTERNATIONAL, INC. yFIBER THERAP TAB 500MG 49614035178 MEDICINE SHOPPE INTERNATIONAL, INC. yNITE TIME LIQ REGULAR 49614035338 MEDICINE SHOPPE INTERNATIONAL, INC. yANTACID/ SUS SIMETH 49614035840 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TUSS DM LIQ DIABETIC 49614036026 MEDICINE SHOPPE INTERNATIONAL, INC. yNVP SMOOTH POW 58.6%ORG 49614036649 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRYL ELX 12.5/5ML 49614037926 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-BROM ELX CLD/ALLG 49614038026 MEDICINE SHOPPE INTERNATIONAL, INC. yHEMORRHOIDAL OIN 49614038716 MEDICINE SHOPPE INTERNATIONAL, INC. yDAIRY DIGES CHW 9000UNIT 49614038866 MEDICINE SHOPPE INTERNATIONAL, INC. ySCAR GEL 49614039715 MEDICINE SHOPPE INTERNATIONAL, INC. yANTISEPTIC SOL 49614039826 MEDICINE SHOPPE INTERNATIONAL, INC. yMUSCLE RUB LOT ULTRA ST 49614040116 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-CORT CRE 1% 49614040410 MEDICINE SHOPPE INTERNATIONAL, INC. yANTIFUNGAL LIQ 10% 49614040510 MEDICINE SHOPPE INTERNATIONAL, INC. yPOVIDONE-IOD SOL 10% 49614040734 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-MUCIL CAP 0.52GM 49614040878 MEDICINE SHOPPE INTERNATIONAL, INC. yTRIPLE ANTIB OIN 49614040910 MEDICINE SHOPPE INTERNATIONAL, INC. yPAIN RELIEV GEL 7% 49614041226 MEDICINE SHOPPE INTERNATIONAL, INC. yARTHRITIS CRE 49614041316 MEDICINE SHOPPE INTERNATIONAL, INC. yANTI-ITCH CRE 2-0.1% 49614041510 MEDICINE SHOPPE INTERNATIONAL, INC. yFIRST AID OIN LIDOCAIN 49614041610 MEDICINE SHOPPE INTERNATIONAL, INC. yASPIRIN TAB 325MG 49614041678 MEDICINE SHOPPE INTERNATIONAL, INC. yASPIRIN TAB 325MG 49614041687 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDICATED OIN RUB 49614042019 MEDICINE SHOPPE INTERNATIONAL, INC. y

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ANTACID/PAIN TAB RELIEVER 49614042168 MEDICINE SHOPPE INTERNATIONAL, INC. yARTHRTS PAIN TAB 650MG 49614042378 MEDICINE SHOPPE INTERNATIONAL, INC. yGAS RELIEF CAP 125MG XS 49614042865 MEDICINE SHOPPE INTERNATIONAL, INC. yGAS RELIEF CAP ULTRA 49614042872 MEDICINE SHOPPE INTERNATIONAL, INC. yLIQUID TEARS SOL OP 49614043005 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRIN TAB 30MG 49614043252 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRIN TAB 30MG 49614043262 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRIN TAB 30MG 49614043280 MEDICINE SHOPPE INTERNATIONAL, INC. y12HR DECONGE TAB 120MG CR 49614043362 MEDICINE SHOPPE INTERNATIONAL, INC. yAPHEDRID TAB 2.5-60MG 49614043462 MEDICINE SHOPPE INTERNATIONAL, INC. yCOLD RELIEF TAB PLUS 49614043560 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS PM TAB 25-500MG 49614043900 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS PM TAB 25-500MG 49614043971 MEDICINE SHOPPE INTERNATIONAL, INC. ySINUS HEADAC TAB NO DROWS 49614044762 MEDICINE SHOPPE INTERNATIONAL, INC. yCHEST CONGES TAB RELIEF 49614044871 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRIN TAB PLUS 49614045062 MEDICINE SHOPPE INTERNATIONAL, INC. yBACKACHE REL TAB EX ST 49614045162 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRYL CAP 25MG 49614046262 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PHEDRYL CAP 25MG 49614046278 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY TAB 4MG 49614046362 MEDICINE SHOPPE INTERNATIONAL, INC. yALLERGY TAB 4MG 49614046378 MEDICINE SHOPPE INTERNATIONAL, INC. yCHILD ASA CHW 81MG 49614046767 MEDICINE SHOPPE INTERNATIONAL, INC. yCHILD ASA CHW 81MG 49614046768 MEDICINE SHOPPE INTERNATIONAL, INC. yCHILD'S ASA CHW 81MG 49614046867 MEDICINE SHOPPE INTERNATIONAL, INC. yCHILD'S ASA CHW 81MG 49614046868 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-BISMUTH CHW 262MG 49614046965 MEDICINE SHOPPE INTERNATIONAL, INC. yANALGESIC CRE ALOE 49614047021 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB FLU 49614047962 MEDICINE SHOPPE INTERNATIONAL, INC. yNATURAL COLD CRE SORE 2% 49614048213 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TUSSIN CAP CGH/COLD 49614048753 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614048885 MEDICINE SHOPPE INTERNATIONAL, INC. yHYGIENIC PAD CLEANSNG 49614050878 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-TABS TAB SINUS 49614051162 MEDICINE SHOPPE INTERNATIONAL, INC. yCOMPLETE TAB MAX STR 49614052562 MEDICINE SHOPPE INTERNATIONAL, INC. yLICE TRTMNT LIQ CRM RNSE 49614053426 MEDICINE SHOPPE INTERNATIONAL, INC. yADLT ASA LOW TAB 81MG EC 49614053531 MEDICINE SHOPPE INTERNATIONAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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ADLT ASA LOW TAB 81MG EC 49614053576 MEDICINE SHOPPE INTERNATIONAL, INC. yANTI-DIARRHE TAB 2MG 49614055453 MEDICINE SHOPPE INTERNATIONAL, INC. yANTI-DIARRHE TAB 2MG 49614055462 MEDICINE SHOPPE INTERNATIONAL, INC. yMICONAZOLE 7 CRE 2% 49614059029 MEDICINE SHOPPE INTERNATIONAL, INC. yM-ZOLE 3 KIT COMBO PK 49614059194 MEDICINE SHOPPE INTERNATIONAL, INC. yTIOCONAZOLE OIN 6.5% VAG 49614059594 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614060490 MEDICINE SHOPPE INTERNATIONAL, INC. yPRENATAL TAB VITAMINS 49614061378 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614064778 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN TAB 200MG 49614064878 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-ITCH CRE MAX STR 49614080616 MEDICINE SHOPPE INTERNATIONAL, INC. yMEDI-PROFEN SUS 100/5ML 49614089726 MEDICINE SHOPPE INTERNATIONAL, INC. yLOPROX SHA 1% 99207001010 MEDICIS DERMATOLOGICS, INC. yLOPROX GEL TOPICAL 99207001301 MEDICIS DERMATOLOGICS, INC. yLOPROX GEL TOPICAL 99207001330 MEDICIS DERMATOLOGICS, INC. yLOPROX GEL TOPICAL 99207001345 MEDICIS DERMATOLOGICS, INC. yLOPROX CRE 0.77% 99207001590 MEDICIS DERMATOLOGICS, INC. yLOPROX SUS 0.77% 99207002230 MEDICIS DERMATOLOGICS, INC. yLOPROX SUS 0.77% 99207002260 MEDICIS DERMATOLOGICS, INC. yTRIAZ PAD 9% 99207022330 MEDICIS DERMATOLOGICS, INC. yTRIAZ PAD 9% 99207022360 MEDICIS DERMATOLOGICS, INC. yZIANA GEL 99207030030 MEDICIS DERMATOLOGICS, INC. yZIANA GEL 99207030060 MEDICIS DERMATOLOGICS, INC. ySOLODYN TAB 45MG 99207046010 MEDICIS DERMATOLOGICS, INC. ySOLODYN TAB 45MG 99207046030 MEDICIS DERMATOLOGICS, INC. ySOLODYN TAB 90MG 99207046110 MEDICIS DERMATOLOGICS, INC. ySOLODYN TAB 90MG 99207046130 MEDICIS DERMATOLOGICS, INC. ySOLODYN TAB 135MG 99207046210 MEDICIS DERMATOLOGICS, INC. ySOLODYN TAB 135MG 99207046230 MEDICIS DERMATOLOGICS, INC. ySALAC LIQ 2% 99207047077 MEDICIS DERMATOLOGICS, INC. yDYNACIN CAP 75MG 99207048910 MEDICIS DERMATOLOGICS, INC. yDYNACIN CAP 75MG 99207048911 MEDICIS DERMATOLOGICS, INC. ySYNALAR CRE 0.025% 99207050113 MEDICIS DERMATOLOGICS, INC. ySYNALAR CRE 0.025% 99207050117 MEDICIS DERMATOLOGICS, INC. ySYNALAR OIN 0.025% 99207050413 MEDICIS DERMATOLOGICS, INC. ySYNALAR OIN 0.025% 99207050417 MEDICIS DERMATOLOGICS, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SYNALAR SOL 0.01% 99207050644 MEDICIS DERMATOLOGICS, INC. ySYNALAR SOL 0.01% 99207050646 MEDICIS DERMATOLOGICS, INC. yLIDEX GEL 0.05% 99207050713 MEDICIS DERMATOLOGICS, INC. yLIDEX GEL 0.05% 99207050714 MEDICIS DERMATOLOGICS, INC. yLIDEX GEL 0.05% 99207050717 MEDICIS DERMATOLOGICS, INC. yLIDEX CRE 0.05% 99207051113 MEDICIS DERMATOLOGICS, INC. yLIDEX CRE 0.05% 99207051114 MEDICIS DERMATOLOGICS, INC. yLIDEX CRE 0.05% 99207051117 MEDICIS DERMATOLOGICS, INC. yLIDEX-E CRE 0.05% 99207051313 MEDICIS DERMATOLOGICS, INC. yLIDEX-E CRE 0.05% 99207051314 MEDICIS DERMATOLOGICS, INC. yLIDEX-E CRE 0.05% 99207051317 MEDICIS DERMATOLOGICS, INC. yLIDEX OIN 0.05% 99207051413 MEDICIS DERMATOLOGICS, INC. yLIDEX OIN 0.05% 99207051414 MEDICIS DERMATOLOGICS, INC. yLIDEX OIN 0.05% 99207051417 MEDICIS DERMATOLOGICS, INC. yLIDEX SOL 0.05% 99207051746 MEDICIS DERMATOLOGICS, INC. yVANOS CRE 0.1% 99207052510 MEDICIS DERMATOLOGICS, INC. yVANOS CRE 0.1% 99207052530 MEDICIS DERMATOLOGICS, INC. yVANOS CRE 0.1% 99207052560 MEDICIS DERMATOLOGICS, INC. yPLEXION CLTH MIS 10-5% 99207074530 MEDICIS DERMATOLOGICS, INC. yPLEXION CLTH MIS 10-5% 99207074560 MEDICIS DERMATOLOGICS, INC. yOCCLUSAL-HP LIQ 17% 99207075410 MEDICIS DERMATOLOGICS, INC. yPENTRAX TAR SHA 5% 99207086508 MEDICIS DERMATOLOGICS, INC. yETHYOL INJ 500MG 58178001701 MEDIMMUNE ONCOLOGY, INC. yETHYOL INJ 500MG 58178001703 MEDIMMUNE ONCOLOGY, INC. yNEUTREXIN INJ 25MG 58178002010 MEDIMMUNE ONCOLOGY, INC. yCYTOGAM INJ 60574310101 MEDIMMUNE, INC. ySYNAGIS INJ 100MG 60574411101 MEDIMMUNE, INC. ySYNAGIS INJ 50MG 60574411201 MEDIMMUNE, INC. ySYNAGIS INJ 100MG/ML 60574411301 MEDIMMUNE, INC. ySYNAGIS INJ 50MG 60574411401 MEDIMMUNE, INC. yINZO CRE BARRIER 53329077757 MEDLINE INDUSTRIES, INC. yBUTISOL SOD ELX 30MG/5ML 00037011016 MEDPOINTE PHARMACEUTICALS yBUTISOL SOD TAB 30MG 00037011360 MEDPOINTE PHARMACEUTICALS yBUTISOL SOD TAB 30MG 00037011380 MEDPOINTE PHARMACEUTICALS yBUTISOL SOD TAB 50MG 00037011460 MEDPOINTE PHARMACEUTICALS yASTELIN NASA SPR 137MCG 00037024130 MEDPOINTE PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FELBATOL TAB 400MG 00037043001 MEDPOINTE PHARMACEUTICALS yFELBATOL TAB 400MG 00037043011 MEDPOINTE PHARMACEUTICALS yFELBATOL TAB 600MG 00037043101 MEDPOINTE PHARMACEUTICALS yFELBATOL SUS 600/5ML 00037044217 MEDPOINTE PHARMACEUTICALS yFELBATOL SUS 600/5ML 00037044267 MEDPOINTE PHARMACEUTICALS yLUFYLLIN TAB 200MG 00037052192 MEDPOINTE PHARMACEUTICALS yLUFYLLIN-GG TAB 200-200 00037054192 MEDPOINTE PHARMACEUTICALS yLUFYLLIN-GG ELX 100-100 00037054568 MEDPOINTE PHARMACEUTICALS yRYNA-12 S SUS 00037065504 MEDPOINTE PHARMACEUTICALS yRYNA-12 TAB 60-25MG 00037067310 MEDPOINTE PHARMACEUTICALS yTUSSI-12 TAB 5-60MG 00037068110 MEDPOINTE PHARMACEUTICALS yTUSSI-12 S SUS 4-30MG/5 00037068204 MEDPOINTE PHARMACEUTICALS yTUSSI-12D TAB 10-40-60 00037069210 MEDPOINTE PHARMACEUTICALS yTUSSI-12D S SUS 00037069304 MEDPOINTE PHARMACEUTICALS yRYNATAN TAB 9-25MG 00037070710 MEDPOINTE PHARMACEUTICALS yRYNATAN PEDI CHW 4.5-5MG 00037071203 MEDPOINTE PHARMACEUTICALS yRYNATAN PED SUS 00037071416 MEDPOINTE PHARMACEUTICALS yRYNATUSS TAB 00037071792 MEDPOINTE PHARMACEUTICALS yLUFYLLIN TAB 400MG 00037073192 MEDPOINTE PHARMACEUTICALS yRYNA-12X TAB 00037170803 MEDPOINTE PHARMACEUTICALS yRYNA-12X TAB 00037170810 MEDPOINTE PHARMACEUTICALS yRYNA-12X SUS 5-30-100 00037180904 MEDPOINTE PHARMACEUTICALS ySOMA TAB 350MG 00037200101 MEDPOINTE PHARMACEUTICALS ySOMA TAB 350MG 00037200103 MEDPOINTE PHARMACEUTICALS ySOMA CPD TAB 00037210301 MEDPOINTE PHARMACEUTICALS ySOMA CPD/COD TAB 00037240301 MEDPOINTE PHARMACEUTICALS yORGANIDIN NR LIQ 100/5ML 00037421410 MEDPOINTE PHARMACEUTICALS yORGANIDIN NR TAB 200MG 00037431201 MEDPOINTE PHARMACEUTICALS yDEPEN TITRA TAB 250MG 00037440101 MEDPOINTE PHARMACEUTICALS yTUSSI-ORGANI LIQ NR DM 00037471410 MEDPOINTE PHARMACEUTICALS yTUSSI-ORGANI LIQ NR 00037481410 MEDPOINTE PHARMACEUTICALS ySINA-12X TAB 25-200MG 00037630103 MEDPOINTE PHARMACEUTICALS ySINA-12X SUS 00037630204 MEDPOINTE PHARMACEUTICALS yOPTIVAR DRO 0.05% 00037702560 MEDPOINTE PHARMACEUTICALS yZOMIG TAB 2.5MG 00037721020 MEDPOINTE PHARMACEUTICALS yZOMIG TAB 5MG 00037721125 MEDPOINTE PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DORAL TAB 15MG 00037900201 MEDPOINTE PHARMACEUTICALS yMALTSUPEX POW 00037910112 MEDPOINTE PHARMACEUTICALS yLIORESAL INT INJ 10/20ML 58281056001 MEDTRONIC INC yLIORESAL INT INJ 10/20ML 58281056002 MEDTRONIC INC yLIORESAL INT INJ 10MG/5ML 58281056102 MEDTRONIC INC yLIORESAL INT INJ 0.05MG/1 58281056201 MEDTRONIC INC yLIORESAL INT INJ 40MG/20 58281056301 MEDTRONIC INC yLIORESAL INT INJ 40MG/20 58281056302 MEDTRONIC INC yPRINIVIL TAB 2.5MG 00006001528 MERCK & CO., INC. yPRINIVIL TAB 2.5MG 00006001531 MERCK & CO., INC. yPRINIVIL TAB 2.5MG 00006001558 MERCK & CO., INC. yPRINIVIL TAB 5MG 00006001928 MERCK & CO., INC. yPRINIVIL TAB 5MG 00006001954 MERCK & CO., INC. yPRINIVIL TAB 5MG 00006001982 MERCK & CO., INC. yFOSAMAX TAB 70MG 00006003121 MERCK & CO., INC. yFOSAMAX TAB 70MG 00006003144 MERCK & CO., INC. ySTROMECTOL TAB 3MG 00006003220 MERCK & CO., INC. yDECADRON TAB 0.5MG 00006004168 MERCK & CO., INC. yMEPHYTON TAB 5MG 00006004368 MERCK & CO., INC. yDECADRON TAB 0.75MG 00006006368 MERCK & CO., INC. yEDECRIN TAB 25MG 00006006568 MERCK & CO., INC. yTIMOLIDE TAB 10/25 00006006768 MERCK & CO., INC. yPROPECIA TAB 1MG 00006007131 MERCK & CO., INC. yPROPECIA TAB 1MG 00006007154 MERCK & CO., INC. yPROPECIA TAB PRO-PAK 00006007161 MERCK & CO., INC. yPROSCAR TAB 5MG 00006007228 MERCK & CO., INC. yPROSCAR TAB 5MG 00006007231 MERCK & CO., INC. yPROSCAR TAB 5MG 00006007258 MERCK & CO., INC. yPROSCAR TAB 5MG 00006007282 MERCK & CO., INC. yFOSAMAX TAB 35MG 00006007721 MERCK & CO., INC. yFOSAMAX TAB 35MG 00006007744 MERCK & CO., INC. yMIDAMOR TAB 5MG 00006009268 MERCK & CO., INC. yPRINIVIL TAB 10MG 00006010654 MERCK & CO., INC. yPRINIVIL TAB 10MG 00006010682 MERCK & CO., INC. yJANUVIA TAB 50MG 00006011231 MERCK & CO., INC. yJANUVIA TAB 50MG 00006011254 MERCK & CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SINGULAIR TAB 10MG 00006011728 MERCK & CO., INC. ySINGULAIR TAB 10MG 00006011731 MERCK & CO., INC. ySINGULAIR TAB 10MG 00006011754 MERCK & CO., INC. ySINGULAIR TAB 10MG 00006011780 MERCK & CO., INC. yPRINZIDE TAB 20-12.5 00006014058 MERCK & CO., INC. yPRINZIDE TAB 20-25MG 00006014231 MERCK & CO., INC. yPRINZIDE TAB 20-25MG 00006014258 MERCK & CO., INC. yPRINZIDE TAB 10/12.5 00006014558 MERCK & CO., INC. yPRINIVIL TAB 20MG 00006020754 MERCK & CO., INC. yPRINIVIL TAB 20MG 00006020782 MERCK & CO., INC. yFOSAMAX TAB 40MG 00006021231 MERCK & CO., INC. yJANUVIA TAB 25MG 00006022131 MERCK & CO., INC. yJANUVIA TAB 25MG 00006022154 MERCK & CO., INC. yPRINIVIL TAB 40MG 00006023758 MERCK & CO., INC. yMAXALT TAB 5MG 00006026606 MERCK & CO., INC. yMAXALT TAB 5MG 00006026609 MERCK & CO., INC. yMAXALT TAB 10MG 00006026706 MERCK & CO., INC. yMAXALT TAB 10MG 00006026709 MERCK & CO., INC. ySINGULAIR CHW 5MG 00006027528 MERCK & CO., INC. ySINGULAIR CHW 5MG 00006027531 MERCK & CO., INC. ySINGULAIR CHW 5MG 00006027554 MERCK & CO., INC. yJANUVIA TAB 100MG 00006027728 MERCK & CO., INC. yJANUVIA TAB 100MG 00006027731 MERCK & CO., INC. yJANUVIA TAB 100MG 00006027754 MERCK & CO., INC. yEMEND CAP 80MG 00006046105 MERCK & CO., INC. yEMEND CAP 80MG 00006046106 MERCK & CO., INC. yEMEND CAP 80MG 00006046130 MERCK & CO., INC. yEMEND CAP 125MG 00006046205 MERCK & CO., INC. yEMEND CAP 125MG 00006046206 MERCK & CO., INC. yEMEND CAP 125MG 00006046230 MERCK & CO., INC. yEMEND CAP 40MG 00006046405 MERCK & CO., INC. yEMEND CAP 40MG 00006046410 MERCK & CO., INC. yZOCOR TAB 80MG 00006054328 MERCK & CO., INC. yZOCOR TAB 80MG 00006054331 MERCK & CO., INC. yZOCOR TAB 80MG 00006054354 MERCK & CO., INC. yZOCOR TAB 80MG 00006054382 MERCK & CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZOLINZA CAP 100MG 00006056840 MERCK & CO., INC. yCRIXIVAN CAP 100MG 00006057062 MERCK & CO., INC. yCRIXIVAN CAP 200MG 00006057143 MERCK & CO., INC. yCRIXIVAN CAP 400MG 00006057318 MERCK & CO., INC. yCRIXIVAN CAP 400MG 00006057340 MERCK & CO., INC. yCRIXIVAN CAP 400MG 00006057342 MERCK & CO., INC. yCRIXIVAN CAP 400MG 00006057354 MERCK & CO., INC. yCRIXIVAN CAP 400MG 00006057362 MERCK & CO., INC. yCRIXIVAN CAP 333MG 00006057465 MERCK & CO., INC. yCUPRIMINE CAP 250MG 00006060268 MERCK & CO., INC. ySYPRINE CAP 250MG 00006066168 MERCK & CO., INC. yDEMSER CAP 250MG 00006069068 MERCK & CO., INC. yDOLOBID TAB 500MG 00006069761 MERCK & CO., INC. yNOROXIN TAB 400MG 00006070520 MERCK & CO., INC. yNOROXIN TAB 400MG 00006070528 MERCK & CO., INC. yNOROXIN TAB 400MG 00006070568 MERCK & CO., INC. yFOSAMAX PLUS TAB D 00006071021 MERCK & CO., INC. yFOSAMAX PLUS TAB D 00006071044 MERCK & CO., INC. ySINGULAIR CHW 4MG 00006071128 MERCK & CO., INC. ySINGULAIR CHW 4MG 00006071131 MERCK & CO., INC. ySINGULAIR CHW 4MG 00006071154 MERCK & CO., INC. yHYZAAR TAB 50-12.5 00006071728 MERCK & CO., INC. yHYZAAR TAB 50-12.5 00006071731 MERCK & CO., INC. yHYZAAR TAB 50-12.5 00006071754 MERCK & CO., INC. yHYZAAR TAB 50-12.5 00006071782 MERCK & CO., INC. yHYZAAR TAB 50-12.5 00006071786 MERCK & CO., INC. yZOCOR TAB 5MG 00006072628 MERCK & CO., INC. yZOCOR TAB 5MG 00006072631 MERCK & CO., INC. yZOCOR TAB 5MG 00006072654 MERCK & CO., INC. yZOCOR TAB 5MG 00006072682 MERCK & CO., INC. yMEVACOR TAB 20MG 00006073161 MERCK & CO., INC. yMEVACOR TAB 40MG 00006073261 MERCK & CO., INC. yZOCOR TAB 10MG 00006073528 MERCK & CO., INC. yZOCOR TAB 10MG 00006073531 MERCK & CO., INC. yZOCOR TAB 10MG 00006073554 MERCK & CO., INC. yZOCOR TAB 10MG 00006073582 MERCK & CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZOCOR TAB 10MG 00006073587 MERCK & CO., INC. yZOCOR TAB 20MG 00006074028 MERCK & CO., INC. yZOCOR TAB 20MG 00006074031 MERCK & CO., INC. yZOCOR TAB 20MG 00006074054 MERCK & CO., INC. yZOCOR TAB 20MG 00006074082 MERCK & CO., INC. yZOCOR TAB 20MG 00006074087 MERCK & CO., INC. yHYZAAR TAB 100-12.5 00006074528 MERCK & CO., INC. yHYZAAR TAB 100-12.5 00006074531 MERCK & CO., INC. yHYZAAR TAB 100-12.5 00006074554 MERCK & CO., INC. yHYZAAR TAB 100-12.5 00006074582 MERCK & CO., INC. yHYZAAR TAB 100-12.5 00006074586 MERCK & CO., INC. yHYZAAR TAB 100-25 00006074728 MERCK & CO., INC. yHYZAAR TAB 100-25 00006074731 MERCK & CO., INC. yHYZAAR TAB 100-25 00006074754 MERCK & CO., INC. yHYZAAR TAB 100-25 00006074781 MERCK & CO., INC. yHYZAAR TAB 100-25 00006074782 MERCK & CO., INC. yZOCOR TAB 40MG 00006074928 MERCK & CO., INC. yZOCOR TAB 40MG 00006074931 MERCK & CO., INC. yZOCOR TAB 40MG 00006074954 MERCK & CO., INC. yZOCOR TAB 40MG 00006074982 MERCK & CO., INC. yMINTEZOL CHW 500MG 00006090736 MERCK & CO., INC. yMODURETIC TAB 5-50 00006091768 MERCK & CO., INC. yFOSAMAX TAB 5MG 00006092531 MERCK & CO., INC. yFOSAMAX TAB 5MG 00006092558 MERCK & CO., INC. yFOSAMAX TAB 10MG 00006093628 MERCK & CO., INC. yFOSAMAX TAB 10MG 00006093631 MERCK & CO., INC. yFOSAMAX TAB 10MG 00006093658 MERCK & CO., INC. yFOSAMAX TAB 10MG 00006093682 MERCK & CO., INC. yCLINORIL TAB 200MG 00006094268 MERCK & CO., INC. yCOZAAR TAB 25MG 00006095128 MERCK & CO., INC. yCOZAAR TAB 25MG 00006095154 MERCK & CO., INC. yCOZAAR TAB 25MG 00006095182 MERCK & CO., INC. yCOZAAR TAB 25MG 00006095187 MERCK & CO., INC. yCOZAAR TAB 50MG 00006095228 MERCK & CO., INC. yCOZAAR TAB 50MG 00006095231 MERCK & CO., INC. yCOZAAR TAB 50MG 00006095254 MERCK & CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COZAAR TAB 50MG 00006095282 MERCK & CO., INC. yCOZAAR TAB 50MG 00006095287 MERCK & CO., INC. yCOZAAR TAB 100MG 00006096028 MERCK & CO., INC. yCOZAAR TAB 100MG 00006096031 MERCK & CO., INC. yCOZAAR TAB 100MG 00006096054 MERCK & CO., INC. yCOZAAR TAB 100MG 00006096082 MERCK & CO., INC. yCOZAAR TAB 100MG 00006096086 MERCK & CO., INC. yPEPCID TAB 20MG 00006096328 MERCK & CO., INC. yPEPCID TAB 20MG 00006096331 MERCK & CO., INC. yPEPCID TAB 20MG 00006096358 MERCK & CO., INC. yPEPCID TAB 20MG 00006096372 MERCK & CO., INC. yPEPCID TAB 20MG 00006096382 MERCK & CO., INC. yPEPCID TAB 20MG 00006096394 MERCK & CO., INC. yPEPCID TAB 40MG 00006096428 MERCK & CO., INC. yPEPCID TAB 40MG 00006096431 MERCK & CO., INC. yPEPCID TAB 40MG 00006096458 MERCK & CO., INC. yPEPCID TAB 40MG 00006096462 MERCK & CO., INC. yPEPCID TAB 40MG 00006096472 MERCK & CO., INC. yPEPCID TAB 40MG 00006096482 MERCK & CO., INC. yPEPCID TAB 40MG 00006096494 MERCK & CO., INC. yDIURIL SUS 250/5ML 00006323966 MERCK & CO., INC. yCOGENTIN INJ 1MG/ML 00006327538 MERCK & CO., INC. yCOSMEGEN INJ 0.5MG 00006329822 MERCK & CO., INC. yINDOCIN SUS 25MG/5ML 00006337666 MERCK & CO., INC. yLACRISERT MIS 5MG OP 00006338060 MERCK & CO., INC. yAMINOHIPPURA INJ 20% 00006339511 MERCK & CO., INC. yINDOCIN IV INJ 1MG 00006340617 MERCK & CO., INC. yPRIMAXIN IV INJ 250MG 00006351458 MERCK & CO., INC. yPRIMAXIN IV INJ 500MG 00006351659 MERCK & CO., INC. yPRIMAXIN IV INJ 500MG 00006351775 MERCK & CO., INC. yTRUSOPT SOL 00006351935 MERCK & CO., INC. yTRUSOPT SOL 00006351936 MERCK & CO., INC. yPEPCID PREMX SOL 20MG/50M 00006353750 MERCK & CO., INC. yPEPCID SUS 40MG/5ML 00006353892 MERCK & CO., INC. yPEPCID I.V. INJ 20MG/2ML 00006353904 MERCK & CO., INC. yMEFOXIN/DEX INJ 1GM 00006354524 MERCK & CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MEFOXIN/DEX INJ 2GM 00006354725 MERCK & CO., INC. yPRIMAXIN IV INJ 250MG 00006355158 MERCK & CO., INC. yPRIMAXIN IV INJ 500MG 00006355259 MERCK & CO., INC. yTIMOPTIC-XE SOL 0.25% OP 00006355735 MERCK & CO., INC. yTIMOPTIC-XE SOL 0.5% OP 00006355835 MERCK & CO., INC. yPRIMAXIN IM INJ 500MG 00006358275 MERCK & CO., INC. yDIURIL IV INJ 500MG 00006361932 MERCK & CO., INC. ySOD EDECRIN INJ 50MG 00006362050 MERCK & CO., INC. yCOSOPT SOL 2-0.5%OP 00006362835 MERCK & CO., INC. yCOSOPT SOL 2-0.5%OP 00006362836 MERCK & CO., INC. yPRIMAXIN IV INJ 500MG 00006366659 MERCK & CO., INC. yMAXALT-MLT TAB 5MG 00006380006 MERCK & CO., INC. yMAXALT-MLT TAB 5MG 00006380009 MERCK & CO., INC. yMAXALT-MLT TAB 10MG 00006380106 MERCK & CO., INC. yMAXALT-MLT TAB 10MG 00006380109 MERCK & CO., INC. yCANCIDAS INJ 50MG 00006382210 MERCK & CO., INC. yCANCIDAS INJ 70MG 00006382310 MERCK & CO., INC. yFOSAMAX SOL 00006383334 MERCK & CO., INC. ySINGULAIR GRA 4MG 00006384130 MERCK & CO., INC. yINVANZ INJ 1GM 00006384371 MERCK & CO., INC. yEMEND CAP 80-125MG 00006386203 MERCK & CO., INC. yANTIVENIN KIT LAT MACT 00006408400 MERCK & CO., INC. yELSPAR INJ 10000UNT 00006461200 MERCK & CO., INC. yMUSTARGEN INJ 10MG 00006775331 MERCK & CO., INC. yTIMOPTIC SOL 0.25% OP 00006889535 MERCK & CO., INC. yTIMOPTIC SOL 0.25% OP 00006889536 MERCK & CO., INC. yTIMOPTIC SOL 0.5% OP 00006889635 MERCK & CO., INC. yTIMOPTIC SOL 0.5% OP 00006889636 MERCK & CO., INC. yTIMOPTIC OCU SOL 0.25% OP 00006968960 MERCK & CO., INC. yTIMOPTIC OCU SOL 0.5% OP 00006969060 MERCK & CO., INC. yVYTORIN TAB 10-10MG 66582031128 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-10MG 66582031131 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-10MG 66582031154 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-10MG 66582031182 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-20MG 66582031228 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-20MG 66582031231 MERCK/SCHERING-PLOUGH JV y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VYTORIN TAB 10-20MG 66582031254 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-20MG 66582031282 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-40MG 66582031331 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-40MG 66582031352 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-40MG 66582031354 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-40MG 66582031374 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-80MG 66582031531 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-80MG 66582031552 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-80MG 66582031554 MERCK/SCHERING-PLOUGH JV yVYTORIN TAB 10-80MG 66582031574 MERCK/SCHERING-PLOUGH JV yZETIA TAB 10MG 66582041428 MERCK/SCHERING-PLOUGH JV yZETIA TAB 10MG 66582041431 MERCK/SCHERING-PLOUGH JV yZETIA TAB 10MG 66582041454 MERCK/SCHERING-PLOUGH JV yZETIA TAB 10MG 66582041474 MERCK/SCHERING-PLOUGH JV yNU-IRON 150 CAP 150MG 00259029101 MERZ PHARMACEUTICALS yELDERTONIC ELX 00259035116 MERZ PHARMACEUTICALS ySTERAPRED DS PAK 10MG 00259036421 MERZ PHARMACEUTICALS ySTERAPRED DS PAK 10MG 12D 00259038948 MERZ PHARMACEUTICALS ySTERAPRED PAK 5MG 00259039021 MERZ PHARMACEUTICALS ySTERAPRED PAK 5MG 12DY 00259039148 MERZ PHARMACEUTICALS ySEDAPAP TAB 650-50MG 00259039201 MERZ PHARMACEUTICALS yELDERCAPS CAP 00259039301 MERZ PHARMACEUTICALS yERYGEL GEL 2% 00259431230 MERZ PHARMACEUTICALS yERYGEL GEL 2% 00259431260 MERZ PHARMACEUTICALS yNAFTIN GEL 1% 00259477020 MERZ PHARMACEUTICALS yNAFTIN GEL 1% 00259477040 MERZ PHARMACEUTICALS yNAFTIN GEL 1% 00259477060 MERZ PHARMACEUTICALS yHEXALEN CAP 50MG 58063000170 MGI PHARMA, INC. yDACOGEN INJ 50MG 58063060050 MGI PHARMA, INC. ySALAGEN TAB 5MG 58063070510 MGI PHARMA, INC. ySALAGEN TAB 7.5MG 58063077510 MGI PHARMA, INC. yALOXI SOL 0.25MG/5 58063079725 MGI PHARMA, INC. yBEN-TANN SUS 25MG/5ML 68308012204 MIDLOTHIAN LABORATORIES yD-TANN SUS 25-7.5MG 68308012604 MIDLOTHIAN LABORATORIES yD-TANN CT SUS 68308013004 MIDLOTHIAN LABORATORIES yD-TANN HC SUS 68308013404 MIDLOTHIAN LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FOLCAPS TAB 68308032410 MIDLOTHIAN LABORATORIES yFOLTABS 800 TAB 68308032560 MIDLOTHIAN LABORATORIES yFABB TAB 68308032610 MIDLOTHIAN LABORATORIES yX-HIST DRO 2-2MG/ML 68308043030 MIDLOTHIAN LABORATORIES yX-HIST DM DRO 68308043130 MIDLOTHIAN LABORATORIES yFA/B12/B6 TAB 68308051610 MIDLOTHIAN LABORATORIES yRE-TANN SUS 68308073116 MIDLOTHIAN LABORATORIES yDUR-TANN DM SUS 68308073516 MIDLOTHIAN LABORATORIES yFOLAMIN TAB 68308078090 MIDLOTHIAN LABORATORIES yIRON CHEWS CHW PEDIATRI 68308091060 MIDLOTHIAN LABORATORIES yB-VEX SUS 12MG/5ML 68308092204 MIDLOTHIAN LABORATORIES yL-ALL 12 SUS 68308092404 MIDLOTHIAN LABORATORIES yB-VEX D SUS 68308092604 MIDLOTHIAN LABORATORIES yHYDROCO/APAP TAB 5-500MG 46672005210 MIKART INC. yHYDROCO/APAP TAB 5-500MG 46672005250 MIKART INC. yBUT/APAP/CAF TAB 46672005310 MIKART INC. yBUT/APAP/CAF TAB 46672005350 MIKART INC. yTANAMINE TAB 46672009310 MIKART INC. yTANAMINE TAB 46672009350 MIKART INC. yYOHIMBINE TAB 5.4MG 46672011110 MIKART INC. yYOHIMBINE TAB 5.4MG 46672011111 MIKART INC. yYOHIMBINE TAB 5.4MG 46672011125 MIKART INC. yAPAP/CODEINE ELX 120-12/5 46672056116 MIKART INC. yAMANTADINE SYP 50MG/5ML 46672060616 MIKART INC. yFENTEX SOL 46672060816 MIKART INC. yDYFILIN-GG ELX 100-100 46672061416 MIKART INC. yVELCADE INJ 3.5MG 63020004901 MILLENNIUM PHARMACEUTICALS, INC. yFOSFREE TAB 00178003112 MISSION PHARMACAL COMPANY yFOSFREE TAB 00178003160 MISSION PHARMACAL COMPANY yMISSION PREN TAB 00178013201 MISSION PHARMACAL COMPANY yMISSION PREN TAB /FA 00178015301 MISSION PHARMACAL COMPANY yMISSION PREN TAB HP 00178016101 MISSION PHARMACAL COMPANY yCALCET TAB 00178025101 MISSION PHARMACAL COMPANY yMAGTRATE TAB 500MG 00178029901 MISSION PHARMACAL COMPANY yTHERA-GESIC CRE 00178032003 MISSION PHARMACAL COMPANY yTHERA-GESIC CRE 00178032005 MISSION PHARMACAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LITHOSTAT TAB 250MG 00178050001 MISSION PHARMACAL COMPANY yUROCIT-K 5 TAB 00178060001 MISSION PHARMACAL COMPANY yUROCIT-K 10 TAB 00178061001 MISSION PHARMACAL COMPANY yCITRACAL TAB 200 MG 00178080001 MISSION PHARMACAL COMPANY yCITRACAL TAB 200 MG 00178080020 MISSION PHARMACAL COMPANY yCITRACAL TAB PREN RX 00178085201 MISSION PHARMACAL COMPANY yTHIOLA TAB 100MG 00178090001 MISSION PHARMACAL COMPANY yTUSSEND TAB 61570001101 MONARCH PHARMACEUTICALS, INC. yNUCOFED CAP 61570001860 MONARCH PHARMACEUTICALS, INC. yTHALITONE TAB 15MG 61570002401 MONARCH PHARMACEUTICALS, INC. yCORTISPORIN OIN 1% 61570003150 MONARCH PHARMACEUTICALS, INC. yCORTISPORIN CRE 0.5% 61570003275 MONARCH PHARMACEUTICALS, INC. yCORTISPORIN SUS 1% OTIC 61570003310 MONARCH PHARMACEUTICALS, INC. yCORTISPORIN SOL 1% OTIC 61570003410 MONARCH PHARMACEUTICALS, INC. yCORTISPORIN SUS OP 1% 61570003675 MONARCH PHARMACEUTICALS, INC. yVIROPTIC SOL 1% OP 61570003775 MONARCH PHARMACEUTICALS, INC. yPEDIOTIC SUS 1% OTIC 61570003875 MONARCH PHARMACEUTICALS, INC. yNEOSPORIN SOL OP 61570004510 MONARCH PHARMACEUTICALS, INC. yNEOSPORIN GU SOL 40/ML IR 61570004710 MONARCH PHARMACEUTICALS, INC. yNEOSPORIN GU SOL 40/ML IR 61570004750 MONARCH PHARMACEUTICALS, INC. yNEOSPORIN GU SOL 40/ML IR 61570004820 MONARCH PHARMACEUTICALS, INC. ySEPTRA TAB 400-80MG 61570005201 MONARCH PHARMACEUTICALS, INC. ySEPTRA DS TAB 800-160 61570005301 MONARCH PHARMACEUTICALS, INC. ySEPTRA DS TAB 800-160 61570005305 MONARCH PHARMACEUTICALS, INC. ySEPTRA DS TAB 800-160 61570005320 MONARCH PHARMACEUTICALS, INC. yPROLOPRIM TAB 100MG 61570005701 MONARCH PHARMACEUTICALS, INC. yKEMADRIN TAB 5MG 61570005901 MONARCH PHARMACEUTICALS, INC. yPROCANBID TAB 500MG CR 61570006901 MONARCH PHARMACEUTICALS, INC. yPROCANBID TAB 500MG CR 61570006970 MONARCH PHARMACEUTICALS, INC. yPROCANBID TAB 1000 MG 61570007101 MONARCH PHARMACEUTICALS, INC. yMENEST TAB 0.3MG 61570007201 MONARCH PHARMACEUTICALS, INC. yMENEST TAB 0.625MG 61570007301 MONARCH PHARMACEUTICALS, INC. yMENEST TAB 1.25MG 61570007401 MONARCH PHARMACEUTICALS, INC. yMENEST TAB 2.5MG 61570007550 MONARCH PHARMACEUTICALS, INC. yTIGAN CAP 300MG 61570007901 MONARCH PHARMACEUTICALS, INC. yTUSSIGON TAB 5MG 61570008101 MONARCH PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TUSSIGON TAB 5MG 61570008105 MONARCH PHARMACEUTICALS, INC. yPEN G PROC INJ 600000 61570008510 MONARCH PHARMACEUTICALS, INC. yPEN G PROC INJ 600000 61570008610 MONARCH PHARMACEUTICALS, INC. yCORTISPORIN SUS -TC OTIC 61570009010 MONARCH PHARMACEUTICALS, INC. yBREVITAL SOD INJ 500MG 61570009501 MONARCH PHARMACEUTICALS, INC. yBREVITAL SOD INJ 500MG 61570009525 MONARCH PHARMACEUTICALS, INC. yBREVITAL SOD INJ 2.5GM 61570009625 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 1.25MG 61570011001 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 2.5MG 61570011101 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 2.5MG 61570011105 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 2.5MG 61570011156 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 5MG 61570011201 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 5MG 61570011205 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 5MG 61570011256 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 10MG 61570012001 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 10MG 61570012005 MONARCH PHARMACEUTICALS, INC. yALTACE CAP 10MG 61570012080 MONARCH PHARMACEUTICALS, INC. ySILVADENE CRE 1% 61570013120 MONARCH PHARMACEUTICALS, INC. ySILVADENE CRE 1% 61570013140 MONARCH PHARMACEUTICALS, INC. ySILVADENE CRE 1% 61570013150 MONARCH PHARMACEUTICALS, INC. ySILVADENE CRE 1% 61570013185 MONARCH PHARMACEUTICALS, INC. ySILVADENE CRE 1% 61570013198 MONARCH PHARMACEUTICALS, INC. yLORABID SUS 100/5ML 61570013510 MONARCH PHARMACEUTICALS, INC. yLORABID SUS 200/5ML 61570013610 MONARCH PHARMACEUTICALS, INC. yBICILLIN C-R INJ 600000 61570013910 MONARCH PHARMACEUTICALS, INC. yBICILLIN C-R INJ 1200000 61570014010 MONARCH PHARMACEUTICALS, INC. yBICILLIN C-R INJ 600000 61570014110 MONARCH PHARMACEUTICALS, INC. yBICILLIN C-R INJ 2400000 61570014210 MONARCH PHARMACEUTICALS, INC. yBICILLIN C-R INJ 900/300 61570014310 MONARCH PHARMACEUTICALS, INC. yBICILLIN C-R INJ 900/300 61570014410 MONARCH PHARMACEUTICALS, INC. yBICILLIN L-A INJ 600000 61570014610 MONARCH PHARMACEUTICALS, INC. yBICILLIN L-A INJ 1200000 61570014710 MONARCH PHARMACEUTICALS, INC. yBICILLIN L-A INJ 2400000 61570014810 MONARCH PHARMACEUTICALS, INC. yLORABID CAP 200MG 61570017001 MONARCH PHARMACEUTICALS, INC. yLORABID CAP 400MG 61570017101 MONARCH PHARMACEUTICALS, INC. yCORZIDE TAB 40/5 61570017501 MONARCH PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CORZIDE TAB 80/5 61570017601 MONARCH PHARMACEUTICALS, INC. yDELESTROGEN INJ 10MG/ML 61570018001 MONARCH PHARMACEUTICALS, INC. yDELESTROGEN INJ 20MG/ML 61570018101 MONARCH PHARMACEUTICALS, INC. yDELESTROGEN INJ 40MG/ML 61570018201 MONARCH PHARMACEUTICALS, INC. yFLORINEF TAB 0.1MG 61570019001 MONARCH PHARMACEUTICALS, INC. yCORGARD TAB 20MG 61570020001 MONARCH PHARMACEUTICALS, INC. yCORGARD TAB 40MG 61570020101 MONARCH PHARMACEUTICALS, INC. yCORGARD TAB 80MG 61570020201 MONARCH PHARMACEUTICALS, INC. yCORGARD TAB 120MG 61570020301 MONARCH PHARMACEUTICALS, INC. ySYNERCID INJ 500MG 61570026010 MONARCH PHARMACEUTICALS, INC. yADRENALIN SOL 1:1000 61570030031 MONARCH PHARMACEUTICALS, INC. yADRENALIN INJ 1MG/ML 61570040111 MONARCH PHARMACEUTICALS, INC. yCHLOROMYCET INJ 1GM 61570040571 MONARCH PHARMACEUTICALS, INC. yCOLY-MYCIN-M INJ 150MG 61570041451 MONARCH PHARMACEUTICALS, INC. yPITOCIN INJ 10UNT/ML 61570041605 MONARCH PHARMACEUTICALS, INC. yADRENALIN INJ 1MG/ML 61570041881 MONARCH PHARMACEUTICALS, INC. yPITRESSIN INJ 20UNT/ML 61570042003 MONARCH PHARMACEUTICALS, INC. yHUMATIN CAP 250MG 61570052910 MONARCH PHARMACEUTICALS, INC. yTIGAN INJ 100MG/ML 61570054002 MONARCH PHARMACEUTICALS, INC. yTIGAN INJ 100MG/ML 61570054120 MONARCH PHARMACEUTICALS, INC. yTIGAN INJ 100MG/ML 61570054325 MONARCH PHARMACEUTICALS, INC. yKETALAR INJ 10MG/ML 61570058110 MONARCH PHARMACEUTICALS, INC. yKETALAR INJ 50MG/ML 61570058210 MONARCH PHARMACEUTICALS, INC. yKETALAR INJ 100MG/ML 61570058510 MONARCH PHARMACEUTICALS, INC. yCIMETIDINE SOL 300/5ML 60432000708 MORTON GROVE PHARMACEUTICALS, INC yANTISPASMOD ELX 16MG/5ML 60432000904 MORTON GROVE PHARMACEUTICALS, INC yANTISPASMOD ELX 16MG/5ML 60432000916 MORTON GROVE PHARMACEUTICALS, INC yTANNIHIST-12 SUS D 60432001504 MORTON GROVE PHARMACEUTICALS, INC yTANNIHIST-12 SUS D 60432001516 MORTON GROVE PHARMACEUTICALS, INC yDEC-CHLORPHN SYP DM 60432002804 MORTON GROVE PHARMACEUTICALS, INC yDEC-CHLORPHN SYP DM 60432002816 MORTON GROVE PHARMACEUTICALS, INC yDIPHEN AF SYP 12.5/5ML 60432003304 MORTON GROVE PHARMACEUTICALS, INC yDIPHEN AF SYP 12.5/5ML 60432003308 MORTON GROVE PHARMACEUTICALS, INC yDIPHEN AF SYP 12.5/5ML 60432003316 MORTON GROVE PHARMACEUTICALS, INC yDEC-CHLORPHN DRO DM 60432003630 MORTON GROVE PHARMACEUTICALS, INC yLACTULOSE SOL 10GM/15 60432003708 MORTON GROVE PHARMACEUTICALS, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LACTULOSE SOL 10GM/15 60432003732 MORTON GROVE PHARMACEUTICALS, INC yGENERLAC SOL 10GM/15 60432003816 MORTON GROVE PHARMACEUTICALS, INC yGENERLAC SOL 10GM/15 60432003864 MORTON GROVE PHARMACEUTICALS, INC yDEC-CHLORPHN SYP 60432003904 MORTON GROVE PHARMACEUTICALS, INC yDEC-CHLORPHN SYP 60432003916 MORTON GROVE PHARMACEUTICALS, INC yDEC-CHLORPHN LIQ 60432004130 MORTON GROVE PHARMACEUTICALS, INC yMYTUSSIN AC SYP 10-100/5 60432004504 MORTON GROVE PHARMACEUTICALS, INC yMYTUSSIN AC SYP 10-100/5 60432004516 MORTON GROVE PHARMACEUTICALS, INC yGUAIFENESIN LIQ DM 60432004816 MORTON GROVE PHARMACEUTICALS, INC yGUAIFENESIN LIQ AC 60432008804 MORTON GROVE PHARMACEUTICALS, INC yGUAIFENESIN LIQ AC 60432008816 MORTON GROVE PHARMACEUTICALS, INC yPRED SOD PHO LIQ 6.7/5ML 60432008904 MORTON GROVE PHARMACEUTICALS, INC yOXYBUTYNIN SYP 5MG/5ML 60432009216 MORTON GROVE PHARMACEUTICALS, INC yAMANTADINE SYP 50MG/5ML 60432009316 MORTON GROVE PHARMACEUTICALS, INC yHYOSCYAMINE DRO 0.125/ML 60432010315 MORTON GROVE PHARMACEUTICALS, INC yTETRA TANN SUS PED 60432011708 MORTON GROVE PHARMACEUTICALS, INC yTETRA TANN SUS PED 60432011716 MORTON GROVE PHARMACEUTICALS, INC yMEGESTROL AC SUS 40MG/ML 60432012608 MORTON GROVE PHARMACEUTICALS, INC yMEGESTROL AC SUS 40MG/ML 60432012616 MORTON GROVE PHARMACEUTICALS, INC yCARBAMAZEPIN SUS 100/5ML 60432012916 MORTON GROVE PHARMACEUTICALS, INC yPHENYTOIN SUS 125/5ML 60432013108 MORTON GROVE PHARMACEUTICALS, INC yCLOBETASOL SOL 0.05% 60432013325 MORTON GROVE PHARMACEUTICALS, INC yCLOBETASOL SOL 0.05% 60432013350 MORTON GROVE PHARMACEUTICALS, INC yPREDNISOLONE SYP 15MG/5ML 60432013708 MORTON GROVE PHARMACEUTICALS, INC yCYCLOSPORINE SOL 100MG/ML 60432014050 MORTON GROVE PHARMACEUTICALS, INC yHYDROXYZ HCL SYP 10MG/5ML 60432015004 MORTON GROVE PHARMACEUTICALS, INC yHYDROXYZ HCL SYP 10MG/5ML 60432015016 MORTON GROVE PHARMACEUTICALS, INC yFLUOXETINE SOL 20MG/5ML 60432016204 MORTON GROVE PHARMACEUTICALS, INC yPYRILAFEN TA SUS 30-5MG/5 60432019104 MORTON GROVE PHARMACEUTICALS, INC yPYRILAFEN TA SUS 30-5MG/5 60432019116 MORTON GROVE PHARMACEUTICALS, INC yC-PHED DPD SUS TANNATE 60432019804 MORTON GROVE PHARMACEUTICALS, INC yC-PHED DPD SUS TANNATE 60432019816 MORTON GROVE PHARMACEUTICALS, INC yPREDNISOLONE SOL 15MG/5ML 60432021208 MORTON GROVE PHARMACEUTICALS, INC yCARBAXEFED DRO 1-15/ML 60432023430 MORTON GROVE PHARMACEUTICALS, INC yBROMAXEFED SYP RF 60432023504 MORTON GROVE PHARMACEUTICALS, INC yBROMAXEFED SYP RF 60432023516 MORTON GROVE PHARMACEUTICALS, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BROMAXEFED SYP DM RF 60432023604 MORTON GROVE PHARMACEUTICALS, INC yBROMAXEFED SYP DM RF 60432023608 MORTON GROVE PHARMACEUTICALS, INC yBROMAXEFED SYP DM RF 60432023616 MORTON GROVE PHARMACEUTICALS, INC yCARBAXEFED D DRO RF 60432023730 MORTON GROVE PHARMACEUTICALS, INC yAPAP/CODEINE SOL 120-12/5 60432024504 MORTON GROVE PHARMACEUTICALS, INC yAPAP/CODEINE SOL 120-12/5 60432024516 MORTON GROVE PHARMACEUTICALS, INC yPHENCLOR TAN SUS PEDI 60432034504 MORTON GROVE PHARMACEUTICALS, INC yPHENCLOR TAN SUS PEDI 60432034516 MORTON GROVE PHARMACEUTICALS, INC yHYDROCOD/HOM SYP 5-1.5/5 60432045516 MORTON GROVE PHARMACEUTICALS, INC yPAREGORIC TIN 2MG/5ML 60432045716 MORTON GROVE PHARMACEUTICALS, INC yLIDOCAINE SOL 2% VISC 60432046400 MORTON GROVE PHARMACEUTICALS, INC yLIDOCAINE SOL 4% 60432046550 MORTON GROVE PHARMACEUTICALS, INC yDEXAMETHASON ELX 0.5/5ML 60432046608 MORTON GROVE PHARMACEUTICALS, INC yMYPHETANE DX SYP 60432048216 MORTON GROVE PHARMACEUTICALS, INC ySELENIUM SUL SHA 2.5% 60432052804 MORTON GROVE PHARMACEUTICALS, INC yCHLORAL HYDR SYP 500/5ML 60432053316 MORTON GROVE PHARMACEUTICALS, INC yNYSTATIN SUS 100000 60432053716 MORTON GROVE PHARMACEUTICALS, INC yNYSTATIN SUS 100000 60432053760 MORTON GROVE PHARMACEUTICALS, INC yDEXCHLORPHEN SYP 2MG/5ML 60432053916 MORTON GROVE PHARMACEUTICALS, INC yMYTUSSIN DAC SOL 60432054104 MORTON GROVE PHARMACEUTICALS, INC yMYTUSSIN DAC SOL 60432054116 MORTON GROVE PHARMACEUTICALS, INC yLINDANE LOT 1% 60432054660 MORTON GROVE PHARMACEUTICALS, INC yLINDANE SHA 1% 60432054760 MORTON GROVE PHARMACEUTICALS, INC yTRIAMCINOLON LOT 0.025% 60432056060 MORTON GROVE PHARMACEUTICALS, INC yTRIAMCINOLON LOT 0.1% 60432056160 MORTON GROVE PHARMACEUTICALS, INC yPROMETHAZINE SYP DM 60432060404 MORTON GROVE PHARMACEUTICALS, INC yPROMETHAZINE SYP DM 60432060416 MORTON GROVE PHARMACEUTICALS, INC yPROMETH/COD SYP 6.25-10 60432060616 MORTON GROVE PHARMACEUTICALS, INC yPROMETHAZINE SYP 6.25/5ML 60432060804 MORTON GROVE PHARMACEUTICALS, INC yPROMETHAZINE SYP 6.25/5ML 60432060816 MORTON GROVE PHARMACEUTICALS, INC yFUROSEMIDE SOL 10MG/ML 60432061304 MORTON GROVE PHARMACEUTICALS, INC yFUROSEMIDE SOL 10MG/ML 60432061360 MORTON GROVE PHARMACEUTICALS, INC yLITHIUM CITR SYP 8MEQ/5ML 60432061616 MORTON GROVE PHARMACEUTICALS, INC yVALPROIC ACD SYP 250/5ML 60432062116 MORTON GROVE PHARMACEUTICALS, INC yMETOCLOPRAM SOL 5MG/5ML 60432062216 MORTON GROVE PHARMACEUTICALS, INC yDOXEPIN HCL CON 10MG/ML 60432065104 MORTON GROVE PHARMACEUTICALS, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ERYTHROMYCIN SOL 2% 60432067160 MORTON GROVE PHARMACEUTICALS, INC yCLINDAMYCIN SOL 1% 60432069360 MORTON GROVE PHARMACEUTICALS, INC yACETIC ACID SOL 2% OTIC 60432074115 MORTON GROVE PHARMACEUTICALS, INC yNORMLSHIELD CRE 4.5% 66977002204 MPM MEDICAL, INC. yANTI-FUNGAL CRE 1% 66977002304 MPM MEDICAL, INC. yANTISEPTIC LIQ CLEANSER 66977003204 MPM MEDICAL, INC. yANTISEPTIC LIQ CLEANSER 66977003208 MPM MEDICAL, INC. yREGENECARE GEL 66977010003 MPM MEDICAL, INC. yRADIAPLEXRX GEL 66977010106 MPM MEDICAL, INC. yORAMAGICRX SUS 66977022208 MPM MEDICAL, INC. yORAMAGICRX SUS 66977022212 MPM MEDICAL, INC. yAMITRIPTYLIN TAB 10MG 53489010401 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 10MG 53489010410 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 25MG 53489010501 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 25MG 53489010510 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 50MG 53489010601 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 50MG 53489010610 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 75MG 53489010701 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 75MG 53489010705 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 100MG 53489010801 MUTUAL PHARMACEUTICAL COMPANY yAMITRIPTYLIN TAB 150MG 53489010901 MUTUAL PHARMACEUTICAL COMPANY yCARISOPRODOL TAB 350MG 53489011001 MUTUAL PHARMACEUTICAL COMPANY yCARISOPRODOL TAB 350MG 53489011005 MUTUAL PHARMACEUTICAL COMPANY yCARISOPRODOL TAB 350MG 53489011010 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCL HYC CAP 50MG 53489011802 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCL HYC CAP 50MG 53489011805 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCL HYC CAP 100MG 53489011902 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCL HYC CAP 100MG 53489011905 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCL HYC TAB 100MG 53489012002 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCL HYC TAB 100MG 53489012005 MUTUAL PHARMACEUTICAL COMPANY yHYDROXYZ HCL TAB 25MG 53489012701 MUTUAL PHARMACEUTICAL COMPANY yHYDROXYZ HCL TAB 25MG 53489012705 MUTUAL PHARMACEUTICAL COMPANY yHYDROXYZ HCL TAB 25MG 53489012710 MUTUAL PHARMACEUTICAL COMPANY yHYDROXYZ HCL TAB 50MG 53489012801 MUTUAL PHARMACEUTICAL COMPANY yHYDROXYZ HCL TAB 50MG 53489012805 MUTUAL PHARMACEUTICAL COMPANY yHYDROXYZ HCL TAB 50MG 53489012810 MUTUAL PHARMACEUTICAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METRONIDAZOL TAB 250MG 53489013501 MUTUAL PHARMACEUTICAL COMPANY yMETRONIDAZOL TAB 250MG 53489013503 MUTUAL PHARMACEUTICAL COMPANY yMETRONIDAZOL TAB 500MG 53489013601 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 5MG 53489013801 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 5MG 53489013810 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 10MG 53489013901 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 10MG 53489013905 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 10MG 53489013910 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 20MG 53489014001 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 20MG 53489014005 MUTUAL PHARMACEUTICAL COMPANY yPREDNISONE TAB 20MG 53489014010 MUTUAL PHARMACEUTICAL COMPANY yQUINIDINE GL TAB 324MG CR 53489014101 MUTUAL PHARMACEUTICAL COMPANY yQUINIDINE GL TAB 324MG CR 53489014103 MUTUAL PHARMACEUTICAL COMPANY yQUINIDINE GL TAB 324MG CR 53489014105 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 25MG 53489014301 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 25MG 53489014305 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 25MG 53489014310 MUTUAL PHARMACEUTICAL COMPANY ySPIRONO/HCTZ TAB 25/25 53489014401 MUTUAL PHARMACEUTICAL COMPANY ySPIRONO/HCTZ TAB 25/25 53489014405 MUTUAL PHARMACEUTICAL COMPANY ySPIRONO/HCTZ TAB 25/25 53489014410 MUTUAL PHARMACEUTICAL COMPANY ySMZ-TMP TAB 400-80MG 53489014501 MUTUAL PHARMACEUTICAL COMPANY ySMZ-TMP TAB 400-80MG 53489014505 MUTUAL PHARMACEUTICAL COMPANY ySMZ/TMP DS TAB 800-160 53489014601 MUTUAL PHARMACEUTICAL COMPANY ySMZ/TMP DS TAB 800-160 53489014605 MUTUAL PHARMACEUTICAL COMPANY ySULFASALAZIN TAB 500MG 53489014701 MUTUAL PHARMACEUTICAL COMPANY ySULFASALAZIN TAB 500MG 53489014705 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 10MG 53489014801 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 10MG 53489014810 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 25MG 53489014901 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 25MG 53489014910 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 50MG 53489015001 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 50MG 53489015010 MUTUAL PHARMACEUTICAL COMPANY yALLOPURINOL TAB 100MG 53489015601 MUTUAL PHARMACEUTICAL COMPANY yALLOPURINOL TAB 100MG 53489015605 MUTUAL PHARMACEUTICAL COMPANY yALLOPURINOL TAB 100MG 53489015610 MUTUAL PHARMACEUTICAL COMPANY yALLOPURINOL TAB 300MG 53489015701 MUTUAL PHARMACEUTICAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALLOPURINOL TAB 300MG 53489015705 MUTUAL PHARMACEUTICAL COMPANY yALLOPURINOL TAB 300MG 53489015710 MUTUAL PHARMACEUTICAL COMPANY yACETAZOLAMID TAB 125MG 53489016601 MUTUAL PHARMACEUTICAL COMPANY yALBUTEROL TAB 2MG 53489017601 MUTUAL PHARMACEUTICAL COMPANY yALBUTEROL TAB 2MG 53489017605 MUTUAL PHARMACEUTICAL COMPANY yALBUTEROL TAB 4MG 53489017701 MUTUAL PHARMACEUTICAL COMPANY yALBUTEROL TAB 4MG 53489017705 MUTUAL PHARMACEUTICAL COMPANY yCLONIDINE TAB 0.1MG 53489021501 MUTUAL PHARMACEUTICAL COMPANY yCLONIDINE TAB 0.1MG 53489021510 MUTUAL PHARMACEUTICAL COMPANY yCLONIDINE TAB 0.2MG 53489021601 MUTUAL PHARMACEUTICAL COMPANY yCLONIDINE TAB 0.2MG 53489021610 MUTUAL PHARMACEUTICAL COMPANY yCLONIDINE TAB 0.3MG 53489021701 MUTUAL PHARMACEUTICAL COMPANY yQUININE SULF CAP 5GR 53489022101 MUTUAL PHARMACEUTICAL COMPANY yQUININE SULF CAP 5GR 53489022107 MUTUAL PHARMACEUTICAL COMPANY yQUININE SULF CAP 5GR 53489022110 MUTUAL PHARMACEUTICAL COMPANY yERGOLOID MES TAB 1MG ORAL 53489028101 MUTUAL PHARMACEUTICAL COMPANY yERGOLOID MES TAB 1MG ORAL 53489028105 MUTUAL PHARMACEUTICAL COMPANY yERGOLOID MES TAB 1MG ORAL 53489028110 MUTUAL PHARMACEUTICAL COMPANY yGABAPENTIN CAP 100MG 53489028401 MUTUAL PHARMACEUTICAL COMPANY yGABAPENTIN CAP 300MG 53489028501 MUTUAL PHARMACEUTICAL COMPANY yGABAPENTIN CAP 400MG 53489028601 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 50MG 53489032801 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 50MG 53489032805 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 100MG 53489032901 MUTUAL PHARMACEUTICAL COMPANY ySPIRONOLACT TAB 100MG 53489032905 MUTUAL PHARMACEUTICAL COMPANY yIMIPRAM HCL TAB 10MG 53489033001 MUTUAL PHARMACEUTICAL COMPANY yIMIPRAM HCL TAB 25MG 53489033101 MUTUAL PHARMACEUTICAL COMPANY yIMIPRAM HCL TAB 25MG 53489033110 MUTUAL PHARMACEUTICAL COMPANY yIMIPRAM HCL TAB 50MG 53489033201 MUTUAL PHARMACEUTICAL COMPANY yIMIPRAM HCL TAB 50MG 53489033210 MUTUAL PHARMACEUTICAL COMPANY yLABETALOL TAB 100MG 53489035401 MUTUAL PHARMACEUTICAL COMPANY yLABETALOL TAB 100MG 53489035405 MUTUAL PHARMACEUTICAL COMPANY yLABETALOL TAB 200MG 53489035501 MUTUAL PHARMACEUTICAL COMPANY yLABETALOL TAB 200MG 53489035505 MUTUAL PHARMACEUTICAL COMPANY yLABETALOL TAB 300MG 53489035601 MUTUAL PHARMACEUTICAL COMPANY yLABETALOL TAB 300MG 53489035605 MUTUAL PHARMACEUTICAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LORAZEPAM TAB 0.5MG 53489035701 MUTUAL PHARMACEUTICAL COMPANY yLORAZEPAM TAB 0.5MG 53489035705 MUTUAL PHARMACEUTICAL COMPANY yLORAZEPAM TAB 1MG 53489035801 MUTUAL PHARMACEUTICAL COMPANY yLORAZEPAM TAB 1MG 53489035805 MUTUAL PHARMACEUTICAL COMPANY yLORAZEPAM TAB 1MG 53489035810 MUTUAL PHARMACEUTICAL COMPANY yLORAZEPAM TAB 2MG 53489035901 MUTUAL PHARMACEUTICAL COMPANY yLORAZEPAM TAB 2MG 53489035905 MUTUAL PHARMACEUTICAL COMPANY yMETOPROLOL TAB 50MG 53489036601 MUTUAL PHARMACEUTICAL COMPANY yMETOPROLOL TAB 50MG 53489036610 MUTUAL PHARMACEUTICAL COMPANY yMETOPROLOL TAB 100MG 53489036701 MUTUAL PHARMACEUTICAL COMPANY yMETOPROLOL TAB 100MG 53489036710 MUTUAL PHARMACEUTICAL COMPANY yFELODIPINE TAB 2.5MG ER 53489036801 MUTUAL PHARMACEUTICAL COMPANY yFELODIPINE TAB 5MG ER 53489036901 MUTUAL PHARMACEUTICAL COMPANY yFELODIPINE TAB 10MG ER 53489037001 MUTUAL PHARMACEUTICAL COMPANY yTRIMETHOBENZ CAP 300MG 53489037601 MUTUAL PHARMACEUTICAL COMPANY yMETOCLOPRAM TAB 5MG 53489038401 MUTUAL PHARMACEUTICAL COMPANY yMETOCLOPRAM TAB 5MG 53489038405 MUTUAL PHARMACEUTICAL COMPANY yMINOXIDIL TAB 2.5MG 53489038601 MUTUAL PHARMACEUTICAL COMPANY yMINOXIDIL TAB 10MG 53489038701 MUTUAL PHARMACEUTICAL COMPANY yNYSTATIN TAB 500000 53489040001 MUTUAL PHARMACEUTICAL COMPANY yPHENTERMINE TAB 37.5MG 53489040601 MUTUAL PHARMACEUTICAL COMPANY yPHENTERMINE TAB 37.5MG 53489040610 MUTUAL PHARMACEUTICAL COMPANY yGG/PSE CR TAB 600-120 53489042401 MUTUAL PHARMACEUTICAL COMPANY yGG/PSE CR TAB 600-120 53489042405 MUTUAL PHARMACEUTICAL COMPANY yGG/PSE CR TAB 600-60MG 53489042501 MUTUAL PHARMACEUTICAL COMPANY yPHENTERMINE CAP 30MG 53489043301 MUTUAL PHARMACEUTICAL COMPANY yPHENTERMINE CAP 30MG 53489043310 MUTUAL PHARMACEUTICAL COMPANY yQUINIDINE SU TAB 300MG 53489046001 MUTUAL PHARMACEUTICAL COMPANY yQUINIDINE SU TAB 200MG 53489046101 MUTUAL PHARMACEUTICAL COMPANY yQUINIDINE SU TAB 200MG 53489046110 MUTUAL PHARMACEUTICAL COMPANY ySALSALATE TAB 500MG 53489046501 MUTUAL PHARMACEUTICAL COMPANY ySALSALATE TAB 750MG 53489046601 MUTUAL PHARMACEUTICAL COMPANY yMETFORMIN TAB 500MG 53489046701 MUTUAL PHARMACEUTICAL COMPANY yMETFORMIN TAB 500MG 53489046705 MUTUAL PHARMACEUTICAL COMPANY yMETFORMIN TAB 500MG 53489046710 MUTUAL PHARMACEUTICAL COMPANY yMETFORMIN TAB 850MG 53489046801 MUTUAL PHARMACEUTICAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METFORMIN TAB 850MG 53489046805 MUTUAL PHARMACEUTICAL COMPANY yMETFORMIN TAB 850MG 53489046810 MUTUAL PHARMACEUTICAL COMPANY ySULINDAC TAB 150MG 53489047801 MUTUAL PHARMACEUTICAL COMPANY ySULINDAC TAB 150MG 53489047805 MUTUAL PHARMACEUTICAL COMPANY ySULINDAC TAB 200MG 53489047901 MUTUAL PHARMACEUTICAL COMPANY ySULINDAC TAB 200MG 53489047905 MUTUAL PHARMACEUTICAL COMPANY yTRAMADOL HCL TAB 50MG 53489049901 MUTUAL PHARMACEUTICAL COMPANY yTRAMADOL HCL TAB 50MG 53489049905 MUTUAL PHARMACEUTICAL COMPANY yTRAMADOL HCL TAB 50MG 53489049910 MUTUAL PHARMACEUTICAL COMPANY yTHIORIDAZINE TAB 100MG 53489050001 MUTUAL PHARMACEUTICAL COMPANY yTOLMETIN SOD TAB 200MG 53489050601 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 50MG 53489051001 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 50MG 53489051005 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 50MG 53489051010 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 100MG 53489051101 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 100MG 53489051105 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 100MG 53489051110 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 150MG 53489051701 MUTUAL PHARMACEUTICAL COMPANY yTRAZODONE TAB 150MG 53489051705 MUTUAL PHARMACEUTICAL COMPANY yATENOLOL TAB 50MG 53489052901 MUTUAL PHARMACEUTICAL COMPANY yATENOLOL TAB 50MG 53489052910 MUTUAL PHARMACEUTICAL COMPANY yATENOLOL TAB 100MG 53489053001 MUTUAL PHARMACEUTICAL COMPANY yATENOLOL TAB 100MG 53489053010 MUTUAL PHARMACEUTICAL COMPANY yATENOL/CHLOR TAB 50-25MG 53489053101 MUTUAL PHARMACEUTICAL COMPANY yATENOL/CHLOR TAB 100-25MG 53489053201 MUTUAL PHARMACEUTICAL COMPANY yATENOLOL TAB 25MG 53489053601 MUTUAL PHARMACEUTICAL COMPANY yATENOLOL TAB 25MG 53489053610 MUTUAL PHARMACEUTICAL COMPANY yPROPAFENONE TAB 150MG 53489055101 MUTUAL PHARMACEUTICAL COMPANY yPROPAFENONE TAB 150MG 53489055103 MUTUAL PHARMACEUTICAL COMPANY yPROPAFENONE TAB 225MG 53489055201 MUTUAL PHARMACEUTICAL COMPANY yPROPAFENONE TAB 225MG 53489055203 MUTUAL PHARMACEUTICAL COMPANY yPROPAFENONE TAB 300MG 53489055301 MUTUAL PHARMACEUTICAL COMPANY yKETOCONAZOLE TAB 200MG 53489055401 MUTUAL PHARMACEUTICAL COMPANY yKETOCONAZOLE TAB 200MG 53489055407 MUTUAL PHARMACEUTICAL COMPANY yBISOPROL FUM TAB 5MG 53489055501 MUTUAL PHARMACEUTICAL COMPANY yBISOPROL FUM TAB 5MG 53489055507 MUTUAL PHARMACEUTICAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BISOPROL FUM TAB 10MG 53489055601 MUTUAL PHARMACEUTICAL COMPANY yBISOPROL FUM TAB 10MG 53489055607 MUTUAL PHARMACEUTICAL COMPANY yFOLIC ACID TAB 1MG 53489058001 MUTUAL PHARMACEUTICAL COMPANY yFOLIC ACID TAB 1MG 53489058010 MUTUAL PHARMACEUTICAL COMPANY yCILOSTAZOL TAB 50MG 53489058706 MUTUAL PHARMACEUTICAL COMPANY yCILOSTAZOL TAB 100MG 53489058806 MUTUAL PHARMACEUTICAL COMPANY yCYCLOBENZAPR TAB 5MG 53489059001 MUTUAL PHARMACEUTICAL COMPANY yCYCLOBENZAPR TAB 10MG 53489059101 MUTUAL PHARMACEUTICAL COMPANY yCYCLOBENZAPR TAB 10MG 53489059105 MUTUAL PHARMACEUTICAL COMPANY yCYCLOBENZAPR TAB 10MG 53489059110 MUTUAL PHARMACEUTICAL COMPANY yPRIMIDONE TAB 50MG 53489060201 MUTUAL PHARMACEUTICAL COMPANY yPRIMIDONE TAB 250MG 53489060301 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 10MG 53489060701 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 10MG 53489060706 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 20MG 53489060801 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 20MG 53489060806 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 20MG 53489060810 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 40MG 53489060901 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 40MG 53489060906 MUTUAL PHARMACEUTICAL COMPANY yLOVASTATIN TAB 40MG 53489060910 MUTUAL PHARMACEUTICAL COMPANY yZONISAMIDE CAP 25MG 53489061701 MUTUAL PHARMACEUTICAL COMPANY yZONISAMIDE CAP 50MG 53489061801 MUTUAL PHARMACEUTICAL COMPANY yZONISAMIDE CAP 100MG 53489061901 MUTUAL PHARMACEUTICAL COMPANY yMELOXICAM TAB 7.5MG 53489062001 MUTUAL PHARMACEUTICAL COMPANY yMELOXICAM TAB 7.5MG 53489062005 MUTUAL PHARMACEUTICAL COMPANY yMELOXICAM TAB 15MG 53489062101 MUTUAL PHARMACEUTICAL COMPANY yMELOXICAM TAB 15MG 53489062105 MUTUAL PHARMACEUTICAL COMPANY yDOXYCYCLINE TAB 20MG 53489064701 MUTUAL PHARMACEUTICAL COMPANY yCLORPRES TAB 0.1-15MG 62794000101 MYLAN BERTEK PHARMACEUTICALS, INC. yGRANULEX AER 62794000250 MYLAN BERTEK PHARMACEUTICALS, INC. yGRANULEX AER 62794000251 MYLAN BERTEK PHARMACEUTICALS, INC. yCLORPRES TAB 0.2-15MG 62794002701 MYLAN BERTEK PHARMACEUTICALS, INC. yCLORPRES TAB 0.3-15MG 62794007201 MYLAN BERTEK PHARMACEUTICALS, INC. yACTICIN CRE 5% 62794013106 MYLAN BERTEK PHARMACEUTICALS, INC. yAVITA GEL 0.025% 62794014002 MYLAN BERTEK PHARMACEUTICALS, INC. yAVITA GEL 0.025% 62794014003 MYLAN BERTEK PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AVITA CRE 0.025% 62794014102 MYLAN BERTEK PHARMACEUTICALS, INC. yAVITA CRE 0.025% 62794014103 MYLAN BERTEK PHARMACEUTICALS, INC. yDIGITEK TAB 0.125MG 62794014501 MYLAN BERTEK PHARMACEUTICALS, INC. yDIGITEK TAB 0.125MG 62794014510 MYLAN BERTEK PHARMACEUTICALS, INC. yDIGITEK TAB 0.125MG 62794014556 MYLAN BERTEK PHARMACEUTICALS, INC. yDIGITEK TAB 0.25MG 62794014601 MYLAN BERTEK PHARMACEUTICALS, INC. yDIGITEK TAB 0.25MG 62794014610 MYLAN BERTEK PHARMACEUTICALS, INC. yDIGITEK TAB 0.25MG 62794014656 MYLAN BERTEK PHARMACEUTICALS, INC. yMENTAX CRE 1% 62794015102 MYLAN BERTEK PHARMACEUTICALS, INC. yMENTAX CRE 1% 62794015103 MYLAN BERTEK PHARMACEUTICALS, INC. yNITREK DIS 0.2MG/HR 62794020293 MYLAN BERTEK PHARMACEUTICALS, INC. yNITREK DIS 0.4MG/HR 62794020493 MYLAN BERTEK PHARMACEUTICALS, INC. yNITREK DIS 0.6MG/HR 62794020693 MYLAN BERTEK PHARMACEUTICALS, INC. yAPOKYN INJ 62794025513 MYLAN BERTEK PHARMACEUTICALS, INC. yAPOKYN INJ 62794025537 MYLAN BERTEK PHARMACEUTICALS, INC. yMAXZIDE TAB 75-50 62794046001 MYLAN BERTEK PHARMACEUTICALS, INC. yMAXZIDE TAB 75-50 62794046005 MYLAN BERTEK PHARMACEUTICALS, INC. yMAXZIDE TAB 75-50 62794046088 MYLAN BERTEK PHARMACEUTICALS, INC. yMAXZIDE-25 TAB 62794046401 MYLAN BERTEK PHARMACEUTICALS, INC. yKRISTALOSE PAK 10GM 62794050117 MYLAN BERTEK PHARMACEUTICALS, INC. yKRISTALOSE PAK 10GM 62794050193 MYLAN BERTEK PHARMACEUTICALS, INC. yKRISTALOSE PAK 20GM 62794050217 MYLAN BERTEK PHARMACEUTICALS, INC. yKRISTALOSE PAK 20GM 62794050293 MYLAN BERTEK PHARMACEUTICALS, INC. yAMNESTEEM CAP 10MG 62794061193 MYLAN BERTEK PHARMACEUTICALS, INC. yAMNESTEEM CAP 20MG 62794061288 MYLAN BERTEK PHARMACEUTICALS, INC. yAMNESTEEM CAP 20MG 62794061293 MYLAN BERTEK PHARMACEUTICALS, INC. yAMNESTEEM CAP 40MG 62794061488 MYLAN BERTEK PHARMACEUTICALS, INC. yAMNESTEEM CAP 40MG 62794061493 MYLAN BERTEK PHARMACEUTICALS, INC. yPHENYTEK CAP 200MG 62794067001 MYLAN BERTEK PHARMACEUTICALS, INC. yPHENYTEK CAP 200MG 62794067093 MYLAN BERTEK PHARMACEUTICALS, INC. yPHENYTEK CAP 300MG 62794075001 MYLAN BERTEK PHARMACEUTICALS, INC. yPHENYTEK CAP 300MG 62794075093 MYLAN BERTEK PHARMACEUTICALS, INC. yMETHOTREXATE TAB 2.5MG 00378001401 MYLAN PHARMACEUTICALS, INC. yMETHOTREXATE TAB 2.5MG 00378001450 MYLAN PHARMACEUTICALS, INC. yMETOPROLOL TAB 25MG 00378001801 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM TAB 30MG 00378002301 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DILTIAZEM TAB 30MG 00378002305 MYLAN PHARMACEUTICALS, INC. yNADOLOL TAB 20MG 00378002801 MYLAN PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 3.75MG 00378003001 MYLAN PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 3.75MG 00378003005 MYLAN PHARMACEUTICALS, INC. yMETOPROLOL TAB 50MG 00378003201 MYLAN PHARMACEUTICALS, INC. yMETOPROLOL TAB 50MG 00378003210 MYLAN PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 7.5MG 00378004001 MYLAN PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 7.5MG 00378004005 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 4-10MG 00378004201 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM TAB 60MG 00378004501 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM TAB 60MG 00378004505 MYLAN PHARMACEUTICALS, INC. yMETOPROLOL TAB 100MG 00378004701 MYLAN PHARMACEUTICALS, INC. yMETOPROLOL TAB 100MG 00378004710 MYLAN PHARMACEUTICALS, INC. yPINDOLOL TAB 5MG 00378005201 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 200MG 00378005301 MYLAN PHARMACEUTICALS, INC. yTIMOLOL MAL TAB 5MG 00378005501 MYLAN PHARMACEUTICALS, INC. yMAPROTILINE TAB 25MG 00378006001 MYLAN PHARMACEUTICALS, INC. yINDAPAMIDE TAB 1.25MG 00378006901 MYLAN PHARMACEUTICALS, INC. yINDAPAMIDE TAB 1.25MG 00378006905 MYLAN PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 15MG 00378007001 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 4-50MG 00378007301 MYLAN PHARMACEUTICALS, INC. yFLURBIPROFEN TAB 50MG 00378007601 MYLAN PHARMACEUTICALS, INC. yINDAPAMIDE TAB 2.5MG 00378008001 MYLAN PHARMACEUTICALS, INC. yINDAPAMIDE TAB 2.5MG 00378008010 MYLAN PHARMACEUTICALS, INC. yCAPTOPR/HCTZ TAB 25-15MG 00378008101 MYLAN PHARMACEUTICALS, INC. yCAPTOPR/HCTZ TAB 25-25MG 00378008301 MYLAN PHARMACEUTICALS, INC. yCAPTOPR/HCTZ TAB 50-15MG 00378008401 MYLAN PHARMACEUTICALS, INC. yCAPTOPR/HCTZ TAB 50-25MG 00378008601 MYLAN PHARMACEUTICALS, INC. yMAPROTILINE TAB 50MG 00378008701 MYLAN PHARMACEUTICALS, INC. yCARB/LEVO ER TAB 25/100 00378008801 MYLAN PHARMACEUTICALS, INC. yMAPROTILINE TAB 75MG 00378009201 MYLAN PHARMACEUTICALS, INC. yFLURBIPROFEN TAB 100MG 00378009301 MYLAN PHARMACEUTICALS, INC. yFLURBIPROFEN TAB 100MG 00378009305 MYLAN PHARMACEUTICALS, INC. yCARB/LEVO ER TAB 50-200MG 00378009401 MYLAN PHARMACEUTICALS, INC. yTETRACYCLINE CAP 250MG 00378010110 MYLAN PHARMACEUTICALS, INC. yTETRACYCLINE CAP 500MG 00378010201 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TETRACYCLINE CAP 500MG 00378010205 MYLAN PHARMACEUTICALS, INC. yPINDOLOL TAB 10MG 00378012701 MYLAN PHARMACEUTICALS, INC. yPROPOXY/APAP TAB 65-650MG 00378013001 MYLAN PHARMACEUTICALS, INC. yPROPOXY/APAP TAB 65-650MG 00378013005 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM TAB 90MG 00378013501 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM TAB 90MG 00378013505 MYLAN PHARMACEUTICALS, INC. yALLOPURINOL TAB 100MG 00378013701 MYLAN PHARMACEUTICALS, INC. yALLOPURINOL TAB 100MG 00378013710 MYLAN PHARMACEUTICALS, INC. ySPIRONO/HCTZ TAB 25/25 00378014101 MYLAN PHARMACEUTICALS, INC. ySPIRONO/HCTZ TAB 25/25 00378014105 MYLAN PHARMACEUTICALS, INC. yINDOMETHACIN CAP 25MG 00378014301 MYLAN PHARMACEUTICALS, INC. yINDOMETHACIN CAP 25MG 00378014310 MYLAN PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 00378014405 MYLAN PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 00378014491 MYLAN PHARMACEUTICALS, INC. yINDOMETHACIN CAP 50MG 00378014701 MYLAN PHARMACEUTICALS, INC. yINDOMETHACIN CAP 50MG 00378014705 MYLAN PHARMACEUTICALS, INC. yCHLOROTHIAZ TAB 250MG 00378015001 MYLAN PHARMACEUTICALS, INC. yCLONIDINE TAB 0.1MG 00378015201 MYLAN PHARMACEUTICALS, INC. yCLONIDINE TAB 0.1MG 00378015210 MYLAN PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00378015501 MYLAN PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00378015505 MYLAN PHARMACEUTICALS, INC. yPROBENECID TAB 500MG 00378015601 MYLAN PHARMACEUTICALS, INC. yMETHYCLOTHIA TAB 5MG 00378016001 MYLAN PHARMACEUTICALS, INC. yCHLOROTHIAZ TAB 500MG 00378016201 MYLAN PHARMACEUTICALS, INC. yCHLOROTHIAZ TAB 500MG 00378016210 MYLAN PHARMACEUTICALS, INC. yALLOPURINOL TAB 300MG 00378018101 MYLAN PHARMACEUTICALS, INC. yALLOPURINOL TAB 300MG 00378018105 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 10MG 00378018201 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 10MG 00378018210 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 20MG 00378018301 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 20MG 00378018310 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 40MG 00378018401 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 40MG 00378018410 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 80MG 00378018501 MYLAN PHARMACEUTICALS, INC. yPROPRANOLOL TAB 80MG 00378018505 MYLAN PHARMACEUTICALS, INC. yCLONIDINE TAB 0.2MG 00378018601 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLONIDINE TAB 0.2MG 00378018610 MYLAN PHARMACEUTICALS, INC. yCHLORPROPAM TAB 100MG 00378019701 MYLAN PHARMACEUTICALS, INC. yCHLORPROPAM TAB 100MG 00378019705 MYLAN PHARMACEUTICALS, INC. yCLONIDINE TAB 0.3MG 00378019901 MYLAN PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00378020801 MYLAN PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00378020810 MYLAN PHARMACEUTICALS, INC. yCHLORPROPAM TAB 250MG 00378021001 MYLAN PHARMACEUTICALS, INC. yCHLORPROPAM TAB 250MG 00378021010 MYLAN PHARMACEUTICALS, INC. yCDP/AMITRIP TAB 5-12.5MG 00378021101 MYLAN PHARMACEUTICALS, INC. yCDP/AMITRIP TAB 5-12.5MG 00378021105 MYLAN PHARMACEUTICALS, INC. yCHLORTHALID TAB 50MG 00378021301 MYLAN PHARMACEUTICALS, INC. yCHLORTHALID TAB 50MG 00378021310 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 2MG 00378021401 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 2MG 00378021410 MYLAN PHARMACEUTICALS, INC. yTOLBUTAMIDE TAB 500MG 00378021501 MYLAN PHARMACEUTICALS, INC. yTOLBUTAMIDE TAB 500MG 00378021505 MYLAN PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 00378021601 MYLAN PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 00378021610 MYLAN PHARMACEUTICALS, INC. yTOLAZAMIDE TAB 250MG 00378021701 MYLAN PHARMACEUTICALS, INC. yATENOLOL TAB 25MG 00378021801 MYLAN PHARMACEUTICALS, INC. yATENOLOL TAB 25MG 00378021810 MYLAN PHARMACEUTICALS, INC. yTIMOLOL MAL TAB 10MG 00378022101 MYLAN PHARMACEUTICALS, INC. yCHLORTHALID TAB 25MG 00378022201 MYLAN PHARMACEUTICALS, INC. yCHLORTHALID TAB 25MG 00378022210 MYLAN PHARMACEUTICALS, INC. yATENOLOL TAB 50MG 00378023101 MYLAN PHARMACEUTICALS, INC. yATENOLOL TAB 50MG 00378023110 MYLAN PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 00378023201 MYLAN PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 00378023205 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG 00378023401 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG 00378023405 MYLAN PHARMACEUTICALS, INC. yETODOLAC TAB 400MG 00378023701 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 850MG 00378024001 MYLAN PHARMACEUTICALS, INC. ySPIRONOLACT TAB 50MG 00378024301 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 1000MG 00378024401 MYLAN PHARMACEUTICALS, INC. yBUMETANIDE TAB 0.5MG 00378024501 MYLAN PHARMACEUTICALS, INC. yALBUTEROL TAB 2MG 00378025501 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALBUTEROL TAB 2MG 00378025505 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 1MG 00378025701 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 1MG 00378025710 MYLAN PHARMACEUTICALS, INC. yKETOCONAZOLE TAB 200MG 00378026101 MYLAN PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00378027101 MYLAN PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00378027105 MYLAN PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00378027401 MYLAN PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 00378027493 MYLAN PHARMACEUTICALS, INC. yCDP/AMITRIP TAB 10-25MG 00378027701 MYLAN PHARMACEUTICALS, INC. yCDP/AMITRIP TAB 10-25MG 00378027705 MYLAN PHARMACEUTICALS, INC. ySOTALOL HCL TAB 80MG 00378030501 MYLAN PHARMACEUTICALS, INC. ySOTALOL HCL TAB 120MG 00378031001 MYLAN PHARMACEUTICALS, INC. yTOLMETIN SOD TAB 600MG 00378031301 MYLAN PHARMACEUTICALS, INC. ySOTALOL HCL TAB 160MG 00378031401 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 00378031701 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 00378031705 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 00378031767 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 0.5MG 00378032101 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 0.5MG 00378032105 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 5MG 00378032701 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 5MG 00378032710 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 2-10MG 00378033001 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 2-10MG 00378033005 MYLAN PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00378034501 MYLAN PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00378034505 MYLAN PHARMACEUTICALS, INC. yPROPRAN/HCTZ TAB 80/25 00378034701 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 750MG ER 00378035001 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 0.5MG 00378035101 MYLAN PHARMACEUTICALS, INC. yHALOPERIDOL TAB 0.5MG 00378035110 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 00378035201 MYLAN PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 00378035205 MYLAN PHARMACEUTICALS, INC. yDICLOFENAC TAB 100MG ER 00378035501 MYLAN PHARMACEUTICALS, INC. yPENTOXIFYLLI TAB 400MG ER 00378035701 MYLAN PHARMACEUTICALS, INC. yPENTOXIFYLLI TAB 400MG ER 00378035705 MYLAN PHARMACEUTICALS, INC. yBUMETANIDE TAB 1MG 00378037001 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 00378037201 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIMETIDINE TAB 400MG 00378037205 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 00378037265 MYLAN PHARMACEUTICALS, INC. yHYDROXYCHLOR TAB 200MG 00378037301 MYLAN PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 00378037701 MYLAN PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 00378037705 MYLAN PHARMACEUTICALS, INC. yFLUVOXAMINE TAB 25MG 00378040701 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 240MG ER 00378041101 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 240MG ER 00378041105 MYLAN PHARMACEUTICALS, INC. yFLUVOXAMINE TAB 50MG 00378041201 MYLAN PHARMACEUTICALS, INC. yFLUVOXAMINE TAB 100MG 00378041401 MYLAN PHARMACEUTICALS, INC. yDIPHEN/ATROP TAB 2.5MG 00378041501 MYLAN PHARMACEUTICALS, INC. yDIPHEN/ATROP TAB 2.5MG 00378041510 MYLAN PHARMACEUTICALS, INC. yBUMETANIDE TAB 2MG 00378041701 MYLAN PHARMACEUTICALS, INC. yMETHYLDOPA TAB 500MG 00378042101 MYLAN PHARMACEUTICALS, INC. yMETHYLDOPA TAB 500MG 00378042105 MYLAN PHARMACEUTICALS, INC. ySULINDAC TAB 150MG 00378042701 MYLAN PHARMACEUTICALS, INC. yBUPROPION TAB 75MG 00378043301 MYLAN PHARMACEUTICALS, INC. yBUPROPION TAB 100MG 00378043501 MYLAN PHARMACEUTICALS, INC. ySPIRONOLACT TAB 100MG 00378043701 MYLAN PHARMACEUTICALS, INC. yBENAZEPRIL TAB 5MG 00378044101 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 2-25MG 00378044201 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 2-25MG 00378044205 MYLAN PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 00378044301 MYLAN PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 00378044401 MYLAN PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 00378044701 MYLAN PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 00378045101 MYLAN PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 00378045105 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 1MG 00378045701 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 1MG 00378045705 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 1MG 00378045710 MYLAN PHARMACEUTICALS, INC. yFENOPROFEN TAB 600MG 00378047101 MYLAN PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00378047701 MYLAN PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00378047705 MYLAN PHARMACEUTICALS, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00378050101 MYLAN PHARMACEUTICALS, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00378050110 MYLAN PHARMACEUTICALS, INC. yBISOPRL/HCTZ TAB 5/6.25MG 00378050301 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BISOPRL/HCTZ TAB 5/6.25MG 00378050310 MYLAN PHARMACEUTICALS, INC. yBISOPRL/HCTZ TAB 10/6.25 00378050501 MYLAN PHARMACEUTICALS, INC. yBISOPRL/HCTZ TAB 10/6.25 00378050505 MYLAN PHARMACEUTICALS, INC. yMETHYLD/HCTZ TAB 250/15 00378050701 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 80MG 00378051201 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 80MG 00378051210 MYLAN PHARMACEUTICALS, INC. yBISOPROL FUM TAB 5MG 00378052301 MYLAN PHARMACEUTICALS, INC. yBISOPROL FUM TAB 5MG 00378052393 MYLAN PHARMACEUTICALS, INC. yBISOPROL FUM TAB 10MG 00378052401 MYLAN PHARMACEUTICALS, INC. yBISOPROL FUM TAB 10MG 00378052493 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM TAB 120MG 00378052501 MYLAN PHARMACEUTICALS, INC. ySULINDAC TAB 200MG 00378053101 MYLAN PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 00378054101 MYLAN PHARMACEUTICALS, INC. yTOLAZAMIDE TAB 500MG 00378055101 MYLAN PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 00378055501 MYLAN PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 00378055505 MYLAN PHARMACEUTICALS, INC. yALBUTEROL TAB 4MG 00378057201 MYLAN PHARMACEUTICALS, INC. yALBUTEROL TAB 4MG 00378057205 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 4-25MG 00378057401 MYLAN PHARMACEUTICALS, INC. yPERPHEN/AMIT TAB 4-25MG 00378057405 MYLAN PHARMACEUTICALS, INC. yAMILOR/HCTZ TAB 5-50 00378057701 MYLAN PHARMACEUTICALS, INC. yAMILOR/HCTZ TAB 5-50 00378057705 MYLAN PHARMACEUTICALS, INC. yMETHYLDOPA TAB 250MG 00378061101 MYLAN PHARMACEUTICALS, INC. yMETHYLDOPA TAB 250MG 00378061110 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 10MG 00378061201 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 10MG 00378061210 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 25MG 00378061401 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 25MG 00378061410 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 50MG 00378061601 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 50MG 00378061610 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 100MG 00378061801 MYLAN PHARMACEUTICALS, INC. yTHIORIDAZINE TAB 100MG 00378061810 MYLAN PHARMACEUTICALS, INC. yMETHYLD/HCTZ TAB 250/25 00378071101 MYLAN PHARMACEUTICALS, INC. yMETHYLD/HCTZ TAB 250/25 00378071110 MYLAN PHARMACEUTICALS, INC. yENALAPR/HCTZ TAB 5-12.5MG 00378071201 MYLAN PHARMACEUTICALS, INC. yTIMOLOL MAL TAB 20MG 00378071501 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TIZANIDINE TAB 2MG 00378072219 MYLAN PHARMACEUTICALS, INC. yENALAPR/HCTZ TAB 10-25MG 00378072301 MYLAN PHARMACEUTICALS, INC. yTIZANIDINE TAB 4MG 00378072419 MYLAN PHARMACEUTICALS, INC. yPROPRAN/HCTZ TAB 40/25 00378073101 MYLAN PHARMACEUTICALS, INC. yCYCLOBENZAPR TAB 10MG 00378075101 MYLAN PHARMACEUTICALS, INC. yCYCLOBENZAPR TAB 10MG 00378075110 MYLAN PHARMACEUTICALS, INC. yATENOLOL TAB 100MG 00378075701 MYLAN PHARMACEUTICALS, INC. yATENOLOL TAB 100MG 00378075710 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 120MG 00378077201 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 120MG 00378077205 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 2MG 00378077701 MYLAN PHARMACEUTICALS, INC. yLORAZEPAM TAB 2MG 00378077705 MYLAN PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00378081001 MYLAN PHARMACEUTICALS, INC. yCLOZAPINE TAB 25MG 00378082501 MYLAN PHARMACEUTICALS, INC. yCLOZAPINE TAB 100MG 00378086001 MYLAN PHARMACEUTICALS, INC. yCLOZAPINE TAB 100MG 00378086005 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 1MG 00378100101 MYLAN PHARMACEUTICALS, INC. yPIROXICAM CAP 10MG 00378101001 MYLAN PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 10-12.5 00378101201 MYLAN PHARMACEUTICALS, INC. yNICARDIPINE CAP 20MG 00378102005 MYLAN PHARMACEUTICALS, INC. yNICARDIPINE CAP 20MG 00378102077 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 10MG 00378104901 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 10MG 00378104910 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 00378105101 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 00378105105 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 00378105201 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 00378105210 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 00378105301 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 00378105310 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 00378105401 MYLAN PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 00378105405 MYLAN PHARMACEUTICALS, INC. yMELOXICAM TAB 7.5MG 00378106601 MYLAN PHARMACEUTICALS, INC. yMELOXICAM TAB 7.5MG 00378106605 MYLAN PHARMACEUTICALS, INC. yMELOXICAM TAB 15MG 00378108901 MYLAN PHARMACEUTICALS, INC. yMELOXICAM TAB 15MG 00378108905 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 1MG 00378110101 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PRAZOSIN HCL CAP 1MG 00378110110 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 1MG 00378110125 MYLAN PHARMACEUTICALS, INC. yGLIPIZIDE TAB 5MG 00378110501 MYLAN PHARMACEUTICALS, INC. yGLIPIZIDE TAB 5MG 00378110505 MYLAN PHARMACEUTICALS, INC. yGLIPIZIDE TAB 10MG 00378111001 MYLAN PHARMACEUTICALS, INC. yGLIPIZIDE TAB 10MG 00378111005 MYLAN PHARMACEUTICALS, INC. yGLYBURID MCR TAB 1.5MG 00378111301 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 120MG ER 00378112001 MYLAN PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 00378112501 MYLAN PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 00378112510 MYLAN PHARMACEUTICALS, INC. yNADOLOL TAB 80MG 00378113201 MYLAN PHARMACEUTICALS, INC. yNADOLOL TAB 80MG 00378113210 MYLAN PHARMACEUTICALS, INC. yKETOROLAC TAB 10MG 00378113401 MYLAN PHARMACEUTICALS, INC. yKETOROLAC TAB 10MG 00378113405 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 00378114001 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 00378114005 MYLAN PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 00378114201 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 00378115001 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 00378115005 MYLAN PHARMACEUTICALS, INC. yGUANFACINE TAB 1MG 00378116001 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 00378116580 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 00378116591 MYLAN PHARMACEUTICALS, INC. yNADOLOL TAB 40MG 00378117101 MYLAN PHARMACEUTICALS, INC. yNADOLOL TAB 40MG 00378117110 MYLAN PHARMACEUTICALS, INC. yBUSPIRONE TAB 30MG 00378117591 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 180MG ER 00378118001 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL TAB 180MG ER 00378118005 MYLAN PHARMACEUTICALS, INC. yGUANFACINE TAB 2MG 00378119001 MYLAN PHARMACEUTICALS, INC. yACEBUTOLOL CAP 200MG 00378120001 MYLAN PHARMACEUTICALS, INC. yETODOLAC TAB 500MG 00378124201 MYLAN PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 250MG 00378132201 MYLAN PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 500MG 00378132301 MYLAN PHARMACEUTICALS, INC. yTRIAMT/HCTZ TAB 37.5-25 00378135201 MYLAN PHARMACEUTICALS, INC. yTRIAMT/HCTZ TAB 37.5-25 00378135205 MYLAN PHARMACEUTICALS, INC. yTRIAMT/HCTZ TAB 75-50MG 00378135501 MYLAN PHARMACEUTICALS, INC. yTRIAMT/HCTZ TAB 75-50MG 00378135505 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACEBUTOLOL CAP 400MG 00378140001 MYLAN PHARMACEUTICALS, INC. yNORTRIPTYLIN CAP 10MG 00378141001 MYLAN PHARMACEUTICALS, INC. yNICARDIPINE CAP 30MG 00378143005 MYLAN PHARMACEUTICALS, INC. yNICARDIPINE CAP 30MG 00378143077 MYLAN PHARMACEUTICALS, INC. yESTRADIOL TAB 0.5MG 00378145201 MYLAN PHARMACEUTICALS, INC. yESTRADIOL TAB 0.5MG 00378145205 MYLAN PHARMACEUTICALS, INC. yESTRADIOL TAB 1MG 00378145401 MYLAN PHARMACEUTICALS, INC. yESTRADIOL TAB 1MG 00378145405 MYLAN PHARMACEUTICALS, INC. yESTRADIOL TAB 2MG 00378145801 MYLAN PHARMACEUTICALS, INC. yESTRADIOL TAB 2MG 00378145805 MYLAN PHARMACEUTICALS, INC. yPHENYTOIN EX CAP 100MG 00378156001 MYLAN PHARMACEUTICALS, INC. yPHENYTOIN EX CAP 100MG 00378156010 MYLAN PHARMACEUTICALS, INC. yTERAZOSIN CAP 10MG 00378157001 MYLAN PHARMACEUTICALS, INC. yDICYCLOMINE CAP 10MG 00378161001 MYLAN PHARMACEUTICALS, INC. yDICYCLOMINE CAP 10MG 00378161005 MYLAN PHARMACEUTICALS, INC. yDICYCLOMINE TAB 20MG 00378162001 MYLAN PHARMACEUTICALS, INC. yDICYCLOMINE TAB 20MG 00378162005 MYLAN PHARMACEUTICALS, INC. yNITROFUR MAC CAP 50MG 00378165001 MYLAN PHARMACEUTICALS, INC. yNITROFUR MAC CAP 50MG 00378165005 MYLAN PHARMACEUTICALS, INC. yNITROFUR MAC CAP 100MG 00378170001 MYLAN PHARMACEUTICALS, INC. yNITROFUR MAC CAP 100MG 00378170005 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 25MCG 00378180001 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 25MCG 00378180005 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 50MCG 00378180301 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 50MCG 00378180310 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 75MCG 00378180501 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 75MCG 00378180510 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 88MCG 00378180701 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 88MCG 00378180705 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 100MCG 00378180901 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 100MCG 00378180910 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 112MCG 00378181101 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 112MCG 00378181105 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 125MCG 00378181301 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 125MCG 00378181310 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 150MCG 00378181501 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LEVOTHYROXIN TAB 150MCG 00378181510 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 175MCG 00378181701 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 175MCG 00378181705 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 200MCG 00378181901 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 200MCG 00378181910 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 300MCG 00378182101 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 137MCG 00378182301 MYLAN PHARMACEUTICALS, INC. yLEVOTHYROXIN TAB 137MCG 00378182305 MYLAN PHARMACEUTICALS, INC. yMIDODRINE TAB 2.5MG 00378190101 MYLAN PHARMACEUTICALS, INC. yMIDODRINE TAB 5MG 00378190201 MYLAN PHARMACEUTICALS, INC. yMIDODRINE TAB 10MG 00378190301 MYLAN PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00378191001 MYLAN PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00378191010 MYLAN PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00378191201 MYLAN PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00378191210 MYLAN PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00378191401 MYLAN PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00378191405 MYLAN PHARMACEUTICALS, INC. yCITALOPRAM TAB 10MG 00378192101 MYLAN PHARMACEUTICALS, INC. yCITALOPRAM TAB 20MG 00378192201 MYLAN PHARMACEUTICALS, INC. yCITALOPRAM TAB 20MG 00378192205 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 2MG 00378200201 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 2MG 00378200210 MYLAN PHARMACEUTICALS, INC. ySELEGILINE TAB 5MG 00378201191 MYLAN PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-12.5 00378201201 MYLAN PHARMACEUTICALS, INC. yPIROXICAM CAP 20MG 00378202001 MYLAN PHARMACEUTICALS, INC. yPIROXICAM CAP 20MG 00378202005 MYLAN PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-25MG 00378202501 MYLAN PHARMACEUTICALS, INC. yATENOL/CHLOR TAB 50-25MG 00378206301 MYLAN PHARMACEUTICALS, INC. yATENOL/CHLOR TAB 100-25MG 00378206401 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 2.5MG 00378207201 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 00378207301 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 00378207310 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 00378207401 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 00378207410 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 00378207501 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 00378207510 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOPRIL TAB 40MG 00378207601 MYLAN PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 00378207701 MYLAN PHARMACEUTICALS, INC. yLOPERAMIDE CAP 2MG 00378210001 MYLAN PHARMACEUTICALS, INC. yLOPERAMIDE CAP 2MG 00378210005 MYLAN PHARMACEUTICALS, INC. ySPIRONOLACT TAB 25MG 00378214601 MYLAN PHARMACEUTICALS, INC. ySPIRONOLACT TAB 25MG 00378214605 MYLAN PHARMACEUTICALS, INC. yMECLOFEN SOD CAP 50MG 00378215001 MYLAN PHARMACEUTICALS, INC. yMECLOFEN SOD CAP 50MG 00378215005 MYLAN PHARMACEUTICALS, INC. ySELEGILINE CAP 5MG 00378225291 MYLAN PHARMACEUTICALS, INC. yTERAZOSIN CAP 1MG 00378226001 MYLAN PHARMACEUTICALS, INC. yTERAZOSIN CAP 2MG 00378226401 MYLAN PHARMACEUTICALS, INC. yTERAZOSIN CAP 5MG 00378226801 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 2MG 00378230201 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 2MG 00378230210 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 2MG 00378230225 MYLAN PHARMACEUTICALS, INC. yNORTRIPTYLIN CAP 25MG 00378232501 MYLAN PHARMACEUTICALS, INC. yTRIFLUOPERAZ TAB 1MG 00378240101 MYLAN PHARMACEUTICALS, INC. yTRIFLUOPERAZ TAB 2MG 00378240201 MYLAN PHARMACEUTICALS, INC. yTRIFLUOPERAZ TAB 5MG 00378240501 MYLAN PHARMACEUTICALS, INC. yTRIFLUOPERAZ TAB 5MG 00378240505 MYLAN PHARMACEUTICALS, INC. yTRIFLUOPERAZ TAB 10MG 00378241001 MYLAN PHARMACEUTICALS, INC. yTRIFLUOPERAZ TAB 10MG 00378241005 MYLAN PHARMACEUTICALS, INC. yDICLOFEN POT TAB 50MG 00378247401 MYLAN PHARMACEUTICALS, INC. yTRIAM/HCTZ CAP 37.5-25 00378253701 MYLAN PHARMACEUTICALS, INC. yTRIAM/HCTZ CAP 37.5-25 00378253710 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 10MG 00378261001 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 10MG 00378261010 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 25MG 00378262501 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 25MG 00378262510 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 50MG 00378265001 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 50MG 00378265010 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 75MG 00378267501 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 100MG 00378268501 MYLAN PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 150MG 00378269501 MYLAN PHARMACEUTICALS, INC. yCILOSTAZOL TAB 50MG 00378297991 MYLAN PHARMACEUTICALS, INC. yCILOSTAZOL TAB 100MG 00378298091 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MECLOFEN SOD CAP 100MG 00378300001 MYLAN PHARMACEUTICALS, INC. yMECLOFEN SOD CAP 100MG 00378300005 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 5MG 00378300501 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 5MG 00378300510 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 12.5MG 00378300701 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 12.5MG 00378300710 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 25MG 00378301201 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 25MG 00378301210 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 50MG 00378301701 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 50MG 00378301710 MYLAN PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00378302001 MYLAN PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00378302005 MYLAN PHARMACEUTICALS, INC. yFAMOTIDINE TAB 20MG 00378302093 MYLAN PHARMACEUTICALS, INC. yCAPTOPRIL TAB 100MG 00378302201 MYLAN PHARMACEUTICALS, INC. yCLOMIPRAMINE CAP 25MG 00378302501 MYLAN PHARMACEUTICALS, INC. yFAMOTIDINE TAB 40MG 00378304001 MYLAN PHARMACEUTICALS, INC. yFAMOTIDINE TAB 40MG 00378304093 MYLAN PHARMACEUTICALS, INC. yCLOMIPRAMINE CAP 50MG 00378305001 MYLAN PHARMACEUTICALS, INC. yCLOMIPRAMINE CAP 75MG 00378307501 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 25MG 00378312501 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 25MG 00378312510 MYLAN PHARMACEUTICALS, INC. yFINASTERIDE TAB 5MG 00378315101 MYLAN PHARMACEUTICALS, INC. yFINASTERIDE TAB 5MG 00378315193 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 5MG 00378320501 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 5MG 00378320505 MYLAN PHARMACEUTICALS, INC. yPRAZOSIN HCL CAP 5MG 00378320525 MYLAN PHARMACEUTICALS, INC. yNORTRIPTYLIN CAP 50MG 00378325001 MYLAN PHARMACEUTICALS, INC. yETOPOSIDE CAP 50MG 00378326694 MYLAN PHARMACEUTICALS, INC. yESTRADIOL DIS 0.025MG 00378334999 MYLAN PHARMACEUTICALS, INC. yESTRADIOL DIS 0.05MG 00378335099 MYLAN PHARMACEUTICALS, INC. yESTRADIOL DIS 0.075MG 00378335199 MYLAN PHARMACEUTICALS, INC. yESTRADIOL DIS 0.1MG 00378335299 MYLAN PHARMACEUTICALS, INC. yESTRADIOL DIS 0.0375MG 00378336099 MYLAN PHARMACEUTICALS, INC. yESTRADIOL DIS 0.06MG 00378336199 MYLAN PHARMACEUTICALS, INC. yNITROFURANTN CAP 100MG 00378342201 MYLAN PHARMACEUTICALS, INC. yNIFEDIPINE TAB 30MG ER 00378347501 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NIFEDIPINE TAB 30MG ER 00378347530 MYLAN PHARMACEUTICALS, INC. yNIFEDIPINE TAB 60MG ER 00378348201 MYLAN PHARMACEUTICALS, INC. yNIFEDIPINE TAB 60MG ER 00378348230 MYLAN PHARMACEUTICALS, INC. yNIFEDIPINE TAB 90MG ER 00378349501 MYLAN PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 15MG 00378351593 MYLAN PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 30MG 00378353093 MYLAN PHARMACEUTICALS, INC. yMIRTAZAPINE TAB 45MG 00378354593 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 0.25MG 00378400101 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 0.25MG 00378400105 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 0.5MG 00378400301 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 0.5MG 00378400305 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 1MG 00378400501 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 1MG 00378400505 MYLAN PHARMACEUTICALS, INC. yALPRAZOLAM TAB 2MG 00378400701 MYLAN PHARMACEUTICALS, INC. yTEMAZEPAM CAP 15MG 00378401001 MYLAN PHARMACEUTICALS, INC. yTEMAZEPAM CAP 15MG 00378401005 MYLAN PHARMACEUTICALS, INC. yGLIMEPIRIDE TAB 1MG 00378401101 MYLAN PHARMACEUTICALS, INC. yGLIMEPIRIDE TAB 2MG 00378401201 MYLAN PHARMACEUTICALS, INC. yGLIMEPIRIDE TAB 4MG 00378401301 MYLAN PHARMACEUTICALS, INC. yDOXAZOSIN TAB 1MG 00378402101 MYLAN PHARMACEUTICALS, INC. yDOXAZOSIN TAB 2MG 00378402201 MYLAN PHARMACEUTICALS, INC. yDOXAZOSIN TAB 4MG 00378402401 MYLAN PHARMACEUTICALS, INC. yDOXAZOSIN TAB 8MG 00378402801 MYLAN PHARMACEUTICALS, INC. yKETOPROFEN CAP 50MG 00378407001 MYLAN PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 00378415101 MYLAN PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 00378415105 MYLAN PHARMACEUTICALS, INC. yNORTRIPTYLIN CAP 75MG 00378417501 MYLAN PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 00378421001 MYLAN PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 00378422001 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 50MG 00378425001 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 50MG 00378425010 MYLAN PHARMACEUTICALS, INC. yFLURAZEPAM CAP 15MG 00378441501 MYLAN PHARMACEUTICALS, INC. yFLURAZEPAM CAP 15MG 00378441505 MYLAN PHARMACEUTICALS, INC. yFLURAZEPAM CAP 30MG 00378443001 MYLAN PHARMACEUTICALS, INC. yFLURAZEPAM CAP 30MG 00378443005 MYLAN PHARMACEUTICALS, INC. yESTROPIPATE TAB 0.75MG 00378455101 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ESTROPIPATE TAB 1.5MG 00378455301 MYLAN PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 5-6.25 00378472501 MYLAN PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 10-12.5 00378473501 MYLAN PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-12.5 00378474501 MYLAN PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-25MG 00378477501 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 10MG 00378501001 MYLAN PHARMACEUTICALS, INC. yTHIOTHIXENE CAP 10MG 00378501010 MYLAN PHARMACEUTICALS, INC. yTEMAZEPAM CAP 30MG 00378505001 MYLAN PHARMACEUTICALS, INC. yTEMAZEPAM CAP 30MG 00378505005 MYLAN PHARMACEUTICALS, INC. yPROCHLORPER TAB 5MG 00378510501 MYLAN PHARMACEUTICALS, INC. yPROCHLORPER TAB 10MG 00378511001 MYLAN PHARMACEUTICALS, INC. yNIZATIDINE CAP 150MG 00378515005 MYLAN PHARMACEUTICALS, INC. yNIZATIDINE CAP 150MG 00378515091 MYLAN PHARMACEUTICALS, INC. yTOLMETIN SOD CAP 400MG 00378520001 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 120MG ER 00378522001 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 120MG ER 00378522005 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 180MG ER 00378528001 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 180MG ER 00378528005 MYLAN PHARMACEUTICALS, INC. yNIZATIDINE CAP 300MG 00378530093 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 240MG ER 00378534001 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 240MG ER 00378534005 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 75MG 00378537501 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 75MG 00378537510 MYLAN PHARMACEUTICALS, INC. yKETOPROFEN CAP 75MG 00378575001 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 1MG 00378600401 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 1MG 00378600405 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 2.5MG 00378600901 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 2.5MG 00378600905 MYLAN PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 15MG ER 00378601501 MYLAN PHARMACEUTICALS, INC. yDOXYCYC MONO TAB 50MG 00378602101 MYLAN PHARMACEUTICALS, INC. yDOXYCYC MONO TAB 75MG 00378602201 MYLAN PHARMACEUTICALS, INC. yDOXYCYC MONO TAB 100MG 00378602389 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 60MG ER 00378606001 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 5MG 00378607401 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 5MG 00378607405 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 90MG ER 00378609001 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUPHENAZINE TAB 10MG 00378609701 MYLAN PHARMACEUTICALS, INC. yFLUPHENAZINE TAB 10MG 00378609705 MYLAN PHARMACEUTICALS, INC. yDILTIAZEM CAP 120MG ER 00378612001 MYLAN PHARMACEUTICALS, INC. yACTICIN CRE 5% 00378613106 MYLAN PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 20MG 00378615001 MYLAN PHARMACEUTICALS, INC. yOMEPRAZOLE CAP 20MG 00378615093 MYLAN PHARMACEUTICALS, INC. yMETOLAZONE TAB 2.5MG 00378617201 MYLAN PHARMACEUTICALS, INC. yMETOLAZONE TAB 5MG 00378617301 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL CAP 120MG ER 00378632001 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL CAP 180MG ER 00378638001 MYLAN PHARMACEUTICALS, INC. yERYTHROM ETH TAB 400MG 00378640001 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 100MG 00378641001 MYLAN PHARMACEUTICALS, INC. yDOXEPIN HCL CAP 100MG 00378641010 MYLAN PHARMACEUTICALS, INC. yVERAPAMIL CAP 240MG ER 00378644001 MYLAN PHARMACEUTICALS, INC. yLOVASTATIN TAB 10MG 00378651091 MYLAN PHARMACEUTICALS, INC. yLOVASTATIN TAB 20MG 00378652005 MYLAN PHARMACEUTICALS, INC. yLOVASTATIN TAB 20MG 00378652091 MYLAN PHARMACEUTICALS, INC. yLOVASTATIN TAB 40MG 00378654005 MYLAN PHARMACEUTICALS, INC. yLOVASTATIN TAB 40MG 00378654091 MYLAN PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG ER 00378660501 MYLAN PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG ER 00378660505 MYLAN PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 10MG ER 00378661001 MYLAN PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 10MG ER 00378661005 MYLAN PHARMACEUTICALS, INC. yAMNESTEEM CAP 20MG 00378661293 MYLAN PHARMACEUTICALS, INC. yAMNESTEEM CAP 40MG 00378661488 MYLAN PHARMACEUTICALS, INC. yAMNESTEEM CAP 40MG 00378661493 MYLAN PHARMACEUTICALS, INC. yZONISAMIDE CAP 25MG 00378672501 MYLAN PHARMACEUTICALS, INC. yZONISAMIDE CAP 50MG 00378672601 MYLAN PHARMACEUTICALS, INC. yZONISAMIDE CAP 100MG 00378672701 MYLAN PHARMACEUTICALS, INC. yZONISAMIDE CAP 100MG 00378672705 MYLAN PHARMACEUTICALS, INC. yANAGRELIDE CAP 0.5MG 00378686801 MYLAN PHARMACEUTICALS, INC. yANAGRELIDE CAP 1MG 00378686901 MYLAN PHARMACEUTICALS, INC. yLOXAPINE CAP 5MG 00378700501 MYLAN PHARMACEUTICALS, INC. yLOXAPINE CAP 10MG 00378701001 MYLAN PHARMACEUTICALS, INC. yLOXAPINE CAP 25MG 00378702501 MYLAN PHARMACEUTICALS, INC. yPROPOXY HCL CAP 65MG 00378706501 MYLAN PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BROMOCRIPTIN CAP 5MG 00378709601 MYLAN PHARMACEUTICALS, INC. yBROMOCRIPTIN CAP 5MG 00378709693 MYLAN PHARMACEUTICALS, INC. yKETOPROFEN CAP 200MG ER 00378820001 MYLAN PHARMACEUTICALS, INC. yFLECAINIDE TAB 50MG 00378850501 MYLAN PHARMACEUTICALS, INC. yFLECAINIDE TAB 100MG 00378851001 MYLAN PHARMACEUTICALS, INC. yFLECAINIDE TAB 150MG 00378851501 MYLAN PHARMACEUTICALS, INC. yCYSTAGON CAP 50MG 00378904001 MYLAN PHARMACEUTICALS, INC. yCYSTAGON CAP 50MG 00378904005 MYLAN PHARMACEUTICALS, INC. yCYSTAGON CAP 150MG 00378904501 MYLAN PHARMACEUTICALS, INC. yCYSTAGON CAP 150MG 00378904505 MYLAN PHARMACEUTICALS, INC. yNITROGLYCER DIS 0.1MG/HR 00378910293 MYLAN PHARMACEUTICALS, INC. yNITROGLYCER DIS 0.2MG/HR 00378910493 MYLAN PHARMACEUTICALS, INC. yNITROGLYCER DIS 0.4MG/HR 00378911293 MYLAN PHARMACEUTICALS, INC. yNITROGLYCER DIS 0.6MG/HR 00378911693 MYLAN PHARMACEUTICALS, INC. yBUTORPHANOL SOL 10MG/ML 00378963943 MYLAN PHARMACEUTICALS, INC. yNABI-HB INJ 59730420201 NABI BIOPHARMACEUTICALS yNABI-HB INJ 59730420301 NABI BIOPHARMACEUTICALS yNP NABI-HB INJ 59730420401 NABI BIOPHARMACEUTICALS yNP NABI-HB INJ 59730420501 NABI BIOPHARMACEUTICALS yALOPRIM INJ 500MG 59730560101 NABI BIOPHARMACEUTICALS yAUTOPLEX T INJ 59730605907 NABI BIOPHARMACEUTICALS yPHOSLO TAB 667MG 59730640101 NABI BIOPHARMACEUTICALS yPHOSLO CAP 667MG 59730640201 NABI BIOPHARMACEUTICALS yNEPHRON FA TAB 59528445601 NEPHRO-TECH, INC. yNEPHRON INH 2.25% 00487350101 NEPHRON PHARMACEUTICALS CORPORATION yS-2 INH 2.25% 00487590101 NEPHRON PHARMACEUTICALS CORPORATION yS-2 INH 2.25% 00487590102 NEPHRON PHARMACEUTICALS CORPORATION yS-2 INH 2.25% 00487590199 NEPHRON PHARMACEUTICALS CORPORATION yRAPHON SOL 2.25% 00487650101 NEPHRON PHARMACEUTICALS CORPORATION ySOD CHLORIDE NEB 0.9% 00487930102 NEPHRON PHARMACEUTICALS CORPORATION ySOD CHLORIDE NEB 0.9% 00487930103 NEPHRON PHARMACEUTICALS CORPORATION ySOD CHLORIDE NEB 0.9% 00487930133 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 0.083% 00487950101 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 0.083% 00487950102 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 0.083% 00487950103 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 0.083% 00487950125 NEPHRON PHARMACEUTICALS CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALBUTEROL NEB 0.083% 00487950160 NEPHRON PHARMACEUTICALS CORPORATION yIPRATROPIUM SOL INHAL 00487980101 NEPHRON PHARMACEUTICALS CORPORATION yIPRATROPIUM SOL INHAL 00487980102 NEPHRON PHARMACEUTICALS CORPORATION yIPRATROPIUM SOL INHAL 00487980125 NEPHRON PHARMACEUTICALS CORPORATION yIPRATROPIUM SOL INHAL 00487980130 NEPHRON PHARMACEUTICALS CORPORATION yIPRATROPIUM SOL INHAL 00487980160 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 0.5% 00487990102 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 0.5% 00487990130 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 1.25MG/3 00487990401 NEPHRON PHARMACEUTICALS CORPORATION yALBUTEROL NEB 1.25MG/3 00487990402 NEPHRON PHARMACEUTICALS CORPORATION yBIDIL TAB 12948000112 NITROMED, INC. yZIKS ARTHRIT CRE RELIEF 63044003060 NNODUM PHARMACEUTICAL CORPORATION yINATAL ADV TAB 63044015364 NNODUM PHARMACEUTICAL CORPORATION yINATAL ULTRA TAB 63044015463 NNODUM PHARMACEUTICAL CORPORATION yINATAL GT TAB 63044015910 NNODUM PHARMACEUTICAL CORPORATION yIFEREX 150 CAP FORTE 63044019862 NNODUM PHARMACEUTICAL CORPORATION yIFEREX 150 CAP 63044020361 NNODUM PHARMACEUTICAL CORPORATION yAMMONIUM LAC CRE 12% 63044040420 NNODUM PHARMACEUTICAL CORPORATION yAMMONIUM LAC LOT 12% 63044048409 NNODUM PHARMACEUTICAL CORPORATION yHEMATOGEN CAP 63044063119 NNODUM PHARMACEUTICAL CORPORATION yHEMATOGEN FA CAP 63044063217 NNODUM PHARMACEUTICAL CORPORATION yHEMATOGEN CAP FORTE 63044063321 NNODUM PHARMACEUTICAL CORPORATION yTRICON CAP 63044063510 NNODUM PHARMACEUTICAL CORPORATION yLOPRESS HCT TAB 50-25MG 00028003501 NOVARTIS yLOPRESSOR TAB 50MG 00028005101 NOVARTIS yLOPRESSOR TAB 50MG 00028005110 NOVARTIS yLOPRESS HCT TAB 100/25MG 00028005301 NOVARTIS yLOPRESSOR TAB 100MG 00028007101 NOVARTIS yLOPRESSOR TAB 100MG 00028007110 NOVARTIS yBRETHINE TAB 2.5MG 00028007201 NOVARTIS yBRETHINE TAB 2.5MG 00028007210 NOVARTIS yLOPRESS HCT TAB 100/50MG 00028007301 NOVARTIS yBRETHINE TAB 5MG 00028010501 NOVARTIS yBRETHINE TAB 5MG 00028010510 NOVARTIS yVOLTAREN-XR TAB 100MG 00028020501 NOVARTIS yVOLTAREN TAB 75MG EC 00028026401 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PARLODEL TAB 2.5MG 00078001705 NOVARTIS yPARLODEL TAB 2.5MG 00078001715 NOVARTIS yCAFERGOT SUP 2/100 00078003302 NOVARTIS yMETHERGINE INJ 0.2MG/ML 00078005303 NOVARTIS yMETHERGINE TAB 0.2MG 00078005405 NOVARTIS yFIORICET TAB 00078008405 NOVARTIS yFIORICET TAB 00078008408 NOVARTIS yPARLODEL CAP 5MG 00078010205 NOVARTIS yPARLODEL CAP 5MG 00078010215 NOVARTIS yFIORINAL CAP 00078010305 NOVARTIS yFIORINAL CAP 00078010308 NOVARTIS yFIORINAL/COD CAP 30MG 00078010705 NOVARTIS ySANDIMMUNE INJ 50MG/ML 00078010901 NOVARTIS ySANDIMMUNE SOL 100MG/ML 00078011022 NOVARTIS ySANDOGLOBULI INJ 6GM 00078012496 NOVARTIS yCLOZARIL TAB 25MG 00078012605 NOVARTIS yCLOZARIL TAB 25MG 00078012606 NOVARTIS yCLOZARIL TAB 100MG 00078012705 NOVARTIS yCLOZARIL TAB 100MG 00078012706 NOVARTIS yMIACALCIN INJ 200/ML 00078014923 NOVARTIS yLESCOL CAP 20MG 00078017605 NOVARTIS yLESCOL CAP 20MG 00078017615 NOVARTIS yLAMISIL TAB 250MG 00078017905 NOVARTIS yLAMISIL TAB 250MG 00078017915 NOVARTIS ySANDOSTATIN INJ 50MCG/ML 00078018001 NOVARTIS ySANDOSTATIN INJ 0.05MG/1 00078018003 NOVARTIS ySANDOSTATIN INJ 100MCG 00078018101 NOVARTIS ySANDOSTATIN INJ 0.1MG/ML 00078018103 NOVARTIS ySANDOSTATIN INJ 500MCG 00078018201 NOVARTIS ySANDOSTATIN INJ 0.5MG/ML 00078018203 NOVARTIS ySANDOSTATIN INJ 0.2MG/ML 00078018325 NOVARTIS ySANDOSTATIN INJ 1MG/ML 00078018425 NOVARTIS yLESCOL CAP 40MG 00078023405 NOVARTIS yLESCOL CAP 40MG 00078023415 NOVARTIS ySANDIMMUNE CAP 25MG 00078024015 NOVARTIS ySANDIMMUNE CAP 100MG 00078024115 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FIORICET/COD CAP 00078024305 NOVARTIS yNEORAL CAP 25MG 00078024615 NOVARTIS yNEORAL CAP 100MG 00078024815 NOVARTIS yFEMARA TAB 2.5MG 00078024915 NOVARTIS yNEORAL SOL 100MG/ML 00078027422 NOVARTIS yMIACALCIN SPR 200/ACT 00078031154 NOVARTIS yDIOVAN HCT TAB 80/12.5 00078031406 NOVARTIS yDIOVAN HCT TAB 80/12.5 00078031434 NOVARTIS yDIOVAN HCT TAB 160/12.5 00078031506 NOVARTIS yDIOVAN HCT TAB 160/12.5 00078031534 NOVARTIS yEXELON CAP 1.5MG 00078032306 NOVARTIS yEXELON CAP 1.5MG 00078032315 NOVARTIS yEXELON CAP 1.5MG 00078032344 NOVARTIS yEXELON CAP 3MG 00078032406 NOVARTIS yEXELON CAP 3MG 00078032415 NOVARTIS yEXELON CAP 3MG 00078032444 NOVARTIS yEXELON CAP 4.5MG 00078032506 NOVARTIS yEXELON CAP 4.5MG 00078032515 NOVARTIS yEXELON CAP 4.5MG 00078032544 NOVARTIS yEXELON CAP 6MG 00078032606 NOVARTIS yEXELON CAP 6MG 00078032615 NOVARTIS yEXELON CAP 6MG 00078032644 NOVARTIS yCOMTAN TAB 200MG 00078032705 NOVARTIS yLAMISIL SPR 1% 00078032882 NOVARTIS ySIMULECT INJ 20MG 00078033184 NOVARTIS yTRILEPTAL TAB 150MG 00078033605 NOVARTIS yTRILEPTAL TAB 150MG 00078033606 NOVARTIS yTRILEPTAL TAB 300MG 00078033705 NOVARTIS yTRILEPTAL TAB 300MG 00078033706 NOVARTIS yTRILEPTAL TAB 600MG 00078033805 NOVARTIS yTRILEPTAL TAB 600MG 00078033806 NOVARTIS yEXELON SOL 2MG/ML 00078033931 NOVARTIS ySANDOSTATIN KIT LAR 10MG 00078034061 NOVARTIS ySANDOSTATIN KIT LAR 10MG 00078034084 NOVARTIS ySANDOSTATIN KIT LAR 20MG 00078034161 NOVARTIS ySANDOSTATIN KIT LAR 20MG 00078034184 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SANDOSTATIN KIT LAR 30MG 00078034261 NOVARTIS ySANDOSTATIN KIT LAR 30MG 00078034284 NOVARTIS yVIVELLE-DOT DIS 0.0375MG 00078034342 NOVARTIS yVIVELLE-DOT DIS 0.0375MG 00078034345 NOVARTIS yVIVELLE-DOT DIS 0.0375MG 00078034362 NOVARTIS yVIVELLE-DOT DIS 0.05MG 00078034442 NOVARTIS yVIVELLE-DOT DIS 0.05MG 00078034445 NOVARTIS yVIVELLE-DOT DIS 0.05MG 00078034462 NOVARTIS yVIVELLE-DOT DIS 0.075MG 00078034542 NOVARTIS yVIVELLE-DOT DIS 0.075MG 00078034545 NOVARTIS yVIVELLE-DOT DIS 0.075MG 00078034562 NOVARTIS yVIVELLE-DOT DIS 0.1MG 00078034642 NOVARTIS yVIVELLE-DOT DIS 0.1MG 00078034645 NOVARTIS yVIVELLE-DOT DIS 0.1MG 00078034662 NOVARTIS yDESFERAL INJ 2GM 00078034751 NOVARTIS ySTARLIX TAB 60MG 00078035105 NOVARTIS ySTARLIX TAB 120MG 00078035205 NOVARTIS yLESCOL XL TAB 80MG 00078035405 NOVARTIS yLESCOL XL TAB 80MG 00078035415 NOVARTIS yZELNORM TAB 2MG 00078035580 NOVARTIS yZELNORM TAB 6MG 00078035680 NOVARTIS yTRILEPTAL SUS 300MG/5M 00078035752 NOVARTIS yDIOVAN TAB 80MG 00078035806 NOVARTIS yDIOVAN TAB 80MG 00078035834 NOVARTIS yDIOVAN TAB 160MG 00078035906 NOVARTIS yDIOVAN TAB 160MG 00078035934 NOVARTIS yDIOVAN TAB 320MG 00078036006 NOVARTIS yDIOVAN TAB 320MG 00078036034 NOVARTIS yLOTREL CAP 10-20MG 00078036405 NOVARTIS yVIVELLE-DOT DIS 0.025MG 00078036542 NOVARTIS yVIVELLE-DOT DIS 0.025MG 00078036545 NOVARTIS yFAMVIR TAB 125MG 00078036615 NOVARTIS yFAMVIR TAB 250MG 00078036715 NOVARTIS yFAMVIR TAB 500MG 00078036815 NOVARTIS yFAMVIR TAB 500MG 00078036864 NOVARTIS yRITALIN LA CAP 20MG 00078037005 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RITALIN LA CAP 30MG 00078037105 NOVARTIS yRITALIN LA CAP 40MG 00078037205 NOVARTIS yELIDEL CRE 1% 00078037546 NOVARTIS yELIDEL CRE 1% 00078037549 NOVARTIS yELIDEL CRE 1% 00078037563 NOVARTIS yDIOVAN TAB 40MG 00078037606 NOVARTIS yDIOVAN TAB 40MG 00078037615 NOVARTIS yCOMBIPATCH DIS .05/.14 00078037742 NOVARTIS yCOMBIPATCH DIS .05/.25 00078037842 NOVARTIS yLOTREL CAP 10-40MG 00078037905 NOVARTIS yFOCALIN TAB 2.5MG 00078038005 NOVARTIS yFOCALIN TAB 5MG 00078038105 NOVARTIS yFOCALIN TAB 10MG 00078038205 NOVARTIS yDIOVAN HCT TAB 160/25MG 00078038306 NOVARTIS yDIOVAN HCT TAB 160/25MG 00078038334 NOVARTIS yLOTREL CAP 5-40MG 00078038405 NOVARTIS yMYFORTIC TAB 180MG 00078038566 NOVARTIS yMYFORTIC TAB 360MG 00078038666 NOVARTIS yZOMETA INJ 4MG/5ML 00078038725 NOVARTIS ySIMULECT INJ 10MG 00078039361 NOVARTIS yLOPRESSOR INJ 5MG/5ML 00078040001 NOVARTIS yGLEEVEC TAB 100MG 00078040105 NOVARTIS yLOTREL CAP 2.5-10MG 00078040405 NOVARTIS yLOTREL CAP 5-10MG 00078040505 NOVARTIS yLOTREL CAP 5-20MG 00078040605 NOVARTIS ySTALEVO 50 TAB 00078040705 NOVARTIS ySTALEVO 100 TAB 00078040805 NOVARTIS ySTALEVO 150 TAB 00078040905 NOVARTIS yENABLEX TAB 7.5MG 00078041915 NOVARTIS yENABLEX TAB 7.5MG 00078041934 NOVARTIS yENABLEX TAB 15MG 00078042015 NOVARTIS yENABLEX TAB 15MG 00078042034 NOVARTIS yDIOVAN TAB 40MG 00078042306 NOVARTIS yDIOVAN TAB 40MG 00078042315 NOVARTIS yRITALIN LA CAP 10MG 00078042405 NOVARTIS yZELNORM TAB 6MG 00078042620 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FOCALIN XR CAP 5MG 00078043005 NOVARTIS yFOCALIN XR CAP 10MG 00078043105 NOVARTIS yFOCALIN XR CAP 20MG 00078043205 NOVARTIS yCATAFLAM TAB 50MG 00078043605 NOVARTIS yVISUDYNE INJ 15MG 00078043761 NOVARTIS yGLEEVEC TAB 400MG 00078043815 NOVARTIS yRITALIN TAB 5MG 00078043905 NOVARTIS yRITALIN TAB 10MG 00078044005 NOVARTIS yRITALIN TAB 20MG 00078044105 NOVARTIS yRITALIN SR TAB 20MG 00078044205 NOVARTIS yVOLTAREN-XR TAB 100MG 00078044605 NOVARTIS yLOTENSIN TAB 5MG 00078044705 NOVARTIS yLOTENSIN TAB 10MG 00078044805 NOVARTIS yLOTENSIN TAB 20MG 00078044905 NOVARTIS yLOTENSIN TAB 40MG 00078045005 NOVARTIS yLOTENSIN HCT TAB 5-6.25MG 00078045105 NOVARTIS yLOTENSIN HCT TAB 10-12.5 00078045205 NOVARTIS yLOTENSIN HCT TAB 20-12.5 00078045305 NOVARTIS yLOTENSIN HCT TAB 20-25MG 00078045405 NOVARTIS yLOPRESSOR TAB 50MG 00078045805 NOVARTIS yLOPRESSOR TAB 50MG 00078045809 NOVARTIS yLOPRESSOR TAB 100MG 00078045905 NOVARTIS yLOPRESSOR TAB 100MG 00078045909 NOVARTIS yLOPRESS HCT TAB 50-25MG 00078046005 NOVARTIS yLOPRESS HCT TAB 100/25MG 00078046105 NOVARTIS yLOPRESS HCT TAB 100/50MG 00078046205 NOVARTIS yAREDIA INJ 90MG 00078046461 NOVARTIS yEXJADE TAB 125MG 00078046815 NOVARTIS yEXJADE TAB 250MG 00078046915 NOVARTIS yEXJADE TAB 500MG 00078047015 NOVARTIS yDIOVAN HCT TAB 320/12.5 00078047134 NOVARTIS yDIOVAN HCT TAB 320/25MG 00078047234 NOVARTIS yZADITOR SOL 0.025%OP 00078047661 NOVARTIS yGENTEAL PF SOL 0.3% 00078047956 NOVARTIS yESTRADERM DIS 0.05MG 00078048042 NOVARTIS yESTRADERM DIS 0.1MG 00078048142 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FOCALIN XR CAP 15MG 00078049305 NOVARTIS yRITALIN TAB 10MG 00083000330 NOVARTIS yRITALIN TAB 5MG 00083000730 NOVARTIS yTEGRETOL SUS 100/5ML 00083001976 NOVARTIS yCYTADREN TAB 250MG 00083002430 NOVARTIS yTEGRETOL TAB 200MG 00083002730 NOVARTIS yTEGRETOL TAB 200MG 00083002732 NOVARTIS yTEGRETOL TAB 200MG 00083002740 NOVARTIS yRITALIN TAB 20MG 00083003430 NOVARTIS yTEGRETOL CHW 100MG 00083005230 NOVARTIS yTEGRETOL CHW 100MG 00083005232 NOVARTIS yLOTENSIN HCT TAB 5-6.25MG 00083005730 NOVARTIS yLOTENSIN TAB 5MG 00083005932 NOVARTIS yLOTENSIN TAB 5MG 00083005990 NOVARTIS yTEGRETOL XR TAB 400MG 00083006030 NOVARTIS yTEGRETOL XR TAB 100MG 00083006130 NOVARTIS yTEGRETOL XR TAB 200MG 00083006230 NOVARTIS yTEGRETOL XR TAB 200MG 00083006232 NOVARTIS yLOTENSIN TAB 10MG 00083006330 NOVARTIS yLOTENSIN TAB 10MG 00083006332 NOVARTIS yLOTENSIN TAB 10MG 00083006390 NOVARTIS yLOTENSIN HCT TAB 10-12.5 00083007230 NOVARTIS yLOTENSIN HCT TAB 20-12.5 00083007430 NOVARTIS yLOTENSIN HCT TAB 20-25MG 00083007530 NOVARTIS yLOTENSIN TAB 20MG 00083007930 NOVARTIS yLOTENSIN TAB 20MG 00083007932 NOVARTIS yLOTENSIN TAB 20MG 00083007990 NOVARTIS yLOTENSIN TAB 40MG 00083009430 NOVARTIS yLOTENSIN TAB 40MG 00083009432 NOVARTIS yLOTENSIN TAB 40MG 00083009490 NOVARTIS yLOTREL CAP 2.5-10MG 00083225530 NOVARTIS yLOTREL CAP 5-10MG 00083226030 NOVARTIS yLOTREL CAP 5-20MG 00083226530 NOVARTIS yESTRADERM DIS 0.05MG 00083231001 NOVARTIS yESTRADERM DIS 0.05MG 00083231008 NOVARTIS yESTRADERM DIS 0.05MG 00083231062 NOVARTIS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ESTRADERM DIS 0.1MG 00083232001 NOVARTIS yESTRADERM DIS 0.1MG 00083232008 NOVARTIS yESTRADERM DIS 0.1MG 00083232062 NOVARTIS yVIVELLE DIS 0.05MG 00083232601 NOVARTIS yVIVELLE DIS 0.1MG 00083232801 NOVARTIS yVIVELLE DIS 0.1MG 00083232808 NOVARTIS yAREDIA INJ 30MG 00083260104 NOVARTIS yAREDIA INJ 90MG 00083260901 NOVARTIS yDESFERAL INJ 500MG 00083380104 NOVARTIS yVOLTAREN SOL 0.1% OP 58768010002 NOVARTIS yVOLTAREN SOL 0.1% OP 58768010005 NOVARTIS yZADITOR SOL 0.025%OP 58768010205 NOVARTIS yHYPOTEARS SOL OP 58768013015 NOVARTIS yHYPOTEARS SOL OP 58768013030 NOVARTIS yHYPOTEARS PF SOL 58768013230 NOVARTIS yVISUDYNE INJ 15MG 58768015015 NOVARTIS yCARBASTAT SOL 0.01% OP 58768073512 NOVARTIS yMIOCHOL-E SOL 1:100 58768077352 NOVARTIS yMIOCHOL-E KIT 58768077353 NOVARTIS yTETRACAINE SOL 0.5% OP 58768078712 NOVARTIS yGENTEAL SOL OPTH 58768078815 NOVARTIS yGENTEAL SOL OPTH 58768078825 NOVARTIS yGENTEAL PF SOL 0.3% 58768078915 NOVARTIS yGENTEAL GEL 58768079035 NOVARTIS yGENTEAL GEL 58768079036 NOVARTIS yGENTEAL MILD DRO 0.2% 58768079115 NOVARTIS yGENTEAL MILD DRO 0.2% 58768079125 NOVARTIS yEX-LAX TAB 15MG 00067000308 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX TAB 15MG 00067000330 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX CHW 15MG 00067000518 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX CHW 15MG 00067000548 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX TAB MAX ST 00067001624 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX TAB MAX ST 00067001648 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX TAB MAX ST 00067001690 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX MILK SUS OF MAGNE 00067002712 NOVARTIS CONSUMER HEALTH, INC. yEX-LAX MILK SUS OF MAGNE 00067002912 NOVARTIS CONSUMER HEALTH, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GAS-X/MAALOX CHW EXTRA ST 00067013008 NOVARTIS CONSUMER HEALTH, INC. yGAS-X/MAALOX CHW EXTRA ST 00067013208 NOVARTIS CONSUMER HEALTH, INC. yGAS-X/MAALOX CHW EXTRA ST 00067013224 NOVARTIS CONSUMER HEALTH, INC. yGAS-X EX STR CAP 125MG 00067013410 NOVARTIS CONSUMER HEALTH, INC. yGAS-X EX STR CAP 125MG 00067013430 NOVARTIS CONSUMER HEALTH, INC. yGAS-X EX STR CAP 125MG 00067013450 NOVARTIS CONSUMER HEALTH, INC. yASCRIPTIN TAB MAX-STR 00067014350 NOVARTIS CONSUMER HEALTH, INC. yASCRIPTIN TAB MAX-STR 00067014385 NOVARTIS CONSUMER HEALTH, INC. yASCRIPTIN RS TAB 00067014910 NOVARTIS CONSUMER HEALTH, INC. yASCRIPTIN RS TAB 00067014922 NOVARTIS CONSUMER HEALTH, INC. yNICOTINE DIS 7MG/24HR 00067021307 NOVARTIS CONSUMER HEALTH, INC. yNICOTINE DIS 7MG/24HR 00067021314 NOVARTIS CONSUMER HEALTH, INC. yNICOTINE DIS 14MG/24H 00067021407 NOVARTIS CONSUMER HEALTH, INC. yNICOTINE DIS 21MG/24H 00067021507 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX CHW 1000-60 00067021965 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX CHW 1000-60 00067021990 NOVARTIS CONSUMER HEALTH, INC. yMAALOX REG SUS STRENGTH 00067022071 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX CHW 1000-60 00067022535 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX CHW 1000-60 00067022565 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX CHW 1000-60 00067022635 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX CHW 1000-60 00067022665 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX SUS WILD BRY 00067022812 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC LIQ SORE THR 00067023004 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC LIQ SORE THR 00067023008 NOVARTIS CONSUMER HEALTH, INC. yDOAN'S RS TAB 325MG 00067023188 NOVARTIS CONSUMER HEALTH, INC. yDOAN'S EX ST TAB 580MG 00067023688 NOVARTIS CONSUMER HEALTH, INC. yDOAN'S EX ST TAB 580MG 00067023689 NOVARTIS CONSUMER HEALTH, INC. yDOANS PM TAB 580/25MG 00067024617 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX SUS VANILLA 00067024712 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX SUS LEMON 00067025371 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX SUS CHERRY 00067025444 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX SUS CHERRY 00067025471 NOVARTIS CONSUMER HEALTH, INC. yMAALOX MAX SUS MINT 00067025671 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC CHW 00067029618 NOVARTIS CONSUMER HEALTH, INC. yMAALOX REG SUS STRENGTH 00067032844 NOVARTIS CONSUMER HEALTH, INC. yMAALOX REG SUS STRENGTH 00067032862 NOVARTIS CONSUMER HEALTH, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MAALOX REG SUS STRENGTH 00067032871 NOVARTIS CONSUMER HEALTH, INC. yMAALOX QUICK CHW DISSOLVE 00067036645 NOVARTIS CONSUMER HEALTH, INC. yMAALOX QUICK CHW DISSOLVE 00067037030 NOVARTIS CONSUMER HEALTH, INC. yMAALOX QUICK CHW DISSOLVE 00067037045 NOVARTIS CONSUMER HEALTH, INC. yMAALOX QUICK CHW DISSOLVE 00067037085 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC LIQ ALLERGY 00067056104 NOVARTIS CONSUMER HEALTH, INC. yDESENEX SHAK POW 2% 00067094915 NOVARTIS CONSUMER HEALTH, INC. yDESENEX SHAK POW 2% 00067094930 NOVARTIS CONSUMER HEALTH, INC. yDESENEX JOCK AER ITCH POW 00067095830 NOVARTIS CONSUMER HEALTH, INC. yDESENEX SPRY AER LIQUID 00067096935 NOVARTIS CONSUMER HEALTH, INC. yMYOFLEX CRE 10% 00067117002 NOVARTIS CONSUMER HEALTH, INC. yMYOFLEX CRE 10% 00067117004 NOVARTIS CONSUMER HEALTH, INC. yMYOFLEX CRE 10% 00067117016 NOVARTIS CONSUMER HEALTH, INC. yTAVIST TAB 1.34MG 00067119008 NOVARTIS CONSUMER HEALTH, INC. yTAVIST TAB 1.34MG 00067119016 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC DIS MENTHOL 00067120906 NOVARTIS CONSUMER HEALTH, INC. yLAMISIL AT CRE 1% 00067399842 NOVARTIS CONSUMER HEALTH, INC. yLAMISIL AT CRE 1% 00067399885 NOVARTIS CONSUMER HEALTH, INC. yLAMISIL AT CRE 1% 00067399942 NOVARTIS CONSUMER HEALTH, INC. yLAMISIL AT SPR 00067400001 NOVARTIS CONSUMER HEALTH, INC. yLAMISIL AT SPR 00067400101 NOVARTIS CONSUMER HEALTH, INC. yTRANSDERM-SC DIS 1.5MG 00067434504 NOVARTIS CONSUMER HEALTH, INC. yEQ NICOTINE DIS 7MG 00067482007 NOVARTIS CONSUMER HEALTH, INC. yNUPERCAINAL OIN 1% 00067581286 NOVARTIS CONSUMER HEALTH, INC. yNUPERCAINAL OIN 1% 00067581296 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC CHW 00067601418 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC CHW 00067601518 NOVARTIS CONSUMER HEALTH, INC. yPERDIEM OVER TAB 15MG 00067602560 NOVARTIS CONSUMER HEALTH, INC. yLORATADINE TAB 10MG 00067607030 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC LIQ CGH/NASL 00067608004 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC SYP 00067608104 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC SOL 00067608504 NOVARTIS CONSUMER HEALTH, INC. yTHERAFLU PAK 00067608706 NOVARTIS CONSUMER HEALTH, INC. yTHERAFLU POW 00067609206 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC LIQ NIGHT TM 00067610204 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC LIQ NIGHT TM 00067610208 NOVARTIS CONSUMER HEALTH, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MAALOX TOTAL SUS 525/15ML 00067610812 NOVARTIS CONSUMER HEALTH, INC. yMAALOX TOTAL SUS 525/15ML 00067610912 NOVARTIS CONSUMER HEALTH, INC. yALLERGY RELF TAB 10MG 00067611710 NOVARTIS CONSUMER HEALTH, INC. yALLERGY RELF TAB 10MG 00067611730 NOVARTIS CONSUMER HEALTH, INC. yTHERAFLU MIS COUGH 00067614612 NOVARTIS CONSUMER HEALTH, INC. yTERAFLU MIS 00067614712 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC MIS COUGH 00067614816 NOVARTIS CONSUMER HEALTH, INC. yTRIAMINIC MIS 00067614916 NOVARTIS CONSUMER HEALTH, INC. yESTRASORB EMU 66500032517 NOVAVAX, INC. yGYNODIOL TAB 1.5MG 00421015801 NOVAVAX, INC. (FORMERLY FIELDING) yGYNODIOL TAB 2MG 00421074801 NOVAVAX, INC. (FORMERLY FIELDING) yGYNODIOL TAB 0.5MG 00421076801 NOVAVAX, INC. (FORMERLY FIELDING) yGYNODIOL TAB 1MG 00421125901 NOVAVAX, INC. (FORMERLY FIELDING) yNESTABS CBF TAB 00421199701 NOVAVAX, INC. (FORMERLY FIELDING) yRELION R INJ 100U/ML 59060183318 NOVO NORDISK, INC. yRELION N INJ 100U/ML 59060183418 NOVO NORDISK, INC. yRELION 70/30 INJ 100U/ML 59060183718 NOVO NORDISK, INC. yRELION N INJ INNOLET 59060231440 NOVO NORDISK, INC. yPRANDIN TAB 0.5MG 00169008181 NOVO NORDISK, INC. yPRANDIN TAB 0.5MG 00169008183 NOVO NORDISK, INC. yPRANDIN TAB 1MG 00169008281 NOVO NORDISK, INC. yPRANDIN TAB 1MG 00169008283 NOVO NORDISK, INC. yPRANDIN TAB 2MG 00169008481 NOVO NORDISK, INC. yPRANDIN TAB 2MG 00169008483 NOVO NORDISK, INC. yNOVOLIN R INJ U-100 00169183311 NOVO NORDISK, INC. yNOVOLIN R INJ U-100 00169183317 NOVO NORDISK, INC. yRELION R INJ U-100 00169183318 NOVO NORDISK, INC. yNOVOLIN N INJ U-100 00169183411 NOVO NORDISK, INC. yNOVOLIN N INJ U-100 00169183417 NOVO NORDISK, INC. yRELION N INJ U-100 00169183418 NOVO NORDISK, INC. yNOVOLIN L INJ U-100 00169183511 NOVO NORDISK, INC. yNOVOLIN INJ 70/30 00169183711 NOVO NORDISK, INC. yNOVOLIN INJ 70/30 00169183717 NOVO NORDISK, INC. yRELION 70/30 INJ 70/30 00169183718 NOVO NORDISK, INC. yNOVOLIN R INJ INNOLET 00169231321 NOVO NORDISK, INC. yNOVOLIN N INJ INNOLET 00169231421 NOVO NORDISK, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NOVOLIN 70/ INJ 30 INNLT 00169231721 NOVO NORDISK, INC. yNOVOLOG INJ PENFILL 00169330312 NOVO NORDISK, INC. yNOVOLIN R INJ PENFILL 00169347318 NOVO NORDISK, INC. yNOVOLIN N INJ PENFILL 00169347418 NOVO NORDISK, INC. yNOVOLIN 70/ INJ 30 PNFIL 00169347718 NOVO NORDISK, INC. yNOVOLOG MIX INJ PENFILL 00169368213 NOVO NORDISK, INC. yNOVOLOG MIX INJ 70/30 00169368512 NOVO NORDISK, INC. yNOVOLOG MIX INJ FLEXPEN 00169369619 NOVO NORDISK, INC. yVAGIFEM TAB 25MCG 00169517303 NOVO NORDISK, INC. yVAGIFEM TAB 25MCG 00169517304 NOVO NORDISK, INC. yACTIVELLA TAB 1-0.5MG 00169517401 NOVO NORDISK, INC. yACTIVELLA TAB 1-0.5MG 00169517402 NOVO NORDISK, INC. yNOVOLOG INJ FLEXPEN 00169633910 NOVO NORDISK, INC. yNOVOSEVEN INJ 1200MCG 00169706001 NOVO NORDISK, INC. yNOVOSEVEN INJ 2400MCG 00169706101 NOVO NORDISK, INC. yNOVOSEVEN INJ 4800MCG 00169706201 NOVO NORDISK, INC. yNOVOLOG INJ 100/ML 00169750111 NOVO NORDISK, INC. yNORDITROPIN INJ 5/1.5ML 00169770411 NOVO NORDISK, INC. yNORDITROPIN INJ 15/1.5ML 00169770811 NOVO NORDISK, INC. yNORDITROPIN INJ 5/1.5ML 00169776811 NOVO NORDISK, INC. yNORDITROPIN INJ 15/1.5ML 00169777011 NOVO NORDISK, INC. yOCUSOFT LID SOL SCRUB 54799030100 OCUSOFT INC. yOCUSOFT LID SOL SCRUB 54799030180 OCUSOFT INC. yOCUSOFT LID PAD SCRUB 54799030190 OCUSOFT INC. yLID SCRUB KIT 54799030500 OCUSOFT INC. yCYLATE SOL 1% OP 54799050102 OCUSOFT INC. yCYLATE SOL 1% OP 54799050112 OCUSOFT INC. yTETRACAINE SOL 0.5% OP 54799050215 OCUSOFT INC. yTETRAVISC SOL 0.5% OP 54799050505 OCUSOFT INC. yGENTASOL SOL 0.3% OP 54799051005 OCUSOFT INC. yNEOCIN SOL OP 54799051105 OCUSOFT INC. yNEOCIN-PG SOL OP 54799051210 OCUSOFT INC. yTOBRASOL SOL 0.3% OP 54799051305 OCUSOFT INC. yPOLYCIN B OIN OP 54799051535 OCUSOFT INC. ySUPRED SOL 10-0.25% 54799051605 OCUSOFT INC. yPOLY-DEX OIN 0.1% OP 54799051935 OCUSOFT INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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POLY-DEX SUS 0.1% OP 54799052005 OCUSOFT INC. yDEXASOL SOL 0.1% OP 54799052505 OCUSOFT INC. yROMYCIN OIN OP 54799054035 OCUSOFT INC. yPREDNISOL SOL 1% OP 54799055010 OCUSOFT INC. yPREDNISOL SOL 1% OP 54799055012 OCUSOFT INC. ySULFAC SOL 10% OP 54799078215 OCUSOFT INC. yALLERSOL SOL 0.1% OP 54799086015 OCUSOFT INC. yTEARS AGAIN GEL NGHT/DAY 54799090335 OCUSOFT INC. yTEARS AGAIN SOL OP 54799090415 OCUSOFT INC. yTEARS AGAIN OIN OP 54799090435 OCUSOFT INC. yTEARS AGAIN SOL MC 54799090515 OCUSOFT INC. ySOCHLOR SOL 5% OP 54799092515 OCUSOFT INC. ySOD CHLORIDE OIN 5% OP 54799092635 OCUSOFT INC. yURECHOLINE TAB 5MG 65473069701 ODYSSEY PHARMACEUTICAL, INC. yURECHOLINE TAB 50MG 65473070001 ODYSSEY PHARMACEUTICAL, INC. yVIVACTIL TAB 5MG 65473070101 ODYSSEY PHARMACEUTICAL, INC. yVIVACTIL TAB 10MG 65473070201 ODYSSEY PHARMACEUTICAL, INC. yURECHOLINE TAB 10MG 65473070301 ODYSSEY PHARMACEUTICAL, INC. yURECHOLINE TAB 25MG 65473070401 ODYSSEY PHARMACEUTICAL, INC. yNYSTATIN TAB 100000 65473070509 ODYSSEY PHARMACEUTICAL, INC. yANTABUSE TAB 250MG 65473070601 ODYSSEY PHARMACEUTICAL, INC. yANTABUSE TAB 500MG 65473070701 ODYSSEY PHARMACEUTICAL, INC. ySURMONTIL CAP 25MG 65473071801 ODYSSEY PHARMACEUTICAL, INC. ySURMONTIL CAP 50MG 65473071901 ODYSSEY PHARMACEUTICAL, INC. ySURMONTIL CAP 100MG 65473072001 ODYSSEY PHARMACEUTICAL, INC. yVOSPIRE ER TAB 4MG 65473075401 ODYSSEY PHARMACEUTICAL, INC. yVOSPIRE ER TAB 8MG 65473075801 ODYSSEY PHARMACEUTICAL, INC. yALLERGY RELF SYP 5MG/5ML 51660020708 OHM PHARMACEUTICALS, INC. yARTHRTS PAIN TAB 650MG 51660033350 OHM PHARMACEUTICALS, INC. yALLERGY RELF TAB 10MG 51660052601 OHM PHARMACEUTICALS, INC. yALLERGY RELF TAB 10MG 51660052605 OHM PHARMACEUTICALS, INC. yALLERGY RELF TAB 10MG 51660052628 OHM PHARMACEUTICALS, INC. yALLERGY RELF TAB 10MG 51660052631 OHM PHARMACEUTICALS, INC. yALLERGY RELF TAB DECONGES 51660072401 OHM PHARMACEUTICALS, INC. yALLERGY RELF TAB DECONGES 51660072415 OHM PHARMACEUTICALS, INC. yCONTROLRX CRE 1.1% 48878310006 OMNII PRODUCTS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CAVIRINSE SOL 0.2% 48878322308 OMNII PRODUCTS yPERIO MED CON 0.63% 48878331500 OMNII PRODUCTS yPERIO MED CON 0.63% 48878331600 OMNII PRODUCTS yPERIO MED CON 0.63% 48878331700 OMNII PRODUCTS yCAVAREST GEL 1.1% 48878350102 OMNII PRODUCTS yCAVAREST GEL 1.1% 48878350202 OMNII PRODUCTS yJUST FOR KID GEL 0.4% GRP 48878402003 OMNII PRODUCTS yOMNII GEL 0.4% GRA 48878402103 OMNII PRODUCTS yOMNII GEL 0.4%RASP 48878403103 OMNII PRODUCTS yOMNII GEL 0.4%CINN 48878404103 OMNII PRODUCTS yOMNII GEL 0.4%NATU 48878405103 OMNII PRODUCTS yOMNII GEL 0.4%MINT 48878406103 OMNII PRODUCTS yJUST FOR KID GEL 0.4%BBGM 48878407003 OMNII PRODUCTS yJUST FOR KID GEL 0.4% FRT 48878408003 OMNII PRODUCTS yOPTASE GEL 16781011695 ONSET THERAPEUTICS yOPTICS MINI DRO 64108021212 OPTICS LABORATORY INC. yOPTICS MINI DRO 64108021213 OPTICS LABORATORY INC. yOPTICS EYE SOL 64108031111 OPTICS LABORATORY INC. yOPTICS EYE SOL 64108031112 OPTICS LABORATORY INC. yREMERON TAB 15MG 00052010530 ORGANON USA INC. yREMERON TAB 15MG 00052010590 ORGANON USA INC. yREMERON SLTB TAB 15MG 00052010630 ORGANON USA INC. yREMERON SLTB TAB 15MG 00052010693 ORGANON USA INC. yREMERON TAB 30MG 00052010730 ORGANON USA INC. yREMERON TAB 30MG 00052010790 ORGANON USA INC. yREMERON SLTB TAB 30MG 00052010830 ORGANON USA INC. yREMERON SLTB TAB 30MG 00052010893 ORGANON USA INC. yREMERON TAB 45MG 00052010930 ORGANON USA INC. yDESOGEN-28 TAB 00052026106 ORGANON USA INC. yDESOGEN-28 TAB 00052026148 ORGANON USA INC. yIMPLANON IMP 68MG 00052027201 ORGANON USA INC. yNUVARING MIS 00052027301 ORGANON USA INC. yNUVARING MIS 00052027303 ORGANON USA INC. yMIRCETTE TAB 28 DAY 00052028106 ORGANON USA INC. yCYCLESSA PAK 00052028306 ORGANON USA INC. yGANIRELIX AC INJ 00052030151 ORGANON USA INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FOLLISTIM AQ INJ 300UNIT 00052031301 ORGANON USA INC. yPREGNYL INJ 10000UNT 00052031510 ORGANON USA INC. yFOLLISTIM AQ INJ 600UNIT 00052031601 ORGANON USA INC. yFOLLISTIM AQ INJ 900UNIT 00052032601 ORGANON USA INC. yZEMURON INJ 10MG/ML 00052045015 ORGANON USA INC. yZEMURON INJ 10MG/ML 00052045016 ORGANON USA INC. yTICE BCG INJ 00052060202 ORGANON USA INC. yTICE BCG INJ 00052060302 ORGANON USA INC. yANTIZOL INJ 1GM/ML 62161000334 ORPHAN MEDICAL, INC. yCYSTADANE POW 62161000420 ORPHAN MEDICAL, INC. yXYREM SOL 500MG/ML 62161000820 ORPHAN MEDICAL, INC. yORTHOCLONE INJ OKT3 59676010101 ORTHO BIOTECH INC. yLEUSTATIN INJ 1MG/ML 59676020101 ORTHO BIOTECH INC. yPROCRIT INJ 2000/ML 59676030201 ORTHO BIOTECH INC. yPROCRIT INJ 2000/ML 59676030202 ORTHO BIOTECH INC. yPROCRIT INJ 3000/ML 59676030301 ORTHO BIOTECH INC. yPROCRIT INJ 3000/ML 59676030302 ORTHO BIOTECH INC. yPROCRIT INJ 4000/ML 59676030401 ORTHO BIOTECH INC. yPROCRIT INJ 4000/ML 59676030402 ORTHO BIOTECH INC. yPROCRIT INJ 10000/ML 59676031001 ORTHO BIOTECH INC. yPROCRIT INJ 10000/ML 59676031002 ORTHO BIOTECH INC. yPROCRIT INJ 10000/ML 59676031200 ORTHO BIOTECH INC. yPROCRIT INJ 10000/ML 59676031201 ORTHO BIOTECH INC. yPROCRIT INJ 20000/ML 59676032001 ORTHO BIOTECH INC. yPROCRIT INJ 40000/ML 59676034001 ORTHO BIOTECH INC. yPREZISTA TAB 300MG 59676056001 ORTHO BIOTECH INC. yRETIN-A LIQ 0.05% 00062007507 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A CRE 0.025% 00062016501 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A CRE 0.025% 00062016502 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A CRE 0.05% 00062017512 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A CRE 0.05% 00062017513 ORTHO PHARMACEUTICAL CORPORATION yRENOVA CRE 0.05% 00062018505 ORTHO PHARMACEUTICAL CORPORATION yRENOVA CRE 0.02% 00062018702 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A MICR GEL 0.1% 00062019002 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A MICR GEL 0.1% 00062019003 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A MICR GEL 0.1%PUMP 00062019011 ORTHO PHARMACEUTICAL CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RETIN-A MICR GEL 0.04% 00062020402 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A MICR GEL 0.04% 00062020403 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A MICR GEL 0.04%PMP 00062020411 ORTHO PHARMACEUTICAL CORPORATION yGRIFULVIN V SUS 125/5ML 00062020604 ORTHO PHARMACEUTICAL CORPORATION yGRIFULVIN V TAB 500MG 00062021460 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A CRE 0.1% 00062027501 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A CRE 0.1% 00062027523 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A GEL 0.025% 00062047542 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A GEL 0.025% 00062047545 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A GEL 0.01% 00062057544 ORTHO PHARMACEUTICAL CORPORATION yRETIN-A GEL 0.01% 00062057546 ORTHO PHARMACEUTICAL CORPORATION yORTHO TRI-CY TAB LO 00062125115 ORTHO PHARMACEUTICAL CORPORATION yORTHO TRI-CY TAB LO 00062125120 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 1/50-28 00062133215 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 1/50-28 00062133220 ORTHO PHARMACEUTICAL CORPORATION yORTHO MICRON TAB DIALPAK 00062141116 ORTHO PHARMACEUTICAL CORPORATION yFLOXIN TAB 300MG 00062154102 ORTHO PHARMACEUTICAL CORPORATION yCENTANY OIN 2% 00062161001 ORTHO PHARMACEUTICAL CORPORATION yCENTANY OIN 2% 00062161003 ORTHO PHARMACEUTICAL CORPORATION yERTACZO CRE 2% 00062165002 ORTHO PHARMACEUTICAL CORPORATION yERTACZO CRE 2% 00062165003 ORTHO PHARMACEUTICAL CORPORATION yMODICON TAB 0.5/35 00062171415 ORTHO PHARMACEUTICAL CORPORATION yMODICON TAB .5/35-28 00062171420 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 1/35-28 00062176115 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 1/35-28 00062176120 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 1/35-28 00062176121 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 7/7/7-28 00062178115 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 7/7/7-28 00062178120 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 7/7/7-28 00062178122 ORTHO PHARMACEUTICAL CORPORATION yORTHO-NOVUM TAB 7/7/7-28 00062178131 ORTHO PHARMACEUTICAL CORPORATION yORTHO-CEPT TAB 28 00062179615 ORTHO PHARMACEUTICAL CORPORATION yORTHO-CEPT TAB 28 00062179620 ORTHO PHARMACEUTICAL CORPORATION yORTHO-CYCLEN TAB 0.25/35 00062190115 ORTHO PHARMACEUTICAL CORPORATION yORTHO-CYCLEN TAB 0.25/35 00062190120 ORTHO PHARMACEUTICAL CORPORATION yORTHO TRI- TAB CYCLEN 00062190315 ORTHO PHARMACEUTICAL CORPORATION yORTHO TRI- TAB CYCLEN 00062190320 ORTHO PHARMACEUTICAL CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ORTHO EVRA DIS WEEK 00062192001 ORTHO PHARMACEUTICAL CORPORATION yORTHO EVRA DIS WEEK 00062192015 ORTHO PHARMACEUTICAL CORPORATION yAXERT TAB 6.25MG 00062208006 ORTHO PHARMACEUTICAL CORPORATION yAXERT TAB 12.5MG 00062208506 ORTHO PHARMACEUTICAL CORPORATION yAXERT TAB 12.5MG 00062208512 ORTHO PHARMACEUTICAL CORPORATION yDELFEN AER STARTER 00062313301 ORTHO PHARMACEUTICAL CORPORATION yDELFEN AER STARTER 00062313302 ORTHO PHARMACEUTICAL CORPORATION yDELFEN AER STARTER 00062313304 ORTHO PHARMACEUTICAL CORPORATION yGYNOL II GEL 2% 00062318011 ORTHO PHARMACEUTICAL CORPORATION yGYNOL II GEL 2% 00062318012 ORTHO PHARMACEUTICAL CORPORATION yGYNOL II GEL 2% 00062318013 ORTHO PHARMACEUTICAL CORPORATION yGYNOL II GEL 3% X-STR 00062318501 ORTHO PHARMACEUTICAL CORPORATION yCONCEPTROL GEL 4% 00062325001 ORTHO PHARMACEUTICAL CORPORATION yCONCEPTROL GEL 4% 00062325002 ORTHO PHARMACEUTICAL CORPORATION yCONCEPTROL GEL 4% 00062325004 ORTHO PHARMACEUTICAL CORPORATION yTERAZOL 7 CRE 0.4% 00062535001 ORTHO PHARMACEUTICAL CORPORATION yTERAZOL 7 CRE 0.4% 00062535004 ORTHO PHARMACEUTICAL CORPORATION yTERAZOL 3 SUP 80MG 00062535101 ORTHO PHARMACEUTICAL CORPORATION yTERAZOL 3 CRE 0.8% 00062535601 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 3 CRE 4% 00062540101 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 KIT 00062542201 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 KIT 00062542202 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 CRE 2% 00062542601 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 CRE 2% 00062542602 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 CRE 2% 00062542605 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 CRE 2% 00062542636 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 SUP 100MG 00062542701 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 7 SUP 100MG 00062542705 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 3 KIT COMBINAT 00062543001 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 3 KIT COMBINAT 00062543002 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 3 KIT COMBINAT 00062543004 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT 3 KIT COMBINAT 00062543005 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT CRE DERM 2% 00062543401 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT CRE DERM 2% 00062543402 ORTHO PHARMACEUTICAL CORPORATION yMONISTAT CRE DERM 2% 00062543403 ORTHO PHARMACEUTICAL CORPORATION ySPECTAZOLE CRE 1% 00062546001 ORTHO PHARMACEUTICAL CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SPECTAZOLE CRE 1% 00062546002 ORTHO PHARMACEUTICAL CORPORATION ySPECTAZOLE CRE 1% 00062546003 ORTHO PHARMACEUTICAL CORPORATION yANTARA CAP 43MG 67707004330 OSCIENT PHARMACEUTICALS CORPORATION yANTARA CAP 130MG 67707013030 OSCIENT PHARMACEUTICALS CORPORATION yFACTIVE TAB 320MG 67707032005 OSCIENT PHARMACEUTICALS CORPORATION yFACTIVE TAB 320MG 67707032007 OSCIENT PHARMACEUTICALS CORPORATION yABILIFY TAB 2MG 59148000613 OTSUKA AMERICA yABILIFY TAB 2MG 59148000635 OTSUKA AMERICA yABILIFY TAB 5MG 59148000713 OTSUKA AMERICA yABILIFY TAB 5MG 59148000735 OTSUKA AMERICA yABILIFY TAB 10MG 59148000813 OTSUKA AMERICA yABILIFY TAB 10MG 59148000835 OTSUKA AMERICA yABILIFY TAB 15MG 59148000913 OTSUKA AMERICA yABILIFY TAB 15MG 59148000935 OTSUKA AMERICA yABILIFY TAB 20MG 59148001013 OTSUKA AMERICA yABILIFY TAB 20MG 59148001035 OTSUKA AMERICA yABILIFY TAB 30MG 59148001113 OTSUKA AMERICA yABILIFY TAB 30MG 59148001135 OTSUKA AMERICA yABILIFY SOL 1MG/ML 59148001215 OTSUKA AMERICA yABILIFY SOL 1MG/ML 59148001315 OTSUKA AMERICA yABILIFY DISC TAB 10MG 59148064023 OTSUKA AMERICA yABILIFY DISC TAB 15MG 59148064123 OTSUKA AMERICA yDESOXYN TAB 5MG 67386010201 OVATION PHARMACEUTICALS, INC. yNEOPROFEN SOL 10MG/ML 67386012252 OVATION PHARMACEUTICALS, INC. yCHEMET CAP 100MG 67386020111 OVATION PHARMACEUTICALS, INC. yTRANXENE T TAB 3.75MG 67386030101 OVATION PHARMACEUTICALS, INC. yTRANXENE T TAB 7.5MG 67386030201 OVATION PHARMACEUTICALS, INC. yTRANXENE T TAB 7.5MG 67386030205 OVATION PHARMACEUTICALS, INC. yTRANXENE T TAB 15MG 67386030301 OVATION PHARMACEUTICALS, INC. yTRANXENE-SD TAB 11.25MG 67386040401 OVATION PHARMACEUTICALS, INC. yTRANXENE-SD TAB 22.5MG 67386040501 OVATION PHARMACEUTICALS, INC. yELSPAR INJ 10000UNT 67386041151 OVATION PHARMACEUTICALS, INC. yNEMBUTAL INJ 50MG/ML 67386050155 OVATION PHARMACEUTICALS, INC. yINDOCIN IV INJ 1MG 67386051151 OVATION PHARMACEUTICALS, INC. yPEGANONE TAB 250MG 67386060101 OVATION PHARMACEUTICALS, INC. yCOGENTIN INJ 1MG/ML 67386061152 OVATION PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PANHEMATIN INJ 313MG 67386070154 OVATION PHARMACEUTICALS, INC. yMEBARAL TAB 32MG 67386080102 OVATION PHARMACEUTICALS, INC. yMEBARAL TAB 50MG 67386080202 OVATION PHARMACEUTICALS, INC. yMEBARAL TAB 100MG 67386080302 OVATION PHARMACEUTICALS, INC. yCOSMEGEN INJ 0.5MG 67386081155 OVATION PHARMACEUTICALS, INC. yMUSTARGEN INJ 10MG 67386091151 OVATION PHARMACEUTICALS, INC. yLEVOBUNOLOL SOL 0.5% OP 60758006005 PACIFIC PHARMA yLEVOBUNOLOL SOL 0.5% OP 60758006010 PACIFIC PHARMA yLEVOBUNOLOL SOL 0.5% OP 60758006015 PACIFIC PHARMA yLEVOBUNOLOL SOL 0.25% OP 60758006305 PACIFIC PHARMA yLEVOBUNOLOL SOL 0.25% OP 60758006310 PACIFIC PHARMA yDIPIVEFRIN SOL 0.1% OP 60758008705 PACIFIC PHARMA yDIPIVEFRIN SOL 0.1% OP 60758008710 PACIFIC PHARMA yDIPIVEFRIN SOL 0.1% OP 60758008715 PACIFIC PHARMA yPREDNISOLONE SUS 1% OP 60758011905 PACIFIC PHARMA yPREDNISOLONE SUS 1% OP 60758011910 PACIFIC PHARMA yPREDNISOLONE SUS 1% OP 60758011915 PACIFIC PHARMA yCROMOLYN SOD SOL 4% OP 60758045810 PACIFIC PHARMA yTIMOLOL MAL SOL 0.5% OP 60758080105 PACIFIC PHARMA yTIMOLOL MAL SOL 0.5% OP 60758080110 PACIFIC PHARMA yTIMOLOL MAL SOL 0.5% OP 60758080115 PACIFIC PHARMA yTIMOLOL MAL SOL 0.25% OP 60758080205 PACIFIC PHARMA yTIMOLOL MAL SOL 0.25% OP 60758080210 PACIFIC PHARMA yTIMOLOL MAL SOL 0.25% OP 60758080215 PACIFIC PHARMA yBRIMONIDINE SOL 0.2% OP 60758086605 PACIFIC PHARMA yBRIMONIDINE SOL 0.2% OP 60758086610 PACIFIC PHARMA yBRIMONIDINE SOL 0.2% OP 60758086615 PACIFIC PHARMA yFLUOROMETHOL SUS 0.1% OP 60758088005 PACIFIC PHARMA yFLUOROMETHOL SUS 0.1% OP 60758088010 PACIFIC PHARMA yFLUOROMETHOL SUS 0.1% OP 60758088015 PACIFIC PHARMA yFLURBIPROFEN SOL 0.03% OP 60758091003 PACIFIC PHARMA yOFLOXACIN SOL 0.3% 60758092905 PACIFIC PHARMA yOFLOXACIN SOL 0.3% 60758092910 PACIFIC PHARMA yRONDEX-DM DRO 16571005030 PACK PHARMACEUTICALS, L.L.C. yRONDEX-DM SYP 16571005116 PACK PHARMACEUTICALS, L.L.C. yRONDEX SYP 16571006104 PACK PHARMACEUTICALS, L.L.C. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RONDEX SYP 16571006116 PACK PHARMACEUTICALS, L.L.C. yASPIRIN TAB 325MG EC 00574000201 PADDOCK LABORATORIES, INC. yASPIRIN TAB 325MG EC 00574000211 PADDOCK LABORATORIES, INC. yBISACODYL TAB 5MG EC 00574000401 PADDOCK LABORATORIES, INC. yBISACODYL TAB 5MG EC 00574000411 PADDOCK LABORATORIES, INC. yIPECAC SYP 00574001201 PADDOCK LABORATORIES, INC. yMILK OF MAGN SUS 00574001816 PADDOCK LABORATORIES, INC. yMILK OF MAGN SUS 00574001832 PADDOCK LABORATORIES, INC. yAQUABASE OIN 00574003016 PADDOCK LABORATORIES, INC. yLANOLIN ANHY OIN 00574004316 PADDOCK LABORATORIES, INC. yHYDROCREAM CRE 00574005216 PADDOCK LABORATORIES, INC. yISOP ALCOHOL SOL 99% 00574006610 PADDOCK LABORATORIES, INC. yISOP ALCOHOL SOL 99% 00574006616 PADDOCK LABORATORIES, INC. yISOP ALCOHOL SOL /WG 70% 00574006710 PADDOCK LABORATORIES, INC. yISOP ALCOHOL SOL /WG 70% 00574006716 PADDOCK LABORATORIES, INC. yGLUTOSE GEL 40% 00574006930 PADDOCK LABORATORIES, INC. yGLUTOSE GEL 40% 00574006945 PADDOCK LABORATORIES, INC. yGLUTOSE 15 GEL 40% 00574007030 PADDOCK LABORATORIES, INC. yDERMABASE CRE 00574007116 PADDOCK LABORATORIES, INC. yPROPYLENE GL SOL 00574007210 PADDOCK LABORATORIES, INC. yPROPYLENE GL SOL 00574007216 PADDOCK LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 00574010101 PADDOCK LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 00574010110 PADDOCK LABORATORIES, INC. yDOCUSATE SOD CAP 250MG 00574010201 PADDOCK LABORATORIES, INC. yDOCUSATE SOD CAP 250MG 00574010210 PADDOCK LABORATORIES, INC. yCLOTRIMAZOLE LOZ 10MG 00574010714 PADDOCK LABORATORIES, INC. yCLOTRIMAZOLE LOZ 10MG 00574010770 PADDOCK LABORATORIES, INC. yMOEXIPRIL TAB 7.5MG 00574011001 PADDOCK LABORATORIES, INC. yMOEXIPRIL TAB 15MG 00574011215 PADDOCK LABORATORIES, INC. yFLAVOXATE TAB 100MG 00574011501 PADDOCK LABORATORIES, INC. yACTIDOSE/SOR LIQ 25/120ML 00574012004 PADDOCK LABORATORIES, INC. yACTIDOSE/SOR LIQ 50/240ML 00574012008 PADDOCK LABORATORIES, INC. yACTIDOSE/SOR LIQ 25/120ML 00574012074 PADDOCK LABORATORIES, INC. yACTIDOSE/SOR LIQ 50/240ML 00574012076 PADDOCK LABORATORIES, INC. yACTIDOSE-AQ LIQ 25/120ML 00574012104 PADDOCK LABORATORIES, INC. yACTIDOSE-AQ LIQ 50/240ML 00574012108 PADDOCK LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACTIDOSE-AQ LIQ 15/72ML 00574012125 PADDOCK LABORATORIES, INC. yACTIDOSE-AQ LIQ 25/120ML 00574012174 PADDOCK LABORATORIES, INC. yACTIDOSE-AQ LIQ 50/240ML 00574012176 PADDOCK LABORATORIES, INC. yEZ CHAR SUS PELLETS 00574012225 PADDOCK LABORATORIES, INC. yPRED SOD PHO LIQ 6.7/5ML 00574014804 PADDOCK LABORATORIES, INC. yMIDAZOLAM SYP 2MG/ML 00574015004 PADDOCK LABORATORIES, INC. yCAFFEINE CIT SOL 20MG/ML 00574015210 PADDOCK LABORATORIES, INC. ySORBITOL SOL 70% 00574016810 PADDOCK LABORATORIES, INC. ySORBITOL SOL 70% 00574016816 PADDOCK LABORATORIES, INC. yGLYCERIN LIQ 00574017810 PADDOCK LABORATORIES, INC. yORA-SWEET SF SYP 00574030216 PADDOCK LABORATORIES, INC. yORA-PLUS LIQ 00574030316 PADDOCK LABORATORIES, INC. yORA-SWEET SYP 00574030416 PADDOCK LABORATORIES, INC. yLIQUADERM-A LIQ 00574030502 PADDOCK LABORATORIES, INC. ySUSPENDOL-S LIQ 00574030716 PADDOCK LABORATORIES, INC. yFATTIBASE OIN 00574030805 PADDOCK LABORATORIES, INC. yFATTIBASE OIN 00574030816 PADDOCK LABORATORIES, INC. yPOLYBASE OIN 00574030905 PADDOCK LABORATORIES, INC. yPOLYBASE OIN 00574030916 PADDOCK LABORATORIES, INC. yPOLYETH GLYC LIQ 400 00574031010 PADDOCK LABORATORIES, INC. yPOLYETH GLYC LIQ 400 00574031016 PADDOCK LABORATORIES, INC. yORA-BLEND SUS CTRS/BRY 00574031116 PADDOCK LABORATORIES, INC. yORA-BLEND SF SUS CTRS/BRY 00574031216 PADDOCK LABORATORIES, INC. yNYSTATIN POW 00574040402 PADDOCK LABORATORIES, INC. yNYSTATIN POW 00574040405 PADDOCK LABORATORIES, INC. yNYSTATIN POW 00574040415 PADDOCK LABORATORIES, INC. yNYSTATIN POW 00574040450 PADDOCK LABORATORIES, INC. yDEXAMETH SOD POW PHOSPHAT 00574040805 PADDOCK LABORATORIES, INC. yDEXAMETH SOD POW PHOSPHAT 00574040810 PADDOCK LABORATORIES, INC. yPOLYETH GLYC POW 3350 NF 00574041202 PADDOCK LABORATORIES, INC. yPOLYETH GLYC POW 3350 NF 00574041205 PADDOCK LABORATORIES, INC. yCOLISTIN SUL POW 00574041701 PADDOCK LABORATORIES, INC. yHYDROCORT POW 00574042001 PADDOCK LABORATORIES, INC. yHYDROCORT POW 00574042010 PADDOCK LABORATORIES, INC. yHYDROCORT POW 00574042025 PADDOCK LABORATORIES, INC. yHYDROCORT AC POW 00574042101 PADDOCK LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCORT AC POW 00574042125 PADDOCK LABORATORIES, INC. yPROGESTERONE POW MICRONIZ 00574043000 PADDOCK LABORATORIES, INC. yPROGESTERONE POW MICRONIZ 00574043001 PADDOCK LABORATORIES, INC. yPROGESTERONE POW MICRONIZ 00574043025 PADDOCK LABORATORIES, INC. yPROGESTERONE POW WETTABLE 00574043100 PADDOCK LABORATORIES, INC. yPROGESTERONE POW WETTABLE 00574043101 PADDOCK LABORATORIES, INC. yPROGESTERONE POW WETTABLE 00574043125 PADDOCK LABORATORIES, INC. yPROGESTERONE POW 00574043200 PADDOCK LABORATORIES, INC. yTRIAMCINOLON POW ACETONID 00574045005 PADDOCK LABORATORIES, INC. yTRIAMCINOLON POW ACETONID 00574045010 PADDOCK LABORATORIES, INC. yTESTOSTERONE POW 00574046005 PADDOCK LABORATORIES, INC. yTESTOSTERONE POW 00574046025 PADDOCK LABORATORIES, INC. yTESTOST PROP POW 00574046105 PADDOCK LABORATORIES, INC. yTESTOST PROP POW 00574046125 PADDOCK LABORATORIES, INC. yBETAMETH VAL POW 00574048010 PADDOCK LABORATORIES, INC. yACACIA POW 00574051004 PADDOCK LABORATORIES, INC. y5-AMINOSALIC POW ACID 00574051501 PADDOCK LABORATORIES, INC. yANTHRALIN POW 00574052525 PADDOCK LABORATORIES, INC. yBENTONITE POW 00574053016 PADDOCK LABORATORIES, INC. yBENZOCAINE POW 00574053501 PADDOCK LABORATORIES, INC. yCITRIC ACID GRA ANHYDROU 00574055516 PADDOCK LABORATORIES, INC. yCOLLODION LIQ FLEXIBLE 00574056004 PADDOCK LABORATORIES, INC. yCOLLODION FL LIQ 00574056016 PADDOCK LABORATORIES, INC. yDEXTROSE POW ANHYDROU 00574057516 PADDOCK LABORATORIES, INC. yFRUCTOSE POW 00574058016 PADDOCK LABORATORIES, INC. yINDOMETHACIN POW 00574059001 PADDOCK LABORATORIES, INC. yPODOPHYLLIN POW 00574060001 PADDOCK LABORATORIES, INC. yPODOPHYLLIN POW 00574060025 PADDOCK LABORATORIES, INC. yPODOCON SOL 25% 00574060115 PADDOCK LABORATORIES, INC. yKAOLIN POW 00574060516 PADDOCK LABORATORIES, INC. yLACTOSE POW HYDROUS 00574060916 PADDOCK LABORATORIES, INC. yPODOFILOX SOL 0.5% 00574061105 PADDOCK LABORATORIES, INC. yLIDOCAINE POW 00574061325 PADDOCK LABORATORIES, INC. yLIDOCAINE POW 00574061725 PADDOCK LABORATORIES, INC. yMINERAL OIL 00574061816 PADDOCK LABORATORIES, INC. yDL-MENTHOL CRY 00574062225 PADDOCK LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METHYLCELLUL POW 00574062716 PADDOCK LABORATORIES, INC. yMETRONIDAZOL POW 00574062901 PADDOCK LABORATORIES, INC. yMONOCHLOROAC POW 00574063216 PADDOCK LABORATORIES, INC. yPHENOL LIQ 00574064016 PADDOCK LABORATORIES, INC. ySALICYLIC AC POW 00574065016 PADDOCK LABORATORIES, INC. ySILICA GEL 00574065201 PADDOCK LABORATORIES, INC. ySILVER NITR CRY 00574065325 PADDOCK LABORATORIES, INC. ySULFUR POW 00574066616 PADDOCK LABORATORIES, INC. yPOTASH POW SULFURAT 00574067016 PADDOCK LABORATORIES, INC. yTRICHLOROACE CRY ACID 00574067704 PADDOCK LABORATORIES, INC. yTRICHLOROACE CRY ACID 00574067716 PADDOCK LABORATORIES, INC. yPOLYSORBATE LIQ 80 00574068116 PADDOCK LABORATORIES, INC. yUREA POW 00574068416 PADDOCK LABORATORIES, INC. yZINC OXIDE POW 00574069016 PADDOCK LABORATORIES, INC. yCAFFEINE CIT INJ 20MG/ML 00574082301 PADDOCK LABORATORIES, INC. yPROMETHAZINE INJ 25MG/ML 00574083625 PADDOCK LABORATORIES, INC. yDIHYDROERGOT INJ 1MG/ML 00574085005 PADDOCK LABORATORIES, INC. yDIHYDROERGOT INJ 1MG/ML 00574085010 PADDOCK LABORATORIES, INC. yNOREPINEPHR INJ 1MG/ML 00574085410 PADDOCK LABORATORIES, INC. yCOLISTIMETH INJ 150MG 00574085801 PADDOCK LABORATORIES, INC. yESMOLOL HCL INJ 10MG/ML 00574086201 PADDOCK LABORATORIES, INC. yCYCLOSPORINE INJ 50MG/ML 00574086610 PADDOCK LABORATORIES, INC. yPOLYETH GLYC OIN 1000 00574100001 PADDOCK LABORATORIES, INC. yLIQUA-GEL GEL 00574192110 PADDOCK LABORATORIES, INC. yLIQUA-GEL GEL 00574192116 PADDOCK LABORATORIES, INC. yGLUTOL SOL 00574195906 PADDOCK LABORATORIES, INC. yKIONEX POW USP 00574200416 PADDOCK LABORATORIES, INC. yMORPHINE POW SULFATE 00574200625 PADDOCK LABORATORIES, INC. yNYSTOP POW 100000 00574200802 PADDOCK LABORATORIES, INC. yNYSTOP POW 100000 00574200815 PADDOCK LABORATORIES, INC. yNYSTOP POW 100000 00574200830 PADDOCK LABORATORIES, INC. yHYDROMORPHON POW HCL 00574201701 PADDOCK LABORATORIES, INC. yCOLOCORT ENE 100MG 00574202001 PADDOCK LABORATORIES, INC. yCOLOCORT ENE 100MG 00574202007 PADDOCK LABORATORIES, INC. yLACCREAM CRE 12% 00574212128 PADDOCK LABORATORIES, INC. yLACCREAM CRE 12% 00574212138 PADDOCK LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CASTOR OIL 95% 00574331202 PADDOCK LABORATORIES, INC. yPOLYETH GLYC OIN 3350 00574335001 PADDOCK LABORATORIES, INC. yASPIRIN SUP 300MG 00574703412 PADDOCK LABORATORIES, INC. yASPIRIN SUP 600MG 00574703612 PADDOCK LABORATORIES, INC. yBELLA/OPIUM SUP 00574704012 PADDOCK LABORATORIES, INC. yBELLADONNA & SUP OPIUM 00574704512 PADDOCK LABORATORIES, INC. yBISACODYL SUP 10MG 00574705012 PADDOCK LABORATORIES, INC. yBISACODYL SUP 10MG 00574705050 PADDOCK LABORATORIES, INC. yHYDROCORT AC SUP 25MG 00574709012 PADDOCK LABORATORIES, INC. yHYDROCORT AC SUP 30MG 00574709312 PADDOCK LABORATORIES, INC. yMORPHINE SUL SUP 5MG 00574711012 PADDOCK LABORATORIES, INC. yMORPHINE SUL SUP 10MG 00574711212 PADDOCK LABORATORIES, INC. yMORPHINE SUL SUP 20MG 00574711412 PADDOCK LABORATORIES, INC. yMORPHINE SUL SUP 30MG 00574711612 PADDOCK LABORATORIES, INC. yTRIMETHOBENZ SUP 100MG 00574722010 PADDOCK LABORATORIES, INC. yTRIMETHOBENZ SUP 200MG 00574722210 PADDOCK LABORATORIES, INC. yTRIMETHOBENZ SUP 200MG 00574722250 PADDOCK LABORATORIES, INC. yHYDROMORPHON SUP 3MG 00574722406 PADDOCK LABORATORIES, INC. yCOMPRO SUP 25MG 00574722612 PADDOCK LABORATORIES, INC. yPHENADOZ SUP 25MG 00574723412 PADDOCK LABORATORIES, INC. yPHENADOZ SUP 12.5MG 00574723612 PADDOCK LABORATORIES, INC. yPOLYETH GLYC OIN 8000 00574800001 PADDOCK LABORATORIES, INC. yBENZOIN CMPD TIN 00574911902 PADDOCK LABORATORIES, INC. yZINCATE CAP 220MG 00574916701 PADDOCK LABORATORIES, INC. yZINCATE CAP 220MG 00574916710 PADDOCK LABORATORIES, INC. yPANLOR DC CAP 00525001601 PAMLAB, LLC yPANLOR SS TAB 00525003201 PAMLAB, LLC yPANLOR SS TAB 00525003205 PAMLAB, LLC yPANLOR SS TAB 00525003210 PAMLAB, LLC yPANFIL-G SYP 00525037616 PAMLAB, LLC yDEPLIN TAB 7.5MG 00525041030 PAMLAB, LLC yDEPLIN TAB 7.5MG 00525041090 PAMLAB, LLC yCEREFOLIN TAB 00525050390 PAMLAB, LLC yCEREFOLIN TAB NAC 00525051090 PAMLAB, LLC yPANNAZ S SYP 00525078116 PAMLAB, LLC yPANNAZ TAB 00525088001 PAMLAB, LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FOLTX TAB 00525090690 PAMLAB, LLC yPANCOF XP SYP 00525111440 PAMLAB, LLC yPANCOF HC SYP 00525117540 PAMLAB, LLC yDIATX ZN TAB 00525428190 PAMLAB, LLC yPALGIC D TAB 8-80MG 00525613101 PAMLAB, LLC yPALGIC DS SYP 2-25MG/5 00525643516 PAMLAB, LLC yPALGIC TAB 4MG 00525674801 PAMLAB, LLC yPALGIC TAB 4MG 00525674805 PAMLAB, LLC yPALGIC LIQ 4MG/5ML 00525675216 PAMLAB, LLC yMETANX TAB 00525801990 PAMLAB, LLC yPANCOF PD SYP 00525988804 PAMLAB, LLC yISOSORB DIN TAB 30MG 49884000901 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 30MG 49884000910 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 5MG 49884002001 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 5MG 49884002010 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 10MG 49884002101 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 10MG 49884002110 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 20MG 49884002201 PAR PHARMACEUTICAL, INC yISOSORB DIN TAB 20MG 49884002210 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 25MG 49884002701 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 25MG 49884002710 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 50MG 49884002801 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 50MG 49884002810 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 10MG 49884002901 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 10MG 49884002910 PAR PHARMACEUTICAL, INC yTRANYLCYPROM TAB 10MG 49884003201 PAR PHARMACEUTICAL, INC yMECLIZINE TAB 12.5MG 49884003401 PAR PHARMACEUTICAL, INC yMECLIZINE TAB 12.5MG 49884003410 PAR PHARMACEUTICAL, INC yMECLIZINE TAB 25MG 49884003501 PAR PHARMACEUTICAL, INC yMECLIZINE TAB 25MG 49884003510 PAR PHARMACEUTICAL, INC yCYPROHEPTAD TAB 4MG 49884004301 PAR PHARMACEUTICAL, INC yCYPROHEPTAD TAB 4MG 49884004305 PAR PHARMACEUTICAL, INC yCYPROHEPTAD TAB 4MG 49884004310 PAR PHARMACEUTICAL, INC yRIBAVIRIN TAB 200MG 49884004532 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 10MG 49884005401 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 10MG 49884005405 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

490 of 774

IMIPRAM HCL TAB 10MG 49884005410 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 25MG 49884005501 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 25MG 49884005505 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 25MG 49884005510 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 50MG 49884005601 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 50MG 49884005605 PAR PHARMACEUTICAL, INC yIMIPRAM HCL TAB 50MG 49884005610 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 1MG 49884006101 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 1MG 49884006105 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 2.5MG 49884006201 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 2.5MG 49884006205 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 2.5MG 49884006210 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 10MG 49884006401 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 10MG 49884006405 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 10MG 49884006410 PAR PHARMACEUTICAL, INC yGLYCOPYRROL TAB 2MG 49884006601 PAR PHARMACEUTICAL, INC yRIBAPAK PAK 1000/DAY 49884007176 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 5MG 49884007601 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 5MG 49884007605 PAR PHARMACEUTICAL, INC yFLUPHENAZINE TAB 5MG 49884007610 PAR PHARMACEUTICAL, INC yCEFACLOR ER TAB 500MG 49884008001 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.25MG 49884008301 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.25MG 49884008310 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.5MG 49884008401 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.5MG 49884008410 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.75MG 49884008501 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.75MG 49884008505 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 0.75MG 49884008510 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 1.5MG 49884008601 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 1.5MG 49884008603 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 1.5MG 49884008605 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 1.5MG 49884008610 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 4MG 49884008701 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 4MG 49884008703 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 4MG 49884008705 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 4MG 49884008710 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

491 of 774

CLOZAPINE TAB 25MG 49884008801 PAR PHARMACEUTICAL, INC yCLOZAPINE TAB 100MG 49884008901 PAR PHARMACEUTICAL, INC yCLOZAPINE TAB 100MG 49884008905 PAR PHARMACEUTICAL, INC yDOXYCYC MONO TAB 50MG 49884009101 PAR PHARMACEUTICAL, INC yDOXYCYC MONO TAB 100MG 49884009303 PAR PHARMACEUTICAL, INC yDOXYCYC MONO TAB 100MG 49884009304 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 100MG 49884010401 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 100MG 49884010405 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 100MG 49884010410 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 300MG 49884010501 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 300MG 49884010505 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 300MG 49884010510 PAR PHARMACEUTICAL, INC yAMILORIDE TAB 5MG 49884011701 PAR PHARMACEUTICAL, INC yAMILORIDE TAB 5MG 49884011705 PAR PHARMACEUTICAL, INC yAMILORIDE TAB 5MG 49884011710 PAR PHARMACEUTICAL, INC yPROPOXY HCL CAP 65MG 49884012001 PAR PHARMACEUTICAL, INC yPROPOXY HCL CAP 65MG 49884012010 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 100MG 49884012101 PAR PHARMACEUTICAL, INC yHYDRALAZINE TAB 100MG 49884012110 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 6MG 49884012901 PAR PHARMACEUTICAL, INC yDEXAMETHASON TAB 6MG 49884012903 PAR PHARMACEUTICAL, INC yCEPHALEXIN CAP 250MG 49884013001 PAR PHARMACEUTICAL, INC yCEPHALEXIN CAP 250MG 49884013005 PAR PHARMACEUTICAL, INC yCEPHALEXIN CAP 500MG 49884013101 PAR PHARMACEUTICAL, INC yCEPHALEXIN CAP 500MG 49884013105 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 25/25 49884014301 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 25/25 49884014305 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 25/25 49884014310 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 50/50 49884014401 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 50/50 49884014405 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 50/50 49884014410 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 100/50 49884014501 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 100/50 49884014505 PAR PHARMACEUTICAL, INC yHYDRAL/HCTZ CAP 100/50 49884014510 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 400MG 49884016201 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 400MG 49884016203 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IBUPROFEN TAB 400MG 49884016205 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 600MG 49884016301 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 600MG 49884016303 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 600MG 49884016305 PAR PHARMACEUTICAL, INC yBENZTROPINE TAB 0.5MG 49884016401 PAR PHARMACEUTICAL, INC yBENZTROPINE TAB 1MG 49884016501 PAR PHARMACEUTICAL, INC yBENZTROPINE TAB 1MG 49884016510 PAR PHARMACEUTICAL, INC yBENZTROPINE TAB 2MG 49884016601 PAR PHARMACEUTICAL, INC yBENZTROPINE TAB 2MG 49884016610 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 800MG 49884021601 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 800MG 49884021603 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 800MG 49884021605 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 10MG 49884021701 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 10MG 49884021705 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 10MG 49884021710 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 25MG 49884021801 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 25MG 49884021805 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 25MG 49884021810 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 50MG 49884021901 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 50MG 49884021905 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 50MG 49884021910 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 75MG 49884022001 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 75MG 49884022005 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 75MG 49884022010 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 100MG 49884022101 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 100MG 49884022105 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 100MG 49884022110 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 150MG 49884022201 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 150MG 49884022203 PAR PHARMACEUTICAL, INC yDOXEPIN HCL CAP 150MG 49884022205 PAR PHARMACEUTICAL, INC yCEFPROZIL TAB 250MG 49884024201 PAR PHARMACEUTICAL, INC yCEFPROZIL TAB 250MG 49884024205 PAR PHARMACEUTICAL, INC yCEFPROZIL TAB 500MG 49884024301 PAR PHARMACEUTICAL, INC yCEFPROZIL TAB 500MG 49884024303 PAR PHARMACEUTICAL, INC yCEFPROZIL TAB 500MG 49884024305 PAR PHARMACEUTICAL, INC yCEFPROZIL SUS 125/5ML 49884024427 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

493 of 774

CEFPROZIL SUS 125/5ML 49884024428 PAR PHARMACEUTICAL, INC yCEFPROZIL SUS 125/5ML 49884024447 PAR PHARMACEUTICAL, INC yCEFPROZIL SUS 250/5ML 49884024527 PAR PHARMACEUTICAL, INC yCEFPROZIL SUS 250/5ML 49884024528 PAR PHARMACEUTICAL, INC yCEFPROZIL SUS 250/5ML 49884024547 PAR PHARMACEUTICAL, INC yCARISOPR/ASA TAB 200-325 49884024601 PAR PHARMACEUTICAL, INC yCARISOPR/ASA TAB 200-325 49884024605 PAR PHARMACEUTICAL, INC yMINOXIDIL TAB 2.5MG 49884025601 PAR PHARMACEUTICAL, INC yMINOXIDIL TAB 10MG 49884025701 PAR PHARMACEUTICAL, INC yMINOXIDIL TAB 10MG 49884025705 PAR PHARMACEUTICAL, INC yMETAPROTEREN TAB 10MG 49884025801 PAR PHARMACEUTICAL, INC yMETAPROTEREN TAB 20MG 49884025901 PAR PHARMACEUTICAL, INC yVERAPAMIL TAB 120MG SR 49884027101 PAR PHARMACEUTICAL, INC yVERAPAMIL TAB 180MG SR 49884027201 PAR PHARMACEUTICAL, INC yVERAPAMIL TAB 240MG SR 49884027301 PAR PHARMACEUTICAL, INC yVERAPAMIL TAB 240MG SR 49884027305 PAR PHARMACEUTICAL, INC yMEGESTROL AC TAB 20MG 49884028901 PAR PHARMACEUTICAL, INC yMEGESTROL AC TAB 40MG 49884029001 PAR PHARMACEUTICAL, INC yMEGESTROL AC TAB 40MG 49884029004 PAR PHARMACEUTICAL, INC yMEGESTROL AC TAB 40MG 49884029005 PAR PHARMACEUTICAL, INC yCLONAZEP ODT TAB 0.125MG 49884030602 PAR PHARMACEUTICAL, INC yCLONAZEP ODT TAB 0.25MG 49884030702 PAR PHARMACEUTICAL, INC yCLONAZEP ODT TAB 0.5MG 49884030802 PAR PHARMACEUTICAL, INC yCLONAZEP ODT TAB 1MG 49884030902 PAR PHARMACEUTICAL, INC yCLONAZEP ODT TAB 2MG 49884031002 PAR PHARMACEUTICAL, INC yPERGOLIDE TAB 0.05MG 49884031601 PAR PHARMACEUTICAL, INC yPERGOLIDE TAB 0.25MG 49884031701 PAR PHARMACEUTICAL, INC yPERGOLIDE TAB 1.0MG 49884031801 PAR PHARMACEUTICAL, INC yRIBAPAK TAB 800/DAY 49884033876 PAR PHARMACEUTICAL, INC yRIBAPAK PAK 1200/DAY 49884034076 PAR PHARMACEUTICAL, INC yESTAZOLAM TAB 1MG 49884034901 PAR PHARMACEUTICAL, INC yESTAZOLAM TAB 2MG 49884035001 PAR PHARMACEUTICAL, INC yLEUPROLIDE INJ 5MG/ML 49884036826 PAR PHARMACEUTICAL, INC yPOT CHLORIDE TAB 20MEQ ER 49884039201 PAR PHARMACEUTICAL, INC yPOT CHLORIDE TAB 20MEQ ER 49884039205 PAR PHARMACEUTICAL, INC yPOT CHLORIDE TAB 20MEQ ER 49884039210 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

494 of 774

ALPRAZOLAM TAB 2MG 49884040001 PAR PHARMACEUTICAL, INC yTRIAZOLAM TAB 0.125MG 49884045305 PAR PHARMACEUTICAL, INC yTRIAZOLAM TAB 0.125MG 49884045312 PAR PHARMACEUTICAL, INC yTRIAZOLAM TAB 0.125MG 49884045362 PAR PHARMACEUTICAL, INC yTRIAZOLAM TAB 0.25MG 49884045405 PAR PHARMACEUTICAL, INC yTRIAZOLAM TAB 0.25MG 49884045412 PAR PHARMACEUTICAL, INC yTRIAZOLAM TAB 0.25MG 49884045462 PAR PHARMACEUTICAL, INC yATENOLOL TAB 50MG 49884045601 PAR PHARMACEUTICAL, INC yATENOLOL TAB 50MG 49884045610 PAR PHARMACEUTICAL, INC yATENOLOL TAB 100MG 49884045701 PAR PHARMACEUTICAL, INC yATENOLOL TAB 100MG 49884045710 PAR PHARMACEUTICAL, INC yAMIODARONE TAB 200MG 49884045802 PAR PHARMACEUTICAL, INC yAMIODARONE TAB 200MG 49884045804 PAR PHARMACEUTICAL, INC yAMIODARONE TAB 200MG 49884045805 PAR PHARMACEUTICAL, INC yCHOLESTYRAM POW 4GM 49884046565 PAR PHARMACEUTICAL, INC yCHOLESTYRAM POW 4GM 49884046566 PAR PHARMACEUTICAL, INC yCHOLESTYRAM POW 4GM LITE 49884046665 PAR PHARMACEUTICAL, INC yCHOLESTYRAM POW 4GM LITE 49884046667 PAR PHARMACEUTICAL, INC yIBU TAB 400MG 49884046701 PAR PHARMACEUTICAL, INC yIBU TAB 400MG 49884046705 PAR PHARMACEUTICAL, INC yIBU TAB 600MG 49884046801 PAR PHARMACEUTICAL, INC yIBU TAB 600MG 49884046805 PAR PHARMACEUTICAL, INC yIBU TAB 800MG 49884046901 PAR PHARMACEUTICAL, INC yIBU TAB 800MG 49884046905 PAR PHARMACEUTICAL, INC yORPHENGESIC TAB 49884047201 PAR PHARMACEUTICAL, INC yORPHENGESIC TAB FORTE 49884047301 PAR PHARMACEUTICAL, INC yORPHENGESIC TAB FORTE 49884047305 PAR PHARMACEUTICAL, INC yCLONAZEPAM TAB 0.5MG 49884049501 PAR PHARMACEUTICAL, INC yCLONAZEPAM TAB 1MG 49884049601 PAR PHARMACEUTICAL, INC yCLONAZEPAM TAB 2MG 49884049701 PAR PHARMACEUTICAL, INC yNICARDIPINE CAP 20MG 49884049801 PAR PHARMACEUTICAL, INC yNICARDIPINE CAP 20MG 49884049805 PAR PHARMACEUTICAL, INC yNICARDIPINE CAP 30MG 49884049901 PAR PHARMACEUTICAL, INC yNICARDIPINE CAP 30MG 49884049905 PAR PHARMACEUTICAL, INC yMINOCYCLINE TAB 50MG 49884051101 PAR PHARMACEUTICAL, INC yMINOCYCLINE TAB 50MG 49884051110 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

495 of 774

MINOCYCLINE TAB 75MG 49884051201 PAR PHARMACEUTICAL, INC yMINOCYCLINE TAB 75MG 49884051210 PAR PHARMACEUTICAL, INC yMINOCYCLINE TAB 100MG 49884051303 PAR PHARMACEUTICAL, INC yMINOCYCLINE TAB 100MG 49884051310 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 150MG 49884054401 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 150MG 49884054402 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 150MG 49884054405 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 150MG 49884054410 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 300MG 49884054501 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 300MG 49884054504 PAR PHARMACEUTICAL, INC yRANITIDINE TAB 300MG 49884054511 PAR PHARMACEUTICAL, INC yPROCHLORPER TAB 5MG 49884054901 PAR PHARMACEUTICAL, INC yPROCHLORPER TAB 10MG 49884055001 PAR PHARMACEUTICAL, INC yDOXAZOSIN TAB 1MG 49884055201 PAR PHARMACEUTICAL, INC yDOXAZOSIN TAB 2MG 49884055301 PAR PHARMACEUTICAL, INC yDOXAZOSIN TAB 4MG 49884055401 PAR PHARMACEUTICAL, INC yDOXAZOSIN TAB 8MG 49884055501 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 2.5MG 49884055601 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 2.5MG 49884055610 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 5MG 49884055701 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 5MG 49884055710 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 10MG 49884055801 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 10MG 49884055810 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 20MG 49884055901 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 20MG 49884055910 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 40MG 49884056001 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 40MG 49884056010 PAR PHARMACEUTICAL, INC yACYCLOVIR CAP 200MG 49884056501 PAR PHARMACEUTICAL, INC yACYCLOVIR TAB 400MG 49884056601 PAR PHARMACEUTICAL, INC yACYCLOVIR TAB 800MG 49884056701 PAR PHARMACEUTICAL, INC yGUANFACINE TAB 1MG 49884057201 PAR PHARMACEUTICAL, INC yGUANFACINE TAB 2MG 49884057301 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 80MG 49884058201 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 80MG 49884058210 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 120MG 49884058301 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 120MG 49884058310 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

496 of 774

SOTALOL HCL TAB 160MG 49884058401 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 160MG 49884058410 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 240MG 49884058501 PAR PHARMACEUTICAL, INC ySOTALOL HCL TAB 240MG 49884058510 PAR PHARMACEUTICAL, INC yACEBUTOLOL CAP 200MG 49884058701 PAR PHARMACEUTICAL, INC yACEBUTOLOL CAP 400MG 49884058801 PAR PHARMACEUTICAL, INC yINDAPAMIDE TAB 1.25MG 49884058901 PAR PHARMACEUTICAL, INC yINDAPAMIDE TAB 1.25MG 49884058910 PAR PHARMACEUTICAL, INC yINDAPAMIDE TAB 2.5MG 49884059001 PAR PHARMACEUTICAL, INC yINDAPAMIDE TAB 2.5MG 49884059010 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 2.5MG 49884059101 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 2.5MG 49884059110 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 5MG 49884059201 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 5MG 49884059210 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 10MG 49884059301 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 10MG 49884059310 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 20MG 49884059401 PAR PHARMACEUTICAL, INC yENALAPRIL TAB 20MG 49884059410 PAR PHARMACEUTICAL, INC yETODOLAC TAB 500MG 49884059601 PAR PHARMACEUTICAL, INC yTICLOPIDINE TAB 250MG 49884059901 PAR PHARMACEUTICAL, INC yTICLOPIDINE TAB 250MG 49884059902 PAR PHARMACEUTICAL, INC yTICLOPIDINE TAB 250MG 49884059905 PAR PHARMACEUTICAL, INC yTICLOPIDINE TAB 250MG 49884059911 PAR PHARMACEUTICAL, INC ySSD CRE 1% 49884060036 PAR PHARMACEUTICAL, INC ySSD CRE 1% 49884060039 PAR PHARMACEUTICAL, INC ySSD CRE 1% 49884060040 PAR PHARMACEUTICAL, INC ySSD CRE 1% 49884060057 PAR PHARMACEUTICAL, INC ySSD CRE 1% 49884060058 PAR PHARMACEUTICAL, INC ySSD CRE 1% 49884060085 PAR PHARMACEUTICAL, INC ySSD AF CRE 1% 49884060136 PAR PHARMACEUTICAL, INC ySSD AF CRE 1% 49884060139 PAR PHARMACEUTICAL, INC ySSD AF CRE 1% 49884060140 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 100MG 49884060201 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 100MG 49884060210 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 300MG 49884060301 PAR PHARMACEUTICAL, INC yALLOPURINOL TAB 300MG 49884060305 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

497 of 774

ALLOPURINOL TAB 300MG 49884060310 PAR PHARMACEUTICAL, INC yFAMOTIDINE TAB 20MG 49884060801 PAR PHARMACEUTICAL, INC yFAMOTIDINE TAB 20MG 49884060810 PAR PHARMACEUTICAL, INC yFAMOTIDINE TAB 20MG 49884060811 PAR PHARMACEUTICAL, INC yFAMOTIDINE TAB 40MG 49884060901 PAR PHARMACEUTICAL, INC yFAMOTIDINE TAB 40MG 49884060910 PAR PHARMACEUTICAL, INC yFAMOTIDINE TAB 40MG 49884060911 PAR PHARMACEUTICAL, INC ySELEGILINE TAB 5MG 49884061002 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 12.5MG 49884061901 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 12.5MG 49884061910 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 25MG 49884062001 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 25MG 49884062010 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 50MG 49884062101 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 50MG 49884062110 PAR PHARMACEUTICAL, INC yCAPTOPRIL TAB 100MG 49884062201 PAR PHARMACEUTICAL, INC yAMOXICILLIN CAP 250MG 49884062301 PAR PHARMACEUTICAL, INC yAMOXICILLIN CAP 250MG 49884062305 PAR PHARMACEUTICAL, INC yAMOXICILLIN CAP 500MG 49884062401 PAR PHARMACEUTICAL, INC yAMOXICILLIN CAP 500MG 49884062405 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 30MG 49884063501 PAR PHARMACEUTICAL, INC yLISINOPRIL TAB 30MG 49884063510 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 250MG 49884063701 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 250MG 49884063705 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 250MG 49884063774 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 500MG 49884063801 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 500MG 49884063805 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 500MG 49884063874 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 750MG 49884063903 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 750MG 49884063905 PAR PHARMACEUTICAL, INC yCIPROFLOXACN TAB 750MG 49884063974 PAR PHARMACEUTICAL, INC yMETHIMAZOLE TAB 5MG 49884064001 PAR PHARMACEUTICAL, INC yMETHIMAZOLE TAB 5MG 49884064074 PAR PHARMACEUTICAL, INC yMETHIMAZOLE TAB 10MG 49884064101 PAR PHARMACEUTICAL, INC yMETHIMAZOLE TAB 10MG 49884064174 PAR PHARMACEUTICAL, INC yRANITIDINE CAP 150MG 49884064702 PAR PHARMACEUTICAL, INC yRANITIDINE CAP 150MG 49884064705 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RANITIDINE CAP 300MG 49884064801 PAR PHARMACEUTICAL, INC yRANITIDINE CAP 300MG 49884064811 PAR PHARMACEUTICAL, INC yNABUMETONE TAB 500MG 49884064901 PAR PHARMACEUTICAL, INC yNABUMETONE TAB 500MG 49884064905 PAR PHARMACEUTICAL, INC yNABUMETONE TAB 750MG 49884065001 PAR PHARMACEUTICAL, INC yNABUMETONE TAB 750MG 49884065005 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 5MG 49884065101 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 5MG 49884065110 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 10MG 49884065201 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 10MG 49884065210 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 20MG 49884065301 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 20MG 49884065310 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 100MG 49884065401 PAR PHARMACEUTICAL, INC yTORSEMIDE TAB 100MG 49884065410 PAR PHARMACEUTICAL, INC yMIRTAZAPINE TAB 15MG 49884065511 PAR PHARMACEUTICAL, INC yMIRTAZAPINE TAB 30MG 49884065611 PAR PHARMACEUTICAL, INC yZORPRIN TAB 800MG CR 49884065701 PAR PHARMACEUTICAL, INC yCABERGOLINE TAB 0.5MG 49884067314 PAR PHARMACEUTICAL, INC yOFLOXACIN TAB 400MG 49884068401 PAR PHARMACEUTICAL, INC yENALAPR/HCTZ TAB 5-12.5MG 49884068601 PAR PHARMACEUTICAL, INC yENALAPR/HCTZ TAB 10-25MG 49884068701 PAR PHARMACEUTICAL, INC yMETHIMAZOLE TAB 20MG 49884068955 PAR PHARMACEUTICAL, INC yFLECAINIDE TAB 50MG 49884069401 PAR PHARMACEUTICAL, INC yFLECAINIDE TAB 100MG 49884069501 PAR PHARMACEUTICAL, INC yFLECAINIDE TAB 150MG 49884069601 PAR PHARMACEUTICAL, INC yCLOMIPHENE TAB 50MG 49884070154 PAR PHARMACEUTICAL, INC yCLOMIPHENE TAB 50MG 49884070155 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 5MG 49884070701 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 5MG 49884070705 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 10MG 49884070801 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 10MG 49884070805 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 15MG 49884072101 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 15MG 49884072102 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 15MG 49884072105 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 15MG 49884072113 PAR PHARMACEUTICAL, INC yOXAPROZIN TAB 600MG 49884072301 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

499 of 774

OXAPROZIN TAB 600MG 49884072305 PAR PHARMACEUTICAL, INC yHYDROXYUREA CAP 500MG 49884072401 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 7.5MG 49884072501 PAR PHARMACEUTICAL, INC yBUSPIRONE TAB 7.5MG 49884072505 PAR PHARMACEUTICAL, INC yDOXYCYC MONO CAP 50MG 49884072601 PAR PHARMACEUTICAL, INC yDOXYCYC MONO CAP 100MG 49884072703 PAR PHARMACEUTICAL, INC yDOXYCYC MONO CAP 100MG 49884072704 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 10MG 49884073201 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 10MG 49884073210 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 20MG 49884073301 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 20MG 49884073310 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 10MG 49884073401 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 10MG 49884073410 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 10MG 49884073411 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 10MG 49884073482 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 20MG 49884073501 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 20MG 49884073510 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 20MG 49884073511 PAR PHARMACEUTICAL, INC yFLUOXETINE TAB 20MG 49884073582 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 500MG 49884073601 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 500MG 49884073605 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 850MG 49884073701 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 850MG 49884073705 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 1000MG 49884073801 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 1000MG 49884073805 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 500MG 49884073901 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 500MG 49884073905 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 850MG 49884074001 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 850MG 49884074005 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 1000MG 49884074101 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 1000MG 49884074105 PAR PHARMACEUTICAL, INC yTRAMADOL HCL TAB 50MG 49884074201 PAR PHARMACEUTICAL, INC yTRAMADOL HCL TAB 50MG 49884074205 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 40MG 49884074301 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 40MG 49884074305 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 40MG 49884074311 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

500 of 774

FLUOXETINE CAP 20MG 49884075101 PAR PHARMACEUTICAL, INC yFLUOXETINE CAP 20MG 49884075110 PAR PHARMACEUTICAL, INC yFLUTAMIDE CAP 125MG 49884075305 PAR PHARMACEUTICAL, INC yFLUTAMIDE CAP 125MG 49884075313 PAR PHARMACEUTICAL, INC yLOVASTATIN TAB 10MG 49884075401 PAR PHARMACEUTICAL, INC yLOVASTATIN TAB 10MG 49884075410 PAR PHARMACEUTICAL, INC yLOVASTATIN TAB 20MG 49884075501 PAR PHARMACEUTICAL, INC yLOVASTATIN TAB 20MG 49884075510 PAR PHARMACEUTICAL, INC yLOVASTATIN TAB 40MG 49884075601 PAR PHARMACEUTICAL, INC yLOVASTATIN TAB 40MG 49884075610 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 150MG 49884076601 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 150MG 49884076602 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 150MG 49884076605 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 150MG 49884076610 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 300MG 49884076701 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 300MG 49884076705 PAR PHARMACEUTICAL, INC yNIZATIDINE CAP 300MG 49884076711 PAR PHARMACEUTICAL, INC yDIPHEN/ATROP TAB 2.5MG 49884077101 PAR PHARMACEUTICAL, INC yDIPHEN/ATROP TAB 2.5MG 49884077110 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 400MG 49884077701 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 400MG 49884077705 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 600MG 49884077801 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 600MG 49884077805 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 800MG 49884077901 PAR PHARMACEUTICAL, INC yIBUPROFEN TAB 800MG 49884077905 PAR PHARMACEUTICAL, INC yTIZANIDINE TAB 2MG 49884078210 PAR PHARMACEUTICAL, INC yTIZANIDINE TAB 2MG 49884078230 PAR PHARMACEUTICAL, INC yTIZANIDINE TAB 2MG 49884078253 PAR PHARMACEUTICAL, INC yTIZANIDINE TAB 4MG 49884078310 PAR PHARMACEUTICAL, INC yTIZANIDINE TAB 4MG 49884078330 PAR PHARMACEUTICAL, INC yTIZANIDINE TAB 4MG 49884078353 PAR PHARMACEUTICAL, INC yQUESTRAN POW 4GM LITE 49884079265 PAR PHARMACEUTICAL, INC yQUESTRAN POW 4GM LITE 49884079289 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 12.5MG 49884079301 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 25MG 49884079401 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 25MG 49884079410 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

501 of 774

CAPOTEN TAB 25MG 49884079474 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 50MG 49884079501 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 50MG 49884079510 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 50MG 49884079574 PAR PHARMACEUTICAL, INC yCAPOTEN TAB 100MG 49884079601 PAR PHARMACEUTICAL, INC ySUMYCIN TAB 250MG 49884079701 PAR PHARMACEUTICAL, INC ySUMYCIN TAB 500MG 49884079801 PAR PHARMACEUTICAL, INC ySUMYCIN SYP 125/5ML 49884079933 PAR PHARMACEUTICAL, INC yCAPOZIDE TAB 25/15MG 49884081501 PAR PHARMACEUTICAL, INC yGLIMEPIRIDE TAB 1MG 49884084501 PAR PHARMACEUTICAL, INC yGLIMEPIRIDE TAB 2MG 49884084601 PAR PHARMACEUTICAL, INC yGLIMEPIRIDE TAB 4MG 49884084701 PAR PHARMACEUTICAL, INC yMELOXICAM TAB 7.5MG 49884085001 PAR PHARMACEUTICAL, INC yMELOXICAM TAB 7.5MG 49884085010 PAR PHARMACEUTICAL, INC yMELOXICAM TAB 15MG 49884085101 PAR PHARMACEUTICAL, INC yMELOXICAM TAB 15MG 49884085110 PAR PHARMACEUTICAL, INC yRIBASPHERE CAP 200MG 49884085656 PAR PHARMACEUTICAL, INC yRIBASPHERE CAP 200MG 49884085692 PAR PHARMACEUTICAL, INC yRIBASPHERE CAP 200MG 49884085693 PAR PHARMACEUTICAL, INC yRIBASPHERE CAP 200MG 49884085694 PAR PHARMACEUTICAL, INC yBENAZEP/HCTZ TAB 5-6.25 49884086101 PAR PHARMACEUTICAL, INC yBENAZEP/HCTZ TAB 10-12.5 49884086201 PAR PHARMACEUTICAL, INC yBENAZEP/HCTZ TAB 20-12.5 49884086301 PAR PHARMACEUTICAL, INC yBENAZEP/HCTZ TAB 20-25MG 49884086401 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 10MG 49884087605 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 10MG 49884087611 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 20MG 49884087701 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 20MG 49884087705 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 20MG 49884087711 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 30MG 49884087805 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 30MG 49884087811 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 40MG 49884087905 PAR PHARMACEUTICAL, INC yPAROXETINE TAB 40MG 49884087911 PAR PHARMACEUTICAL, INC yLEFLUNOMIDE TAB 10MG 49884088805 PAR PHARMACEUTICAL, INC yLEFLUNOMIDE TAB 10MG 49884088811 PAR PHARMACEUTICAL, INC yLEFLUNOMIDE TAB 20MG 49884088905 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

502 of 774

LEFLUNOMIDE TAB 20MG 49884088911 PAR PHARMACEUTICAL, INC yMEGESTROL AC SUS 40MG/ML 49884090738 PAR PHARMACEUTICAL, INC yMEGESTROL AC SUS 40MG/ML 49884090761 PAR PHARMACEUTICAL, INC yMEGESTROL AC SUS 40MG/ML 49884090788 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 50MG 49884091602 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 50MG 49884091605 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 100MG 49884091702 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 100MG 49884091705 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 150MG 49884091802 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 150MG 49884091805 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 200MG 49884091902 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 200MG 49884091905 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 250MG 49884092002 PAR PHARMACEUTICAL, INC yNEFAZODONE TAB 250MG 49884092005 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 500MG ER 49884092101 PAR PHARMACEUTICAL, INC yMETFORMIN TAB 500MG ER 49884092105 PAR PHARMACEUTICAL, INC yMERCAPTOPUR TAB 50MG 49884092202 PAR PHARMACEUTICAL, INC yMERCAPTOPUR TAB 50MG 49884092204 PAR PHARMACEUTICAL, INC yQUESTRAN POW 4GM 49884093666 PAR PHARMACEUTICAL, INC yFLUCONAZOLE TAB 50MG 49884093811 PAR PHARMACEUTICAL, INC yFLUCONAZOLE TAB 100MG 49884093911 PAR PHARMACEUTICAL, INC yFLUCONAZOLE TAB 100MG 49884093974 PAR PHARMACEUTICAL, INC yFLUCONAZOLE TAB 150MG 49884094099 PAR PHARMACEUTICAL, INC yFLUCONAZOLE TAB 200MG 49884094111 PAR PHARMACEUTICAL, INC yFLUCONAZOLE TAB 200MG 49884094174 PAR PHARMACEUTICAL, INC yATENOLOL TAB 25MG 49884094401 PAR PHARMACEUTICAL, INC yATENOLOL TAB 25MG 49884094410 PAR PHARMACEUTICAL, INC yTRAMADL/APAP TAB 49884094601 PAR PHARMACEUTICAL, INC yTRAMADL/APAP TAB 49884094605 PAR PHARMACEUTICAL, INC yMEGACE ES SUS 49884094969 PAR PHARMACEUTICAL, INC yCHLORDIAZEP CAP 5MG 49884095801 PAR PHARMACEUTICAL, INC yCHLORDIAZEP CAP 10MG 49884095901 PAR PHARMACEUTICAL, INC yCHLORDIAZEP CAP 25MG 49884096001 PAR PHARMACEUTICAL, INC yAMITRIP/CDP TAB 12.5-5MG 49884096101 PAR PHARMACEUTICAL, INC yAMITRIP/CDP TAB 25-10MG 49884096201 PAR PHARMACEUTICAL, INC yHYDROQUINONE CRE 4% 49884096342 PAR PHARMACEUTICAL, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GLYB/METFORM TAB 1.25/250 49884096701 PAR PHARMACEUTICAL, INC yGLYB/METFORM TAB 1.25/250 49884096705 PAR PHARMACEUTICAL, INC yGLYB/METFORM TAB 2.5/500 49884096801 PAR PHARMACEUTICAL, INC yGLYB/METFORM TAB 2.5/500 49884096805 PAR PHARMACEUTICAL, INC yGLYB/METFORM TAB 5/500MG 49884096901 PAR PHARMACEUTICAL, INC yGLYB/METFORM TAB 5/500MG 49884096905 PAR PHARMACEUTICAL, INC yNYSTATIN POW 100000 49884098918 PAR PHARMACEUTICAL, INC yNYSTATIN POW 100000 49884098960 PAR PHARMACEUTICAL, INC yQUINAPRIL TAB 20MG 49884099009 PAR PHARMACEUTICAL, INC yQUINAPRIL TAB 40MG 49884099109 PAR PHARMACEUTICAL, INC yQUINAPRIL TAB 5MG 49884099209 PAR PHARMACEUTICAL, INC yQUINAPRIL TAB 10MG 49884099309 PAR PHARMACEUTICAL, INC yCOLY-MYCIN-S SUS OTIC 64029314101 PARKEDALE PHARMACEUTICALS, INC. yAPLISOL INJ 5/0.1ML 64029452501 PARKEDALE PHARMACEUTICALS, INC. yAPLISOL INJ 5/0.1ML 64029452502 PARKEDALE PHARMACEUTICALS, INC. yKETOCONAZOLE SHA 2% 10147075004 PATRIOT PHARMACEUTICALS, LLC yGRISEOFULVIN SUS 125/5ML 10147081004 PATRIOT PHARMACEUTICALS, LLC yITRACONAZOLE CAP 100MG 10147170003 PATRIOT PHARMACEUTICALS, LLC yITRACONAZOLE CAP 100MG 10147170007 PATRIOT PHARMACEUTICALS, LLC yKLOUT LICE KIT TREATMEN 66346001158 PEDIAMED PHARMACEUTICALS, INC. yKLOUT LICE MIS COMB 66346001999 PEDIAMED PHARMACEUTICALS, INC. yVIRAVAN-S SUS 30-12.5 66346003158 PEDIAMED PHARMACEUTICALS, INC. yVIRAVAN-S SUS 30-12.5 66346003165 PEDIAMED PHARMACEUTICALS, INC. yVIRAVAN-T CHW 30-25MG 66346003223 PEDIAMED PHARMACEUTICALS, INC. yENDAL HD SYP 66346012165 PEDIAMED PHARMACEUTICALS, INC. yVIRAVAN DM SUS 66346014165 PEDIAMED PHARMACEUTICALS, INC. yVIRAVAN DM CHW 25-30-25 66346014223 PEDIAMED PHARMACEUTICALS, INC. yACCUHIST DRO 66346016130 PEDIAMED PHARMACEUTICALS, INC. yACCUHIST PDX DRO 66346017130 PEDIAMED PHARMACEUTICALS, INC. yACCUHIST PDX SYP 66346018165 PEDIAMED PHARMACEUTICALS, INC. yTUSSINATE SYP 66346019165 PEDIAMED PHARMACEUTICALS, INC. yHYDRISINOL CRE 00884014204 PEDINOL PHARMACAL INC yFUNGOID TINC SOL 2% 00884029301 PEDINOL PHARMACAL INC yFUNGOID TINC SOL 2% 00884029316 PEDINOL PHARMACAL INC yPEDI-DRI POW 100000 00884039602 PEDINOL PHARMACAL INC yUREACIN-20 CRE 20% 00884044904 PEDINOL PHARMACAL INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BREEZEE MIST AER FOOT PWD 00884065904 PEDINOL PHARMACAL INC yGRIS-PEG TAB 125MG 00884076304 PEDINOL PHARMACAL INC yGRIS-PEG TAB 250MG 00884077304 PEDINOL PHARMACAL INC yGRIS-PEG TAB 250MG 00884077350 PEDINOL PHARMACAL INC yPEDI-BORO POW 00884177310 PEDINOL PHARMACAL INC yPEDI-BORO POW 00884177327 PEDINOL PHARMACAL INC yOSTIDERM LIQ ROLL-ON 00884205203 PEDINOL PHARMACAL INC yHYDRISALIC GEL 6% 00884229601 PEDINOL PHARMACAL INC ySALACTIC FIL SOL 17% 00884259215 PEDINOL PHARMACAL INC yCASTELLANI LIQ PAINT 00884289301 PEDINOL PHARMACAL INC yCASTELLANI LIQ PAINT 00884289316 PEDINOL PHARMACAL INC yCASTELLANI LIQ PAINT/CL 00884299301 PEDINOL PHARMACAL INC yCASTELLANI LIQ PAINT/CL 00884299316 PEDINOL PHARMACAL INC yHYDRISINOL LOT 00884304208 PEDINOL PHARMACAL INC yUREACIN-10 LOT 10% 00884324908 PEDINOL PHARMACAL INC yPEDI-PRO POW 1% 00884359702 PEDINOL PHARMACAL INC yLAZERCREME CRE 00884388602 PEDINOL PHARMACAL INC yLAZERFORMALY SOL 10% 00884398603 PEDINOL PHARMACAL INC ySAL-ACID PAD 40% 00884439314 PEDINOL PHARMACAL INC yRANICLOR CHW 250MG 00884455730 PEDINOL PHARMACAL INC yRANICLOR CHW 375MG 00884455820 PEDINOL PHARMACAL INC yFORMALYDE-10 AER 10% SPRA 00884478902 PEDINOL PHARMACAL INC yNAIL SCRUB LIQ W/BRUSH 00884489102 PEDINOL PHARMACAL INC yLACTINOL-E CRE 00884499004 PEDINOL PHARMACAL INC yLACTINOL-E CRE 00884499008 PEDINOL PHARMACAL INC ySAL-PLANT GEL 17% 00884519215 PEDINOL PHARMACAL INC yLACTINOL LOT 10% 00884529212 PEDINOL PHARMACAL INC yLACTINOL LOT 10% 00884529216 PEDINOL PHARMACAL INC yFUNGOID TINC KIT 00884549301 PEDINOL PHARMACAL INC yNALFON CAP 200MG 00884660010 PEDINOL PHARMACAL INC yNALFON CAP 300MG 00884670010 PEDINOL PHARMACAL INC yTRIAMCINOLON OIN 0.025% 00414005405 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.025% 00414005436 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.1% 00414005505 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.1% 00414005536 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.025% 00414006305 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIAMCINOLON CRE 0.025% 00414006336 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.1% 00414006405 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.1% 00414006429 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.1% 00414006436 PERRIGO PHARMACEUTICALS yIBUPROFEN SUS 100/5ML 10768701901 PERRIGO PHARMACEUTICALS yIBUPROFEN SUS 100/5ML 10768701902 PERRIGO PHARMACEUTICALS yCITALOPRAM TAB 10MG 10768706003 PERRIGO PHARMACEUTICALS yPREDNISONE TAB 20MG 10768708501 PERRIGO PHARMACEUTICALS yNAPROXEN TAB 250MG 10768712101 PERRIGO PHARMACEUTICALS yNAPROXEN TAB 250MG 10768712102 PERRIGO PHARMACEUTICALS yGLIMEPIRIDE TAB 1MG 10768715001 PERRIGO PHARMACEUTICALS yIBUPROFEN TAB 600MG 10768716701 PERRIGO PHARMACEUTICALS yIBUPROFEN TAB 600MG 10768716702 PERRIGO PHARMACEUTICALS yCITALOPRAM TAB 20MG 10768719103 PERRIGO PHARMACEUTICALS yPREDNISONE PAK 10MG 10768728301 PERRIGO PHARMACEUTICALS yPREDNISONE PAK 10MG 10768728302 PERRIGO PHARMACEUTICALS yPREDNISONE TAB 10MG 10768728303 PERRIGO PHARMACEUTICALS yPREDNISONE TAB 10MG 10768728304 PERRIGO PHARMACEUTICALS yIBUPROFEN TAB 400MG 10768737301 PERRIGO PHARMACEUTICALS yIBUPROFEN TAB 400MG 10768737302 PERRIGO PHARMACEUTICALS yIBUPROFEN TAB 800MG 10768752201 PERRIGO PHARMACEUTICALS yIBUPROFEN TAB 800MG 10768752202 PERRIGO PHARMACEUTICALS yNAPROXEN TAB 375MG 10768753401 PERRIGO PHARMACEUTICALS yNAPROXEN TAB 375MG 10768753402 PERRIGO PHARMACEUTICALS yCITALOPRAM TAB 40MG 10768761603 PERRIGO PHARMACEUTICALS yNAPROXEN TAB 500MG 10768763101 PERRIGO PHARMACEUTICALS yNAPROXEN TAB 500MG 10768763102 PERRIGO PHARMACEUTICALS yGLIMEPIRIDE TAB 4MG 10768770001 PERRIGO PHARMACEUTICALS yPREDNISONE PAK 5MG 10768773301 PERRIGO PHARMACEUTICALS yPREDNISONE PAK 5MG 10768773302 PERRIGO PHARMACEUTICALS yPREDNISONE TAB 5MG 10768773303 PERRIGO PHARMACEUTICALS yPREDNISONE TAB 5MG 10768773304 PERRIGO PHARMACEUTICALS yHYDROCORT CRE 2.5% 45802000402 PERRIGO PHARMACEUTICALS yHYDROCORT CRE 2.5% 45802000403 PERRIGO PHARMACEUTICALS yFLUOCINONIDE CRE 0.05% 45802001711 PERRIGO PHARMACEUTICALS yFLUOCINONIDE CRE 0.05% 45802001713 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETAMETH DIP LOT 0.05% 45802002146 PERRIGO PHARMACEUTICALS yTOLNAFTATE CRE 1% 45802003201 PERRIGO PHARMACEUTICALS yTOLNAFTATE CRE 1% 45802003203 PERRIGO PHARMACEUTICALS yTOLNAFTATE SOL 1% 45802003385 PERRIGO PHARMACEUTICALS yTOLNAFTATE POW 1% 45802003486 PERRIGO PHARMACEUTICALS yACNE CLEANS PAD MX-STR 45802003704 PERRIGO PHARMACEUTICALS yERYTHROMYCIN SOL 2% 45802003846 PERRIGO PHARMACEUTICALS ySELENIUM SUL LOT 2.5% 45802004064 PERRIGO PHARMACEUTICALS yGENTAMICIN OIN 0.1% 45802004605 PERRIGO PHARMACEUTICALS yGENTAMICIN OIN 0.1% 45802004611 PERRIGO PHARMACEUTICALS yGENTAMICIN OIN 0.1% 45802004635 PERRIGO PHARMACEUTICALS yANESTHETIC CRE HEMORRH 45802004703 PERRIGO PHARMACEUTICALS yNYSTATIN OIN 100000 45802004811 PERRIGO PHARMACEUTICALS yNYSTATIN OIN 100000 45802004835 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.5% 45802004935 PERRIGO PHARMACEUTICALS yDIBUCAINE OIN 1% 45802005003 PERRIGO PHARMACEUTICALS yPOVIDONE-IOD SOL 10% 45802005207 PERRIGO PHARMACEUTICALS yPOVIDONE-IOD SOL 10% 45802005255 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.025% 45802005435 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.025% 45802005436 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.1% 45802005505 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.1% 45802005535 PERRIGO PHARMACEUTICALS yTRIAMCINOLON OIN 0.1% 45802005536 PERRIGO PHARMACEUTICALS yGENTAMICIN CRE 0.1% 45802005611 PERRIGO PHARMACEUTICALS yGENTAMICIN CRE 0.1% 45802005635 PERRIGO PHARMACEUTICALS yNYSTATIN CRE 100000 45802005911 PERRIGO PHARMACEUTICALS yNYSTATIN CRE 100000 45802005935 PERRIGO PHARMACEUTICALS yBACITRACIN OIN 500/GM 45802006001 PERRIGO PHARMACEUTICALS yBACITRACIN OIN 500/GM 45802006003 PERRIGO PHARMACEUTICALS yBACITRACIN OIN 500/GM 45802006070 PERRIGO PHARMACEUTICALS yTRIPLE ANTIB OIN 45802006101 PERRIGO PHARMACEUTICALS yTRIPLE ANTIB OIN 45802006103 PERRIGO PHARMACEUTICALS yTRIPLE ANTIB OIN 45802006170 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.025% 45802006305 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.025% 45802006335 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.025% 45802006336 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIAMCINOLON CRE 0.1% 45802006435 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.1% 45802006436 PERRIGO PHARMACEUTICALS yTRIAMCINOLON CRE 0.5% 45802006535 PERRIGO PHARMACEUTICALS yBETAMETH VAL CRE 0.1% 45802006935 PERRIGO PHARMACEUTICALS yVITAMIN A&D OIN 45802007010 PERRIGO PHARMACEUTICALS yVITAMIN A&D OIN 45802007044 PERRIGO PHARMACEUTICALS yVITAMIN A&D OIN 45802007071 PERRIGO PHARMACEUTICALS yLUBRICATING GEL 45802007144 PERRIGO PHARMACEUTICALS yBURN OIN 45802007903 PERRIGO PHARMACEUTICALS yERYTHROMYCIN GEL /BENZOYL 45802008302 PERRIGO PHARMACEUTICALS yERYTHROMYCIN GEL /BENZOYL 45802008386 PERRIGO PHARMACEUTICALS yZINC OXIDE OIN 20% 45802008603 PERRIGO PHARMACEUTICALS yZINC OXIDE OIN 20% 45802008605 PERRIGO PHARMACEUTICALS yZINC OXIDE OIN 20% 45802008610 PERRIGO PHARMACEUTICALS yLANOLIN ANHY OIN 45802009025 PERRIGO PHARMACEUTICALS yLANOLIN OIN 45802009103 PERRIGO PHARMACEUTICALS yPETROLATUM GEL WHITE 45802009203 PERRIGO PHARMACEUTICALS yPETROLATUM GEL WHITE 45802009225 PERRIGO PHARMACEUTICALS yPETROLATUM GEL WHITE 45802009229 PERRIGO PHARMACEUTICALS yPETROLATUM GEL WHITE 45802009271 PERRIGO PHARMACEUTICALS yMESALAMINE ENE 4GM 45802009828 PERRIGO PHARMACEUTICALS yMESALAMINE ENE 4GM 45802009851 PERRIGO PHARMACEUTICALS yMOMETASONE SOL 0.1% 45802011846 PERRIGO PHARMACEUTICALS yMOMETASONE SOL 0.1% 45802011859 PERRIGO PHARMACEUTICALS yMOMETASONE OIN 0.1% 45802011937 PERRIGO PHARMACEUTICALS yMOMETASONE OIN 0.1% 45802011942 PERRIGO PHARMACEUTICALS yHALOBETASOL CRE 0.05% 45802012932 PERRIGO PHARMACEUTICALS yHALOBETASOL CRE 0.05% 45802012935 PERRIGO PHARMACEUTICALS yCALAMINE LOT 45802013082 PERRIGO PHARMACEUTICALS yHALOBETASOL OIN 0.05% 45802013132 PERRIGO PHARMACEUTICALS yHALOBETASOL OIN 0.05% 45802013135 PERRIGO PHARMACEUTICALS ySCAR CRE 45802015203 PERRIGO PHARMACEUTICALS yORASOL LIQ 45802016850 PERRIGO PHARMACEUTICALS yORASOL LIQ 45802016863 PERRIGO PHARMACEUTICALS yUREA CRE 40% 45802017003 PERRIGO PHARMACEUTICALS yUREA CRE 40% 45802017053 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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UREA CRE 40% 45802017077 PERRIGO PHARMACEUTICALS yUREA GEL 40% 45802017156 PERRIGO PHARMACEUTICALS yANTI CLEANSE SOL 10% 45802017365 PERRIGO PHARMACEUTICALS yEX STR MUSCL CRE RUB 45802017453 PERRIGO PHARMACEUTICALS yUREA LOT 40% 45802017655 PERRIGO PHARMACEUTICALS yMEDICATED CH CRE RUB 45802017772 PERRIGO PHARMACEUTICALS yMEDICATED CH CRE RUB 45802017788 PERRIGO PHARMACEUTICALS yDIAPER RELIE OIN 40% 45802017944 PERRIGO PHARMACEUTICALS yTRETINOIN CRE 0.025% 45802018202 PERRIGO PHARMACEUTICALS yTRETINOIN CRE 0.025% 45802018242 PERRIGO PHARMACEUTICALS yTRETINOIN CRE 0.1% 45802018302 PERRIGO PHARMACEUTICALS yTRETINOIN CRE 0.1% 45802018342 PERRIGO PHARMACEUTICALS yANESTHETIC GEL 20% 45802018501 PERRIGO PHARMACEUTICALS yHC AC/ALOE CRE 0.5% 45802019003 PERRIGO PHARMACEUTICALS yACNE TREAT CRE VF 10% 45802019503 PERRIGO PHARMACEUTICALS yFLUTICASONE OIN 0.005% 45802022111 PERRIGO PHARMACEUTICALS yFLUTICASONE OIN 0.005% 45802022135 PERRIGO PHARMACEUTICALS yFLUTICASONE OIN 0.005% 45802022137 PERRIGO PHARMACEUTICALS yFLUTICASONE CRE 0.05% 45802022211 PERRIGO PHARMACEUTICALS yFLUTICASONE CRE 0.05% 45802022235 PERRIGO PHARMACEUTICALS yFLUTICASONE CRE 0.05% 45802022237 PERRIGO PHARMACEUTICALS yDRAWING SALV OIN 20% 45802022903 PERRIGO PHARMACEUTICALS yWART LIQUID SOL 17% 45802023663 PERRIGO PHARMACEUTICALS yCORN&CALLUS SOL REMOVER 45802023961 PERRIGO PHARMACEUTICALS yCLOTRIMAZOLE CRE 1% 45802024101 PERRIGO PHARMACEUTICALS yMOMETASONE CRE 0.1% 45802025735 PERRIGO PHARMACEUTICALS yMOMETASONE CRE 0.1% 45802025742 PERRIGO PHARMACEUTICALS yCLINDAMYCIN PAD 1% 45802026337 PERRIGO PHARMACEUTICALS yCLINDAMYCIN PAD 1% 45802026393 PERRIGO PHARMACEUTICALS yHYDROCORT AC CRE 1% 45802027470 PERRIGO PHARMACEUTICALS yHYDROCORT AC OIN 1% 45802027603 PERRIGO PHARMACEUTICALS yHYDROCORT AC OIN 1% 45802027605 PERRIGO PHARMACEUTICALS ySORE THROAT AER 45802028282 PERRIGO PHARMACEUTICALS yHYDROCORT LOT 1% 45802028306 PERRIGO PHARMACEUTICALS yHYDROCORT LOT 1% 45802028346 PERRIGO PHARMACEUTICALS yANTIFUNGAL OIN 45802029903 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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A/B OTIC SOL 45802031156 PERRIGO PHARMACEUTICALS ySORE THROAT AER CHERRY 45802032782 PERRIGO PHARMACEUTICALS yANTISEPTIC PAD 45802034033 PERRIGO PHARMACEUTICALS yCALDYPHEN LOT 45802034182 PERRIGO PHARMACEUTICALS yCALDYPHEN LOT 45802034282 PERRIGO PHARMACEUTICALS yPREP-HEM OIN 45802035410 PERRIGO PHARMACEUTICALS yARTHRICREAM CRE 10% 45802035653 PERRIGO PHARMACEUTICALS ySALINE MIST SPR 0.65% 45802035758 PERRIGO PHARMACEUTICALS yANTI-ITCH CRE 45802035803 PERRIGO PHARMACEUTICALS yTRETINOIN CRE 0.05% 45802036102 PERRIGO PHARMACEUTICALS yTRETINOIN CRE 0.05% 45802036142 PERRIGO PHARMACEUTICALS yTRETINOIN GEL 0.01% 45802036235 PERRIGO PHARMACEUTICALS yTRETINOIN GEL 0.01% 45802036242 PERRIGO PHARMACEUTICALS yTRETINOIN GEL 0.025% 45802036335 PERRIGO PHARMACEUTICALS yTRETINOIN GEL 0.025% 45802036342 PERRIGO PHARMACEUTICALS yDESOXIMETAS GEL 0.05% 45802037135 PERRIGO PHARMACEUTICALS yDESOXIMETAS GEL 0.05% 45802037137 PERRIGO PHARMACEUTICALS yAUG BETAMET CRE 0.05% 45802037632 PERRIGO PHARMACEUTICALS yAUG BETAMET CRE 0.05% 45802037635 PERRIGO PHARMACEUTICALS yVITAMIN A&D OIN 45802039504 PERRIGO PHARMACEUTICALS yVITAMIN A&D OIN 45802039510 PERRIGO PHARMACEUTICALS yVITAMIN A&D OIN 45802039571 PERRIGO PHARMACEUTICALS yGAS RELIEF DRO 40/0.6ML 45802040649 PERRIGO PHARMACEUTICALS yNASAL RELIEF SPR 0.05% 45802041059 PERRIGO PHARMACEUTICALS yNASAL RELIEF SPR 0.05% 45802041060 PERRIGO PHARMACEUTICALS yACNE 10 LOT 10% 45802041349 PERRIGO PHARMACEUTICALS yAMMONIUM LAC LOT 12% 45802041926 PERRIGO PHARMACEUTICALS yAMMONIUM LAC LOT 12% 45802041954 PERRIGO PHARMACEUTICALS yDESONIDE CRE 0.05% 45802042235 PERRIGO PHARMACEUTICALS yDESONIDE CRE 0.05% 45802042237 PERRIGO PHARMACEUTICALS yDESONIDE OIN 0.05% 45802042335 PERRIGO PHARMACEUTICALS yDESONIDE OIN 0.05% 45802042337 PERRIGO PHARMACEUTICALS yTRIDESILON CRE 0.05% 45802042435 PERRIGO PHARMACEUTICALS yTRIDESILON CRE 0.05% 45802042437 PERRIGO PHARMACEUTICALS yTRIDESILON OIN 0.05% 45802042535 PERRIGO PHARMACEUTICALS yTRIDESILON OIN 0.05% 45802042537 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLOTRIMAZOLE CRE 1% 45802043401 PERRIGO PHARMACEUTICALS yCLOTRIMAZOLE CRE 1% 45802043411 PERRIGO PHARMACEUTICALS yHYDROCORT CRE 1% 45802043802 PERRIGO PHARMACEUTICALS yHYDROCORT CRE 1% 45802043803 PERRIGO PHARMACEUTICALS yHYDROCORT CRE 1% 45802043805 PERRIGO PHARMACEUTICALS yHYDROCORT CRE 1% 45802043870 PERRIGO PHARMACEUTICALS yHC VALERATE CRE 0.2% 45802045535 PERRIGO PHARMACEUTICALS yHC VALERATE CRE 0.2% 45802045537 PERRIGO PHARMACEUTICALS yHC VALERATE CRE 0.2% 45802045542 PERRIGO PHARMACEUTICALS yKETOCONAZOLE SHA 2% 45802046564 PERRIGO PHARMACEUTICALS yECONAZOLE CRE 1% 45802046611 PERRIGO PHARMACEUTICALS yECONAZOLE CRE 1% 45802046635 PERRIGO PHARMACEUTICALS yECONAZOLE CRE 1% 45802046653 PERRIGO PHARMACEUTICALS yAMMONIUM LAC CRE 12% 45802049326 PERRIGO PHARMACEUTICALS yAMMONIUM LAC CRE 12% 45802049383 PERRIGO PHARMACEUTICALS yDESOXIMETAS CRE 0.25% 45802049535 PERRIGO PHARMACEUTICALS yDESOXIMETAS CRE 0.25% 45802049537 PERRIGO PHARMACEUTICALS yEAR DROPS SOL 6.5% OT 45802049756 PERRIGO PHARMACEUTICALS yAMMONIUM LAC LOT 12% 45802052526 PERRIGO PHARMACEUTICALS yAMMONIUM LAC LOT 12% 45802052555 PERRIGO PHARMACEUTICALS yTHERA-P HAND LOT & BODY 45802059355 PERRIGO PHARMACEUTICALS yDERMALUBE LOT 45802060317 PERRIGO PHARMACEUTICALS yMOISTURIN CRE 45802061204 PERRIGO PHARMACEUTICALS yMOISTURIN CRE 45802061205 PERRIGO PHARMACEUTICALS yBISACODYL SUP 10MG 45802071030 PERRIGO PHARMACEUTICALS yBISACODYL SUP 10MG 45802071032 PERRIGO PHARMACEUTICALS yBISACODYL SUP 10MG 45802071033 PERRIGO PHARMACEUTICALS yGLYCERIN SUP 3GM 45802071533 PERRIGO PHARMACEUTICALS yGLYCERIN SUP 1.5GM 45802071630 PERRIGO PHARMACEUTICALS yGLYCERIN SUP 1.5GM 45802071631 PERRIGO PHARMACEUTICALS yTERCONAZOLE SUP 80MG 45802071708 PERRIGO PHARMACEUTICALS yTRIMETHOBENZ SUP 100MG 45802072332 PERRIGO PHARMACEUTICALS yTRIMETHOBENZ SUP 100MG 45802072390 PERRIGO PHARMACEUTICALS yHYDROCORT AC SUP 25MG 45802072530 PERRIGO PHARMACEUTICALS yHYDROCORT AC SUP 25MG 45802072531 PERRIGO PHARMACEUTICALS yACETAMIN SUP 650MG 45802073030 PERRIGO PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACETAMIN SUP 650MG 45802073032 PERRIGO PHARMACEUTICALS yACETAMIN SUP 650MG 45802073033 PERRIGO PHARMACEUTICALS yACETAMIN SUP 650MG 45802073034 PERRIGO PHARMACEUTICALS yACETAMIN SUP 120MG 45802073230 PERRIGO PHARMACEUTICALS yACETAMIN SUP 120MG 45802073232 PERRIGO PHARMACEUTICALS yACETAMIN SUP 120MG 45802073233 PERRIGO PHARMACEUTICALS yVERSAL SUP HEMORRHO 45802074230 PERRIGO PHARMACEUTICALS yPREP-HEM SUP 45802075230 PERRIGO PHARMACEUTICALS yPREP-HEM SUP 45802075231 PERRIGO PHARMACEUTICALS yPROMETHAZINE SUP 12.5MG 45802075830 PERRIGO PHARMACEUTICALS yPROMETHAZINE SUP 25MG 45802075930 PERRIGO PHARMACEUTICALS yGLIMEPIRIDE TAB 1MG 45802077078 PERRIGO PHARMACEUTICALS yGLIMEPIRIDE TAB 4MG 45802094778 PERRIGO PHARMACEUTICALS yLISTERINE LIQ ANTISEPT 00501100003 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ ANTISEPT 00501100070 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ ANTISEPT 00501100071 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ ANTISEPT 00501100072 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ ANTISEPT 00501100073 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ COOLMINT 00501100103 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ COOLMINT 00501100170 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ COOLMINT 00501100171 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ COOLMINT 00501100172 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ COOLMINT 00501100173 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ FRSHBRST 00501100303 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ FRSHBRST 00501100370 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ FRSHBRST 00501100371 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ FRSHBRST 00501100372 PFIZER CONSUMER HEALTHCARE yLISTERINE LIQ FRSHBRST 00501100373 PFIZER CONSUMER HEALTHCARE yBENADRYL CAP 25MG 00501200024 PFIZER CONSUMER HEALTHCARE yBENADRYL CAP 25MG 00501200048 PFIZER CONSUMER HEALTHCARE yBENADRYL DF CAP 25MG 00501200124 PFIZER CONSUMER HEALTHCARE yBENADRYL AL/ TAB SIN/HEAD 00501200524 PFIZER CONSUMER HEALTHCARE yBENADRYL AL/ TAB SIN/HEAD 00501200548 PFIZER CONSUMER HEALTHCARE yBENADRYL TAB 25MG 00501200924 PFIZER CONSUMER HEALTHCARE yBENADRYL TAB 25MG 00501200999 PFIZER CONSUMER HEALTHCARE yBENADRYL CHW ALLERGY 00501201024 PFIZER CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACTIFED TAB 2.5-60MG 00501201712 PFIZER CONSUMER HEALTHCARE yACTIFED TAB 2.5-60MG 00501201724 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL TAB FASTMELT 00501202220 PFIZER CONSUMER HEALTHCARE yBENADRYL-D LIQ ALLRGY/S 00501204104 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL MIS 25MG 00501204310 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL MIS 25MG 00501204320 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL MIS 12.5MG 00501204410 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL LIQ 12.5/5ML 00501205004 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL LIQ 12.5/5ML 00501205008 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL LIQ 12.5/5ML 00501205304 PFIZER CONSUMER HEALTHCARE yACTIFED COLD TAB /SINUS 00501208420 PFIZER CONSUMER HEALTHCARE ySINUTAB CAP NON-DRY 00501220524 PFIZER CONSUMER HEALTHCARE ySUDAFED CAP NON-DROW 00501220624 PFIZER CONSUMER HEALTHCARE ySINUTAB SINU TAB NO DROWS 00501220824 PFIZER CONSUMER HEALTHCARE yPEDIACARE DRO DCON/CGH 00501241005 PFIZER CONSUMER HEALTHCARE yPEDIACARE DRO LONG-ACT 00501242105 PFIZER CONSUMER HEALTHCARE ySUDAFED CAP CLD&CGH 00501267710 PFIZER CONSUMER HEALTHCARE ySUDAFED CAP CLD&CGH 00501267720 PFIZER CONSUMER HEALTHCARE ySUDAFED SINU TAB 2.5-60MG 00501275112 PFIZER CONSUMER HEALTHCARE ySUDAFED 12HR TAB 120MG CR 00501278710 PFIZER CONSUMER HEALTHCARE ySUDAFED 12HR TAB 120MG CR 00501278720 PFIZER CONSUMER HEALTHCARE ySUDAFED 24HR TAB NON-DROW 00501279005 PFIZER CONSUMER HEALTHCARE ySUDAFED 24HR TAB NON-DROW 00501279010 PFIZER CONSUMER HEALTHCARE ySUDAFED CHLD CHW NON-DRSY 00501286024 PFIZER CONSUMER HEALTHCARE ySUDAFED CHLD LIQ CLD&CGH 00501287604 PFIZER CONSUMER HEALTHCARE yCHILD SUDAFE LIQ 15MG/5ML 00501288004 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB 10MG 00501290218 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB 10MG 00501290231 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB 10MG 00501290279 PFIZER CONSUMER HEALTHCARE ySINUTAB SINU TAB MAX STR 00501290424 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL TAB SINUS 00501290524 PFIZER CONSUMER HEALTHCARE yBENADRYL ALL TAB SINUS 00501290548 PFIZER CONSUMER HEALTHCARE yBENADRYL TAB ALL/COLD 00501290624 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB NGHT/CLD 00501290720 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB CLD/CGH 00501290910 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB CLD/CGH 00501290920 PFIZER CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SUDAFED PE TAB SEV/COLD 00501291612 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB SEV/COLD 00501291624 PFIZER CONSUMER HEALTHCARE ySUDAFED PE TAB SINUS 00501291724 PFIZER CONSUMER HEALTHCARE ySUDAFED PE MIS QUICK/DS 00501291810 PFIZER CONSUMER HEALTHCARE yPROXACOL SOL 3% 00501300108 PFIZER CONSUMER HEALTHCARE yPROXACOL SOL 3% 00501300135 PFIZER CONSUMER HEALTHCARE yLUBRIDERM DA LOT SPF 15 00501311006 PFIZER CONSUMER HEALTHCARE yLUBRIDERM DA LOT SPF 15 00501311016 PFIZER CONSUMER HEALTHCARE yLUBRIDERM DA LOT SPF 15 00501311099 PFIZER CONSUMER HEALTHCARE yBENADRYL ITC CRE STOP 1% 00501320001 PFIZER CONSUMER HEALTHCARE yBENADRYL M-S CRE 2% 00501320101 PFIZER CONSUMER HEALTHCARE yBENADRYL M-S SPR 2% 00501320302 PFIZER CONSUMER HEALTHCARE yBENADRYL ITC LIQ STICK 00501320433 PFIZER CONSUMER HEALTHCARE yBENADRYL ITC GEL 2% 00501320704 PFIZER CONSUMER HEALTHCARE yCALADRYL LOT 00501325006 PFIZER CONSUMER HEALTHCARE yCALADRYL LOT CLEAR 00501325106 PFIZER CONSUMER HEALTHCARE yDESITIN CRE CREAMY 00501340102 PFIZER CONSUMER HEALTHCARE yDESITIN CRE CREAMY 00501340104 PFIZER CONSUMER HEALTHCARE yNEOSPORIN OIN ORIGINAL 00501373001 PFIZER CONSUMER HEALTHCARE yNEOSPORIN OIN ORIGINAL 00501373005 PFIZER CONSUMER HEALTHCARE yNEOSPORIN OIN ORIGINAL 00501373010 PFIZER CONSUMER HEALTHCARE yNEOSPORIN OIN ORIGINAL 00501373011 PFIZER CONSUMER HEALTHCARE yPOLYSPORIN POW 00501379310 PFIZER CONSUMER HEALTHCARE yPOLYSPORIN OIN 00501379801 PFIZER CONSUMER HEALTHCARE yPOLYSPORIN OIN 00501379805 PFIZER CONSUMER HEALTHCARE yPOLYSPORIN OIN 00501379811 PFIZER CONSUMER HEALTHCARE yTUCKS PAD 00501410040 PFIZER CONSUMER HEALTHCARE yTUCKS PAD 00501410099 PFIZER CONSUMER HEALTHCARE yTUCKS OIN 00501410401 PFIZER CONSUMER HEALTHCARE yTUCKS OIN 1% 00501410507 PFIZER CONSUMER HEALTHCARE yTUCKS SUP 51% 00501410612 PFIZER CONSUMER HEALTHCARE yTUCKS SUP 51% 00501410624 PFIZER CONSUMER HEALTHCARE yKAOPECTATE CAP 240MG 00501502010 PFIZER CONSUMER HEALTHCARE yKAOPECTATE CAP 240MG 00501502030 PFIZER CONSUMER HEALTHCARE yKAOPECTATE CAP 240MG 00501502099 PFIZER CONSUMER HEALTHCARE yGELUSIL CHW 00501510499 PFIZER CONSUMER HEALTHCARE y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZANTAC 75 TAB 00501520004 PFIZER CONSUMER HEALTHCARE yZANTAC 75 TAB 00501520010 PFIZER CONSUMER HEALTHCARE yZANTAC 75 TAB 00501520020 PFIZER CONSUMER HEALTHCARE yZANTAC 75 TAB 00501520030 PFIZER CONSUMER HEALTHCARE yZANTAC 75 TAB 00501520061 PFIZER CONSUMER HEALTHCARE yZANTAC 75 TAB 00501520080 PFIZER CONSUMER HEALTHCARE yZANTAC 150 TAB MAX STR 00501520208 PFIZER CONSUMER HEALTHCARE yZANTAC 150 TAB MAX STR 00501520250 PFIZER CONSUMER HEALTHCARE yZANTAC 150 TAB MAX STR 00501520269 PFIZER CONSUMER HEALTHCARE yROLAIDS CHW 00501541431 PFIZER CONSUMER HEALTHCARE yROLAIDS CHW 00501541631 PFIZER CONSUMER HEALTHCARE yROLAIDS CHW EX ST 00501542030 PFIZER CONSUMER HEALTHCARE yROLAIDS CHW EX ST 00501542130 PFIZER CONSUMER HEALTHCARE yROLAIDS CHW EX ST 00501542230 PFIZER CONSUMER HEALTHCARE yROLAIDS MULT CHW SYMPTOM 00501544030 PFIZER CONSUMER HEALTHCARE yROLAIDS MULT CHW SYMPTOM 00501544130 PFIZER CONSUMER HEALTHCARE yNICOTROL INH 00501630496 PFIZER CONSUMER HEALTHCARE yNICOTROL NS SPR 10MG/ML 00501630604 PFIZER CONSUMER HEALTHCARE yBEN GAY CRE GREASLES 00501750104 PFIZER CONSUMER HEALTHCARE yCORTEF TAB 5MG 00009001201 PFIZER, INC yHALCION TAB 0.25MG 00009001702 PFIZER, INC yHALCION TAB 0.25MG 00009001755 PFIZER, INC yHALCION TAB 0.25MG 00009001759 PFIZER, INC yMEDROL TAB 8MG 00009002201 PFIZER, INC yDIDREX TAB 50MG 00009002401 PFIZER, INC yDIDREX TAB 50MG 00009002402 PFIZER, INC yXANAX TAB 0.25MG 00009002901 PFIZER, INC yXANAX TAB 0.25MG 00009002902 PFIZER, INC yXANAX TAB 0.25MG 00009002914 PFIZER, INC yXANAX TAB 0.25MG 00009002946 PFIZER, INC yCORTEF TAB 10MG 00009003101 PFIZER, INC yCORTEF TAB 20MG 00009004401 PFIZER, INC yMEDROL TAB 2MG 00009004902 PFIZER, INC yPROVERA TAB 10MG 00009005002 PFIZER, INC yPROVERA TAB 10MG 00009005009 PFIZER, INC yPROVERA TAB 10MG 00009005011 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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XANAX TAB 0.5MG 00009005501 PFIZER, INC yXANAX TAB 0.5MG 00009005503 PFIZER, INC yXANAX TAB 0.5MG 00009005515 PFIZER, INC yXANAX TAB 0.5MG 00009005546 PFIZER, INC yMEDROL TAB 4MG 00009005602 PFIZER, INC yMEDROL TAB 4MG 00009005603 PFIZER, INC yMEDROL PAK 4MG 00009005604 PFIZER, INC yMEDROL TAB 4MG 00009005605 PFIZER, INC yXANAX XR TAB 0.5MG 00009005707 PFIZER, INC yXANAX XR TAB 1MG 00009005907 PFIZER, INC yPROVERA TAB 2.5MG 00009006404 PFIZER, INC yPROVERA TAB 2.5MG 00009006406 PFIZER, INC yXANAX XR TAB 2MG 00009006607 PFIZER, INC yXANAX XR TAB 3MG 00009006807 PFIZER, INC yMEDROL TAB 16MG 00009007301 PFIZER, INC yXANAX TAB 1MG 00009009001 PFIZER, INC yXANAX TAB 1MG 00009009004 PFIZER, INC yXANAX TAB 1MG 00009009013 PFIZER, INC yXANAX TAB 2MG 00009009401 PFIZER, INC yXANAX TAB 2MG 00009009403 PFIZER, INC ySOLU-MEDROL INJ 40MG 00009011319 PFIZER, INC yMICRONASE TAB 1.25MG 00009013101 PFIZER, INC yMICRONASE TAB 2.5MG 00009014101 PFIZER, INC yMICRONASE TAB 5MG 00009017105 PFIZER, INC yMICRONASE TAB 5MG 00009017106 PFIZER, INC yMICRONASE TAB 5MG 00009017107 PFIZER, INC yMICRONASE TAB 5MG 00009017111 PFIZER, INC yMICRONASE TAB 5MG 00009017112 PFIZER, INC yMEDROL TAB 32MG 00009017601 PFIZER, INC ySOLU-MEDROL INJ 125MG 00009019016 PFIZER, INC yCLEOCIN CAP 150MG 00009022502 PFIZER, INC yCLEOCIN CAP 150MG 00009022503 PFIZER, INC yBACITRACIN INJ 50000UNT 00009023301 PFIZER, INC yDEPO-TESTAD INJ 50MG-2MG 00009025302 PFIZER, INC yCOLESTID POW 5GM 00009026001 PFIZER, INC yCOLESTID GRA 5GM 00009026002 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COLESTID POW 5GM 00009026004 PFIZER, INC yCOLESTID GRA 5GM 00009026017 PFIZER, INC yDEPO-ESTRADI INJ 5MG/ML 00009027101 PFIZER, INC yDEPO-MEDROL INJ 20MG/ML 00009027401 PFIZER, INC yDEPO-MEDROL INJ 40MG/ML 00009028002 PFIZER, INC yDEPO-MEDROL INJ 40MG/ML 00009028003 PFIZER, INC yDEPO-MEDROL INJ 40MG/ML 00009028051 PFIZER, INC yDEPO-MEDROL INJ 40MG/ML 00009028052 PFIZER, INC yPROVERA TAB 5MG 00009028603 PFIZER, INC yPROVERA TAB 5MG 00009028632 PFIZER, INC yANSAID TAB 100MG 00009030503 PFIZER, INC yDEPO-MEDROL INJ 80MG/ML 00009030602 PFIZER, INC yDEPO-MEDROL INJ 80MG/ML 00009030612 PFIZER, INC yCLEOCIN CAP 75MG 00009033102 PFIZER, INC yGLYNASE TAB 1.5MG 00009034101 PFIZER, INC yDEPO-TESTOST INJ 100MG/ML 00009034702 PFIZER, INC yGLYNASE TAB 3MG 00009035201 PFIZER, INC yGLYNASE TAB 3MG 00009035204 PFIZER, INC yCOLESTID FLA GRA 5/7.5GM 00009037003 PFIZER, INC yCOLESTID FLA GRA 5GM 00009037005 PFIZER, INC yCLEOCIN CAP 300MG 00009039502 PFIZER, INC yCLEOCIN CAP 300MG 00009039514 PFIZER, INC yDEPO-TESTOST INJ 200MG/ML 00009041701 PFIZER, INC yDEPO-TESTOST INJ 200MG/ML 00009041702 PFIZER, INC yR-GENE 10 INJ 10% 00009043624 PFIZER, INC yCOLESTID TAB 1GM 00009045003 PFIZER, INC yLINCOCIN INJ 300MG/ML 00009055501 PFIZER, INC yLINCOCIN INJ 300MG/ML 00009055502 PFIZER, INC yDEPO-PROVERA INJ 400/ML 00009062601 PFIZER, INC ySOLU-MEDROL INJ 1000MG 00009069801 PFIZER, INC yCLEOCIN INJ 9GM 00009072805 PFIZER, INC yCLEOCIN PHOS INJ 9GM 00009072809 PFIZER, INC yDEPO-PROVERA INJ 150MG/ML 00009074630 PFIZER, INC yDEPO-PROVERA INJ 150MG/ML 00009074635 PFIZER, INC ySOLU-MEDROL INJ 500MG 00009075801 PFIZER, INC yCLEOCIN PED SOL 75MG/5ML 00009076004 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SOLU-MEDROL INJ 500MG 00009076502 PFIZER, INC yCLEOCIN PHOS INJ 600MG 00009077526 PFIZER, INC ySOLU-MEDROL INJ 2GM 00009079601 PFIZER, INC ySOLU-CORTEF INJ 100MG 00009082501 PFIZER, INC yPROSTIN E2 SUP 20MG 00009082703 PFIZER, INC yHEMABATE INJ 250MCG 00009085608 PFIZER, INC yCLEOCIN PHOS INJ 300MG 00009087026 PFIZER, INC ySOLU-CORTEF INJ 100MG 00009090013 PFIZER, INC ySOLU-CORTEF INJ 100MG 00009090020 PFIZER, INC yCLEOCIN PHOS INJ 900MG 00009090211 PFIZER, INC yCLEOCIN PHOS INJ 900MG 00009090218 PFIZER, INC ySOLU-CORTEF INJ 250MG 00009090908 PFIZER, INC ySOLU-CORTEF INJ 250MG 00009090916 PFIZER, INC ySOLU-CORTEF INJ 500MG 00009091205 PFIZER, INC ySOLU-CORTEF INJ 1000MG 00009092003 PFIZER, INC yDEPO-MEDROL INJ 40MG/ML 00009307301 PFIZER, INC yDEPO-MEDROL INJ 40MG/ML 00009307303 PFIZER, INC yCLEOCIN-T SOL 1% 00009311601 PFIZER, INC yCLEOCIN-T SOL 1% 00009311602 PFIZER, INC yCLEOCIN-T PAD 1% 00009311614 PFIZER, INC yCLEOCIN PHOS INJ 600MG 00009312403 PFIZER, INC yPROSTIN VR INJ 500MCG 00009316906 PFIZER, INC yCLEOCIN-T LOT 1% 00009332901 PFIZER, INC yCLEOCIN-T GEL 1% 00009333101 PFIZER, INC yCLEOCIN-T GEL 1% 00009333102 PFIZER, INC yPREPIDIL GEL 0.5MG/3G 00009335902 PFIZER, INC yCLEOCIN INJ 600MG 00009337502 PFIZER, INC yCLEOCIN INJ 300MG 00009338102 PFIZER, INC yCLEOCIN INJ 900MG 00009338202 PFIZER, INC ySOLU-MEDROL INJ 1000MG 00009338901 PFIZER, INC yCLEOCIN PHOS INJ 900MG 00009344703 PFIZER, INC yCLEOCIN VAG CRE 2% 00009344801 PFIZER, INC yGLYNASE TAB 6MG 00009344901 PFIZER, INC yGLYNASE TAB 6MG 00009344903 PFIZER, INC yDEPO-MEDROL INJ 80MG/ML 00009347501 PFIZER, INC yDEPO-MEDROL INJ 80MG/ML 00009347503 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VANTIN SUS 50MG/5ML 00009353101 PFIZER, INC yVANTIN SUS 50MG/5ML 00009353103 PFIZER, INC yVANTIN SUS 100/5ML 00009361501 PFIZER, INC yVANTIN SUS 100/5ML 00009361503 PFIZER, INC yVANTIN TAB 100MG 00009361701 PFIZER, INC yVANTIN TAB 100MG 00009361702 PFIZER, INC yVANTIN TAB 200MG 00009361801 PFIZER, INC yVANTIN TAB 200MG 00009361802 PFIZER, INC yDRAMAMINE TAB 50MG 00009364202 PFIZER, INC yDRAMAMINE TAB 50MG 00009364219 PFIZER, INC yDRAMAMINE TAB 25MG 00009364804 PFIZER, INC yCAVERJECT INJ 20MCG 00009370105 PFIZER, INC yOGEN TAB 0.625 00009377201 PFIZER, INC yOGEN TAB 1.25 00009377301 PFIZER, INC yOGEN TAB 2.5 00009377401 PFIZER, INC yROGAINE SOL 2% MEN 00009377901 PFIZER, INC yROGAINE SOL 2% MEN 00009377906 PFIZER, INC yROGAINE SOL 2% MEN 00009377907 PFIZER, INC yROGAINE SOL 2% MEN 00009377908 PFIZER, INC yROGAINE SOL 2% MEN 00009377911 PFIZER, INC yROGAINE SOL 2% MEN 00009377912 PFIZER, INC yROGAINE SOL 2% WOMEN 00009378001 PFIZER, INC yROGAINE SOL 2% WOMEN 00009378006 PFIZER, INC yROGAINE SOL 2% WOMEN 00009378007 PFIZER, INC yROGAINE SOL 2% WOMEN 00009378011 PFIZER, INC yROGAINE SOL 2% WOMEN 00009378012 PFIZER, INC yCORVERT INJ 0.1MG/ML 00009379401 PFIZER, INC yDETROL TAB 1MG 00009454101 PFIZER, INC yDETROL TAB 1MG 00009454102 PFIZER, INC yDETROL TAB 1MG 00009454103 PFIZER, INC yDETROL TAB 2MG 00009454401 PFIZER, INC yDETROL TAB 2MG 00009454402 PFIZER, INC yDETROL TAB 2MG 00009454403 PFIZER, INC yDEPO-SQ PROV INJ 104 00009470901 PFIZER, INC yGLYSET TAB 25MG 00009501201 PFIZER, INC yGLYSET TAB 50MG 00009501301 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GLYSET TAB 100MG 00009501401 PFIZER, INC yELLENCE INJ 2MG/ML 00009509101 PFIZER, INC yELLENCE INJ 2MG/ML 00009509301 PFIZER, INC yZYVOX TAB 600MG 00009513502 PFIZER, INC yZYVOX TAB 600MG 00009513503 PFIZER, INC yZYVOX SUS 100MG/5M 00009513601 PFIZER, INC yZYVOX SOL 2MG/ML 00009513701 PFIZER, INC yZYVOX SOL 2MG/ML 00009514001 PFIZER, INC ySOMAVERT INJ 10MG 00009517601 PFIZER, INC ySOMAVERT INJ 15MG 00009517801 PFIZER, INC ySOMAVERT INJ 20MG 00009518001 PFIZER, INC yCAVERJECT KIT 10MCG 00009518101 PFIZER, INC yCAVERJECT KIT 20MCG 00009518201 PFIZER, INC yDETROL LA CAP 2MG 00009519001 PFIZER, INC yDETROL LA CAP 2MG 00009519002 PFIZER, INC yDETROL LA CAP 2MG 00009519003 PFIZER, INC yDETROL LA CAP 2MG 00009519004 PFIZER, INC yDETROL LA CAP 4MG 00009519101 PFIZER, INC yDETROL LA CAP 4MG 00009519102 PFIZER, INC yDETROL LA CAP 4MG 00009519103 PFIZER, INC yDETROL LA CAP 4MG 00009519104 PFIZER, INC yNICOTROL INH 00009519508 PFIZER, INC yKAOPECTATE SUS 262/15ML 00009521301 PFIZER, INC yKAOPECTATE SUS 262/15ML 00009521302 PFIZER, INC yKAOPECTATE SUS 262/15ML 00009521402 PFIZER, INC yKAOPECTATE SUS 262/15ML 00009521403 PFIZER, INC yPEDIACARE CHW 00009523301 PFIZER, INC yPEDIACARE CHW 00009523401 PFIZER, INC yKAOPECTATE SUS 87MG/5ML 00009527101 PFIZER, INC yDOXIDAN TAB 5MG EC 00009527401 PFIZER, INC yDOXIDAN TAB 5MG EC 00009527402 PFIZER, INC yDOXIDAN TAB 5MG EC 00009527403 PFIZER, INC yATGAM INJ 250MG 00009722402 PFIZER, INC yDEPO-PROVERA INJ 150MG/ML 00009737604 PFIZER, INC yMOTRIN TAB 400MG 00009738501 PFIZER, INC yMOTRIN TAB 400MG 00009738502 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MOTRIN TAB 600MG 00009738601 PFIZER, INC yMOTRIN TAB 600MG 00009738602 PFIZER, INC yMOTRIN TAB 800MG 00009738701 PFIZER, INC yMOTRIN TAB 800MG 00009738702 PFIZER, INC yMOTRIN TAB 800MG 00009738703 PFIZER, INC yMOTRIN TAB 800MG 00009738704 PFIZER, INC yMOTRIN TAB 800MG 00009738705 PFIZER, INC yCAMPTOSAR INJ 20MG/ML 00009752901 PFIZER, INC yCAMPTOSAR INJ 20MG/ML 00009752902 PFIZER, INC yDOXIDAN CAP 100-30 00009757204 PFIZER, INC yEMETROL SOL LEMONMIN 00009757301 PFIZER, INC yEMETROL SOL CHERRY 00009757401 PFIZER, INC yEMETROL SOL CHERRY 00009757402 PFIZER, INC yAROMASIN TAB 25MG 00009766304 PFIZER, INC yCLEOCIN SUP 100MG 00009766701 PFIZER, INC yCAVERJECT INJ 40MCG 00009768604 PFIZER, INC yNASALCROM SPR 5.2/ACT 00009770901 PFIZER, INC yNASALCROM SPR 5.2/ACT 00009770902 PFIZER, INC yPEDIACARE LIQ NITEREST 00009771301 PFIZER, INC yPEDIACARE DRO 7.5/0.8 00009771401 PFIZER, INC yPEDIACARE SOL DCON/CGH 00009771501 PFIZER, INC yPEDIACARE LIQ MULTI-SY 00009771601 PFIZER, INC yMICATIN CRE 2% 00009771802 PFIZER, INC yMICATIN CRE 2% 00009771803 PFIZER, INC yMICATIN JOCK CRE 2% 00009771902 PFIZER, INC yMICATIN AER 2% POWDR 00009772001 PFIZER, INC yMICATIN JOCK AER 2% POWDR 00009772101 PFIZER, INC yMICATIN DEOD AER 2% POWDR 00009772216 PFIZER, INC yMICATIN AER 2% 00009772413 PFIZER, INC yUNASYN INJ 1.5GM 00049001383 PFIZER, INC yUNASYN INJ 3GM 00049001483 PFIZER, INC yUNASYN INJ 1.5GM PB 00049002283 PFIZER, INC yUNASYN INJ 3GM PBU 00049002383 PFIZER, INC yUNASYN INJ 15GM 00049002428 PFIZER, INC yUNASYN INJ 1.5GM 00049003183 PFIZER, INC yUNASYN INJ 3GM 00049003283 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PFIZERPEN G INJ 5MU 00049052083 PFIZER, INC yPFIZERPEN G INJ 20MU 00049053028 PFIZER, INC yERAXIS INJ 50MG 00049101028 PFIZER, INC yGEOCILLIN TAB 382MG 00049143066 PFIZER, INC yGLUCOTROL XL TAB 5MG 00049155066 PFIZER, INC yGLUCOTROL XL TAB 5MG 00049155073 PFIZER, INC yGLUCOTROL XL TAB 10MG 00049156066 PFIZER, INC yGLUCOTROL XL TAB 10MG 00049156073 PFIZER, INC yGLUCOTROL XL TAB 2.5MG 00049162030 PFIZER, INC yANTIVERT TAB 12.5MG 00049210066 PFIZER, INC yANTIVERT TAB 25MG 00049211066 PFIZER, INC yANTIVERT TAB 50MG 00049214066 PFIZER, INC yRELPAX TAB 20MG 00049233034 PFIZER, INC yRELPAX TAB 20MG 00049233045 PFIZER, INC yRELPAX TAB 40MG 00049234034 PFIZER, INC yRELPAX TAB 40MG 00049234045 PFIZER, INC yCARDURA XL TAB 4MG 00049271030 PFIZER, INC yCARDURA XL TAB 8MG 00049272030 PFIZER, INC yCARDURA TAB 1MG 00049275066 PFIZER, INC yCARDURA TAB 2MG 00049276066 PFIZER, INC yCARDURA TAB 4MG 00049277066 PFIZER, INC yCARDURA TAB 8MG 00049278066 PFIZER, INC yVFEND SUS 40MG/ML 00049316044 PFIZER, INC yVFEND TAB 50MG 00049317030 PFIZER, INC yVFEND TAB 200MG 00049318030 PFIZER, INC yVFEND IV INJ 200MG 00049319028 PFIZER, INC yDIFLUCAN/ INJ NACL 200 00049337126 PFIZER, INC yDIFLUCAN/ INJ NACL 400 00049337226 PFIZER, INC yDIFLUCAN TAB 50MG 00049341030 PFIZER, INC yDIFLUCAN TAB 100MG 00049342030 PFIZER, INC yDIFLUCAN TAB 100MG 00049342041 PFIZER, INC yDIFLUCAN TAB 200MG 00049343030 PFIZER, INC yDIFLUCAN TAB 200MG 00049343041 PFIZER, INC yDIFLUCAN/ INJ NACL 200 00049343526 PFIZER, INC yDIFLUCAN/ INJ NACL 400 00049343626 PFIZER, INC yDIFLUCAN/DEX INJ 2MG/ML 00049343726 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIFLUCAN/DEX INJ 2MG/ML 00049343826 PFIZER, INC yDIFLUCAN SUS 10MG/ML 00049344019 PFIZER, INC yDIFLUCAN SUS 40MG/ML 00049345019 PFIZER, INC yDIFLUCAN TAB 150MG 00049350079 PFIZER, INC yGEODON INJ 20MG 00049392083 PFIZER, INC yGEODON CAP 20MG 00049396041 PFIZER, INC yGEODON CAP 20MG 00049396060 PFIZER, INC yGEODON CAP 40MG 00049397041 PFIZER, INC yGEODON CAP 40MG 00049397060 PFIZER, INC yGEODON CAP 60MG 00049398041 PFIZER, INC yGEODON CAP 60MG 00049398060 PFIZER, INC yGEODON CAP 80MG 00049399041 PFIZER, INC yGEODON CAP 80MG 00049399060 PFIZER, INC yGLUCOTROL TAB 5MG 00049411066 PFIZER, INC yGLUCOTROL TAB 5MG 00049411073 PFIZER, INC yGLUCOTROL TAB 10MG 00049412066 PFIZER, INC yGLUCOTROL TAB 10MG 00049412073 PFIZER, INC yZOLOFT TAB 50MG 00049490030 PFIZER, INC yZOLOFT TAB 50MG 00049490041 PFIZER, INC yZOLOFT TAB 50MG 00049490066 PFIZER, INC yZOLOFT TAB 50MG 00049490073 PFIZER, INC yZOLOFT TAB 50MG 00049490094 PFIZER, INC yZOLOFT TAB 100MG 00049491030 PFIZER, INC yZOLOFT TAB 100MG 00049491041 PFIZER, INC yZOLOFT TAB 100MG 00049491066 PFIZER, INC yZOLOFT TAB 100MG 00049491073 PFIZER, INC yZOLOFT TAB 100MG 00049491094 PFIZER, INC yZOLOFT CON 20MG/ML 00049494023 PFIZER, INC yZOLOFT TAB 25MG 00049496030 PFIZER, INC yZOLOFT TAB 25MG 00049496050 PFIZER, INC ySINEQUAN CAP 10MG 00049534066 PFIZER, INC ySINEQUAN CAP 25MG 00049535066 PFIZER, INC ySINEQUAN CAP 50MG 00049536066 PFIZER, INC ySINEQUAN CAP 75MG 00049539066 PFIZER, INC yNAVANE CAP 2MG 00049572066 PFIZER, INC yNAVANE CAP 5MG 00049573066 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NAVANE CAP 10MG 00049574066 PFIZER, INC yNAVANE CAP 20MG 00049577066 PFIZER, INC yEXUBERA COMB POW PACK 12 00069005019 PFIZER, INC yEXUBERA COMB POW PACK 15 00069005053 PFIZER, INC yEXUBERA POW KIT 00069005085 PFIZER, INC yCHANTIX TAB 0.5MG 00069046856 PFIZER, INC yCHANTIX TAB 1MG 00069046956 PFIZER, INC yCHANTIX PAK 1MG 00069046997 PFIZER, INC yCHANTIX PAK 00069047197 PFIZER, INC ySUTENT CAP 12.5MG 00069055030 PFIZER, INC ySUTENT CAP 12.5MG 00069055038 PFIZER, INC ySUTENT CAP 25MG 00069077030 PFIZER, INC ySUTENT CAP 25MG 00069077038 PFIZER, INC yVIBRAMYCIN CAP 100MG 00069095050 PFIZER, INC yVIBRAMYCIN SUS 25MG/5ML 00069097065 PFIZER, INC yVIBRAMYCIN SYP 50MG/5ML 00069097193 PFIZER, INC ySUTENT CAP 50MG 00069098030 PFIZER, INC ySUTENT CAP 50MG 00069098038 PFIZER, INC yVIBRATAB TAB 100MG 00069099050 PFIZER, INC yZYRTEC CHW 5MG 00069144003 PFIZER, INC yZYRTEC CHW 10MG 00069145003 PFIZER, INC yNORVASC TAB 2.5MG 00069152068 PFIZER, INC yNORVASC TAB 5MG 00069153041 PFIZER, INC yNORVASC TAB 5MG 00069153068 PFIZER, INC yNORVASC TAB 5MG 00069153072 PFIZER, INC yNORVASC TAB 10MG 00069154041 PFIZER, INC yNORVASC TAB 10MG 00069154068 PFIZER, INC yZYRTEC-D TAB 5-120MG 00069163066 PFIZER, INC yCADUET TAB 5MG/10MG 00069215030 PFIZER, INC yCADUET TAB 10/10MG 00069216030 PFIZER, INC yCADUET TAB 5MG/20MG 00069217030 PFIZER, INC yCADUET TAB 10/20MG 00069218030 PFIZER, INC yCADUET TAB 5MG/40MG 00069219030 PFIZER, INC yCADUET TAB 10/40MG 00069225030 PFIZER, INC yCADUET TAB 5MG/80MG 00069226030 PFIZER, INC yCADUET TAB 10/80MG 00069227030 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROCARDIA CAP 10MG 00069260066 PFIZER, INC yPROCARDIA XL TAB 30MG CR 00069265041 PFIZER, INC yPROCARDIA XL TAB 30MG CR 00069265066 PFIZER, INC yPROCARDIA XL TAB 30MG CR 00069265072 PFIZER, INC yPROCARDIA XL TAB 60MG CR 00069266041 PFIZER, INC yPROCARDIA XL TAB 60MG CR 00069266066 PFIZER, INC yPROCARDIA XL TAB 60MG CR 00069266072 PFIZER, INC yPROCARDIA XL TAB 90MG CR 00069267066 PFIZER, INC yCADUET TAB 2.5/10MG 00069296030 PFIZER, INC yCADUET TAB 2.5/20MG 00069297030 PFIZER, INC yCADUET TAB 2.5/40MG 00069298030 PFIZER, INC yZITHROMAX POW 1GM PAK 00069305107 PFIZER, INC yZITHROMAX POW 1GM PAK 00069305175 PFIZER, INC yZITHROMAX TAB 250MG 00069306030 PFIZER, INC yZITHROMAX TAB Z-PAK 00069306075 PFIZER, INC yZITHROMAX TAB 250MG 00069306086 PFIZER, INC yZITHROMAX TAB 500MG 00069307030 PFIZER, INC yZITHROMAX TAB TRI-PAK 00069307075 PFIZER, INC yZITHROMAX TAB 500MG 00069307086 PFIZER, INC yZITHROMAX TAB 600MG 00069308030 PFIZER, INC yZITHROMAX SUS 100/5ML 00069311019 PFIZER, INC yZITHROMAX SUS 200/5ML 00069312019 PFIZER, INC yZITHROMAX SUS 200/5ML 00069313019 PFIZER, INC yZITHROMAX SUS 200/5ML 00069314019 PFIZER, INC yZITHROMAX INJ 500MG 00069315014 PFIZER, INC yZITHROMAX INJ 500MG 00069315083 PFIZER, INC yFELDENE CAP 10MG 00069322066 PFIZER, INC yFELDENE CAP 20MG 00069323066 PFIZER, INC yDIABINESE TAB 100MG 00069393066 PFIZER, INC yDIABINESE TAB 250MG 00069394066 PFIZER, INC yZMAX SUS 2GM 00069417021 PFIZER, INC yREVATIO TAB 20MG 00069419068 PFIZER, INC yVIAGRA TAB 25MG 00069420030 PFIZER, INC yVIAGRA TAB 50MG 00069421030 PFIZER, INC yVIAGRA TAB 50MG 00069421066 PFIZER, INC yVIAGRA TAB 100MG 00069422030 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VIAGRA TAB 100MG 00069422066 PFIZER, INC yMINIZIDE CAP 1MG 00069430066 PFIZER, INC yMINIPRESS CAP 1MG 00069431071 PFIZER, INC yMINIZIDE CAP 2MG 00069432066 PFIZER, INC yMINIZIDE CAP 5MG 00069436066 PFIZER, INC yMINIPRESS CAP 2MG 00069437071 PFIZER, INC yMINIPRESS CAP 5MG 00069438071 PFIZER, INC yVISTARIL CAP 25MG 00069541066 PFIZER, INC yVISTARIL CAP 50MG 00069542066 PFIZER, INC yVISTARIL SUS 25MG/5ML 00069544093 PFIZER, INC yVISTARIL SUS 25MG/5ML 00069544097 PFIZER, INC yZYRTEC TAB 5MG 00069550066 PFIZER, INC yZYRTEC TAB 10MG 00069551066 PFIZER, INC yZYRTEC SYP 1MG/ML 00069553047 PFIZER, INC yZYRTEC SYP 1MG/ML 00069553093 PFIZER, INC yTIKOSYN CAP 125MCG 00069580043 PFIZER, INC yTIKOSYN CAP 125MCG 00069580060 PFIZER, INC yTIKOSYN CAP 250MCG 00069581043 PFIZER, INC yTIKOSYN CAP 250MCG 00069581060 PFIZER, INC yTIKOSYN CAP 500MCG 00069582043 PFIZER, INC yTIKOSYN CAP 500MCG 00069582060 PFIZER, INC yDILANTIN CHW 50MG 00071000724 PFIZER, INC yDILANTIN CHW 50MG 00071000740 PFIZER, INC yLIPITOR TAB 10MG 00071015523 PFIZER, INC yLIPITOR TAB 10MG 00071015534 PFIZER, INC yLIPITOR TAB 10MG 00071015540 PFIZER, INC yLIPITOR TAB 20MG 00071015623 PFIZER, INC yLIPITOR TAB 20MG 00071015640 PFIZER, INC yLIPITOR TAB 20MG 00071015694 PFIZER, INC yLIPITOR TAB 40MG 00071015723 PFIZER, INC yLIPITOR TAB 40MG 00071015773 PFIZER, INC yLIPITOR TAB 80MG 00071015823 PFIZER, INC yLIPITOR TAB 80MG 00071015873 PFIZER, INC yACCURETIC TAB 20/12.5 00071022023 PFIZER, INC yACCURETIC TAB 10/12.5 00071022223 PFIZER, INC yACCURETIC TAB 20-25MG 00071022323 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZARONTIN CAP 250MG 00071023724 PFIZER, INC yNARDIL TAB 15MG 00071035024 PFIZER, INC yNARDIL TAB 15MG 00071035060 PFIZER, INC yDILANTIN CAP 100MG 00071036224 PFIZER, INC yDILANTIN CAP 100MG 00071036232 PFIZER, INC yDILANTIN CAP 100MG 00071036240 PFIZER, INC yDILANTIN CAP 30MG 00071036524 PFIZER, INC yNEURONTIN TAB 800MG 00071040124 PFIZER, INC yNITROSTAT SUB 0.3MG 00071041724 PFIZER, INC yNITROSTAT SUB 0.4MG 00071041813 PFIZER, INC yNITROSTAT SUB 0.4MG 00071041824 PFIZER, INC yNITROSTAT SUB 0.6MG 00071041924 PFIZER, INC yNEURONTIN TAB 600MG 00071051324 PFIZER, INC yCELONTIN CAP 300MG 00071052524 PFIZER, INC yACCUPRIL TAB 5MG 00071052723 PFIZER, INC yACCUPRIL TAB 5MG 00071052740 PFIZER, INC yACCUPRIL TAB 10MG 00071053023 PFIZER, INC yACCUPRIL TAB 10MG 00071053040 PFIZER, INC yACCUPRIL TAB 20MG 00071053223 PFIZER, INC yACCUPRIL TAB 20MG 00071053240 PFIZER, INC yACCUPRIL TAB 40MG 00071053523 PFIZER, INC yLOPID TAB 600MG 00071073720 PFIZER, INC yLOPID TAB 600MG 00071073730 PFIZER, INC yNEURONTIN CAP 100MG 00071080324 PFIZER, INC yNEURONTIN CAP 100MG 00071080340 PFIZER, INC yNEURONTIN CAP 300MG 00071080524 PFIZER, INC yNEURONTIN CAP 300MG 00071080540 PFIZER, INC yNEURONTIN CAP 400MG 00071080624 PFIZER, INC yNEURONTIN CAP 400MG 00071080640 PFIZER, INC yLYRICA CAP 25MG 00071101268 PFIZER, INC yLYRICA CAP 50MG 00071101368 PFIZER, INC yLYRICA CAP 75MG 00071101468 PFIZER, INC yLYRICA CAP 100MG 00071101568 PFIZER, INC yLYRICA CAP 150MG 00071101668 PFIZER, INC yLYRICA CAP 200MG 00071101768 PFIZER, INC yLYRICA CAP 300MG 00071101868 PFIZER, INC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LYRICA CAP 225MG 00071101968 PFIZER, INC yNEURONTIN SOL 250/5ML 00071201223 PFIZER, INC yDILANTIN-125 SUS 125/5ML 00071221420 PFIZER, INC yZARONTIN SOL 250/5ML 00071241823 PFIZER, INC yCEREBYX INJ 50MG/ML 00071400705 PFIZER, INC yCEREBYX INJ 50MG/ML 00071400810 PFIZER, INC yBENADRYL INJ 50MG/ML 00071425903 PFIZER, INC yBENADRYL INJ 50MG/ML 00071440210 PFIZER, INC yVIRACEPT TAB 250MG 63010001030 PFIZER, INC yVIRACEPT POW 50MG/GM 63010001190 PFIZER, INC yRESCRIPTOR TAB 100 MG 63010002036 PFIZER, INC yRESCRIPTOR TAB 200MG 63010002118 PFIZER, INC yVIRACEPT TAB 625MG 63010002770 PFIZER, INC yAZULFIDINE TAB 500MG 00013010101 PFIZER, INC. yAZULFIDINE TAB 500MG 00013010120 PFIZER, INC. yAZULFIDINE TAB 500MG EN 00013010201 PFIZER, INC. yAZULFIDINE TAB 500MG EN 00013010220 PFIZER, INC. yEMCYT CAP 140MG 00013013202 PFIZER, INC. yCYKLOKAPRON INJ 100MG/ML 00013111410 PFIZER, INC. yAMPHOCIN INJ 50MG 00013140544 PFIZER, INC. yESTRING MIS 2MG 00013215036 PFIZER, INC. yFRAGMIN INJ 2500/0.2 00013240691 PFIZER, INC. yFRAGMIN INJ 7500/0.3 00013242601 PFIZER, INC. yIDAMYCIN PFS INJ 1MG/ML 00013257691 PFIZER, INC. yIDAMYCIN PFS INJ 1MG/ML 00013258691 PFIZER, INC. yIDAMYCIN PFS INJ 1MG/ML 00013259691 PFIZER, INC. yGENOTROPIN INJ 5.8MG 00013262681 PFIZER, INC. yGENOTROPIN INJ 5.8MG 00013262694 PFIZER, INC. yGENOTROPIN INJ 13.8MG 00013264681 PFIZER, INC. yGENOTROPIN INJ 13.8MG 00013264694 PFIZER, INC. yGENOTROPIN INJ 0.2MG 00013264902 PFIZER, INC. yGENOTROPIN INJ 0.4MG 00013265002 PFIZER, INC. yGENOTROPIN INJ 0.6MG 00013265102 PFIZER, INC. yGENOTROPIN INJ 0.8MG 00013265202 PFIZER, INC. yGENOTROPIN INJ 1MG 00013265302 PFIZER, INC. yGENOTROPIN INJ 1.2MG 00013265402 PFIZER, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GENOTROPIN INJ 1.4MG 00013265502 PFIZER, INC. yGENOTROPIN INJ 1.6MG 00013265602 PFIZER, INC. yGENOTROPIN INJ 1.8MG 00013265702 PFIZER, INC. yGENOTROPIN INJ 2MG 00013265802 PFIZER, INC. yFRAGMIN INJ 10000/ML 00013519001 PFIZER, INC. yFRAGMIN INJ 25000/ML 00013519101 PFIZER, INC. yMYCOBUTIN CAP 150MG 00013530117 PFIZER, INC. yDOSTINEX TAB 0.5MG 00013700112 PFIZER, INC. yXALATAN SOL 0.005% 00013830301 PFIZER, INC. yXALATAN SOL 0.005% 00013830304 PFIZER, INC. yZINECARD INJ 250MG 00013871562 PFIZER, INC. yZINECARD INJ 500MG 00013872589 PFIZER, INC. yLOMOTIL TAB 2.5MG 00025006131 PFIZER, INC. yLOMOTIL TAB 2.5MG 00025006134 PFIZER, INC. yLOMOTIL TAB 2.5MG 00025006151 PFIZER, INC. yLOMOTIL TAB 2.5MG 00025006152 PFIZER, INC. yLOMOTIL TAB 2.5MG 00025006155 PFIZER, INC. yLOMOTIL LIQ 2.5/5 00025006602 PFIZER, INC. yDEMULEN TAB 1/50-28 00025008109 PFIZER, INC. yDEMULEN TAB 1/35-28 00025016109 PFIZER, INC. ySYNAREL SOL 2MG/ML 00025016608 PFIZER, INC. yALDACTONE TAB 25MG 00025100131 PFIZER, INC. yALDACTONE TAB 25MG 00025100151 PFIZER, INC. yALDACTAZIDE TAB 25/25 00025101131 PFIZER, INC. yALDACTAZIDE TAB 50/50 00025102131 PFIZER, INC. yALDACTONE TAB 100MG 00025103131 PFIZER, INC. yALDACTONE TAB 100MG 00025103134 PFIZER, INC. yALDACTONE TAB 50MG 00025104131 PFIZER, INC. yALDACTONE TAB 50MG 00025104134 PFIZER, INC. yDAYPRO TAB 600MG 00025138131 PFIZER, INC. yDAYPRO TAB 600MG 00025138134 PFIZER, INC. yDAYPRO TAB 600MG 00025138151 PFIZER, INC. yARTHROTEC 50 TAB 00025141134 PFIZER, INC. yARTHROTEC 50 TAB 00025141160 PFIZER, INC. yARTHROTEC 50 TAB 00025141190 PFIZER, INC. yARTHROTEC 75 TAB 00025142134 PFIZER, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ARTHROTEC 75 TAB 00025142160 PFIZER, INC. yCYTOTEC TAB 100MCG 00025145120 PFIZER, INC. yCYTOTEC TAB 100MCG 00025145134 PFIZER, INC. yCYTOTEC TAB 100MCG 00025145160 PFIZER, INC. yCYTOTEC TAB 200MCG 00025146131 PFIZER, INC. yCYTOTEC TAB 200MCG 00025146134 PFIZER, INC. yCYTOTEC TAB 200MCG 00025146160 PFIZER, INC. yCELEBREX CAP 100MG 00025152031 PFIZER, INC. yCELEBREX CAP 100MG 00025152034 PFIZER, INC. yCELEBREX CAP 100MG 00025152051 PFIZER, INC. yCELEBREX CAP 200MG 00025152531 PFIZER, INC. yCELEBREX CAP 200MG 00025152534 PFIZER, INC. yCELEBREX CAP 200MG 00025152551 PFIZER, INC. yCELEBREX CAP 400MG 00025153001 PFIZER, INC. yCELEBREX CAP 400MG 00025153002 PFIZER, INC. yINSPRA TAB 25MG 00025171001 PFIZER, INC. yINSPRA TAB 25MG 00025171002 PFIZER, INC. yINSPRA TAB 25MG 00025171003 PFIZER, INC. yINSPRA TAB 50MG 00025172001 PFIZER, INC. yINSPRA TAB 50MG 00025172003 PFIZER, INC. yCALAN TAB 40MG 00025177131 PFIZER, INC. yFLAGYL TAB 500MG 00025182131 PFIZER, INC. yFLAGYL TAB 500MG 00025182150 PFIZER, INC. yFLAGYL TAB 500MG 00025182151 PFIZER, INC. yFLAGYL TAB 250MG 00025183131 PFIZER, INC. yFLAGYL TAB 250MG 00025183150 PFIZER, INC. yFLAGYL TAB 250MG 00025183155 PFIZER, INC. yCALAN TAB 80MG 00025185131 PFIZER, INC. yCALAN TAB 120MG 00025186131 PFIZER, INC. yCALAN SR TAB 240MG 00025189131 PFIZER, INC. yCALAN SR TAB 240MG 00025189134 PFIZER, INC. yCALAN SR TAB 240MG 00025189151 PFIZER, INC. yCALAN SR TAB 120MG 00025190131 PFIZER, INC. yCALAN SR TAB 180MG 00025191131 PFIZER, INC. yCALAN SR TAB 180MG 00025191134 PFIZER, INC. yFLAGYL CAP 375MG 00025194250 PFIZER, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLAGYL ER TAB 750MG 00025196130 PFIZER, INC. yBEXTRA TAB 10MG 00025197531 PFIZER, INC. yBEXTRA TAB 10MG 00025197534 PFIZER, INC. yBEXTRA TAB 10MG 00025197551 PFIZER, INC. yBEXTRA TAB 20MG 00025198034 PFIZER, INC. yBEXTRA TAB 20MG 00025198051 PFIZER, INC. yCOVERA-HS TAB 180MG 00025201131 PFIZER, INC. yCOVERA-HS TAB 180MG 00025201134 PFIZER, INC. yCOVERA-HS TAB 240MG 00025202131 PFIZER, INC. yCOVERA-HS TAB 240MG 00025202134 PFIZER, INC. yNORPACE CAP 100MG CR 00025273231 PFIZER, INC. yNORPACE CAP 100MG CR 00025273251 PFIZER, INC. yNORPACE CAP 150MG CR 00025274231 PFIZER, INC. yNORPACE CAP 150MG CR 00025274234 PFIZER, INC. yNORPACE CAP 150MG CR 00025274251 PFIZER, INC. yNORPACE CAP 100MG 00025275231 PFIZER, INC. yNORPACE CAP 150MG 00025276231 PFIZER, INC. yNORPACE CAP 150MG 00025276252 PFIZER, INC. yKERLONE TAB 10MG 00025510131 PFIZER, INC. yKERLONE TAB 20MG 00025520131 PFIZER, INC. yALPRAZOLAM TAB XR 0.5MG 59762005701 PFIZER, INC. yALPRAZOLAM TAB XR 1MG 59762005901 PFIZER, INC. yALPRAZOLAM TAB XR 2MG 59762006601 PFIZER, INC. yALPRAZOLAM TAB XR 3MG 59762006801 PFIZER, INC. yCABERGOLINE TAB 0.5MG 59762010001 PFIZER, INC. ySULFASALAZIN TAB 500MG DR 59762010401 PFIZER, INC. ySULFASALAZIN TAB 500MG DR 59762010402 PFIZER, INC. yQNAPRIL/HCTZ TAB 20-12.5 59762022001 PFIZER, INC. yQNAPRIL/HCTZ TAB 10-12.5 59762022201 PFIZER, INC. yQNAPRIL/HCTZ TAB 20-25MG 59762022301 PFIZER, INC. yAZITHROMYCIN POW 1GM PAK 59762305101 PFIZER, INC. yAZITHROMYCIN POW 1GM PAK 59762305102 PFIZER, INC. yAZITHROMYCIN TAB 250MG 59762306001 PFIZER, INC. yAZITHROMYCIN TAB 250MG 59762306002 PFIZER, INC. yAZITHROMYCIN TAB 250MG 59762306003 PFIZER, INC. yAZITHROMYCIN TAB 500MG 59762307001 PFIZER, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AZITHROMYCIN TAB 500MG 59762307002 PFIZER, INC. yAZITHROMYCIN TAB 600MG 59762308001 PFIZER, INC. yAZITHROMYCIN SUS 100/5ML 59762311001 PFIZER, INC. yAZITHROMYCIN SUS 200/5ML 59762312001 PFIZER, INC. yAZITHROMYCIN SUS 200/5ML 59762313001 PFIZER, INC. yAZITHROMYCIN SUS 200/5ML 59762314001 PFIZER, INC. yMETHYLPRED PAK 4MG 59762332701 PFIZER, INC. yMETHYLPRED TAB 4MG 59762332702 PFIZER, INC. yCLINDAMYCIN CAP 150MG 59762332801 PFIZER, INC. yTRIAZOLAM TAB 0.125MG 59762371704 PFIZER, INC. yTRIAZOLAM TAB 0.25MG 59762371803 PFIZER, INC. yTRIAZOLAM TAB 0.25MG 59762371804 PFIZER, INC. yALPRAZOLAM TAB 0.25MG 59762371901 PFIZER, INC. yALPRAZOLAM TAB 0.25MG 59762371903 PFIZER, INC. yALPRAZOLAM TAB 0.25MG 59762371904 PFIZER, INC. yALPRAZOLAM TAB 0.5MG 59762372001 PFIZER, INC. yALPRAZOLAM TAB 0.5MG 59762372003 PFIZER, INC. yALPRAZOLAM TAB 0.5MG 59762372004 PFIZER, INC. yALPRAZOLAM TAB 1MG 59762372101 PFIZER, INC. yALPRAZOLAM TAB 1MG 59762372103 PFIZER, INC. yALPRAZOLAM TAB 1MG 59762372104 PFIZER, INC. yALPRAZOLAM TAB 2MG 59762372201 PFIZER, INC. yALPRAZOLAM TAB 2MG 59762372203 PFIZER, INC. yFLURBIPROFEN TAB 100MG 59762372401 PFIZER, INC. yFLURBIPROFEN TAB 100MG 59762372403 PFIZER, INC. yGLYBURIDE TAB 2.5MG 59762372603 PFIZER, INC. yGLYBURIDE TAB 5MG 59762372704 PFIZER, INC. yGLYBURIDE TAB 5MG 59762372706 PFIZER, INC. yGLYBURIDE TAB 5MG 59762372707 PFIZER, INC. yCLINDAMYCIN SOL 1% 59762372801 PFIZER, INC. yCLINDAMYCIN SOL 1% 59762372802 PFIZER, INC. yCLINDAMYCIN PAD 1% 59762372803 PFIZER, INC. yMEDROXYPR AC TAB 2.5MG 59762374001 PFIZER, INC. yMEDROXYPR AC TAB 2.5MG 59762374005 PFIZER, INC. yMEDROXYPR AC TAB 5MG 59762374101 PFIZER, INC. yMEDROXYPR AC TAB 5MG 59762374104 PFIZER, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MEDROXYPR AC TAB 10MG 59762374202 PFIZER, INC. yMEDROXYPR AC TAB 10MG 59762374208 PFIZER, INC. yCLINDAMYCIN GEL 1% 59762374301 PFIZER, INC. yCLINDAMYCIN GEL 1% 59762374302 PFIZER, INC. yCLINDAMYCIN LOT 10MG/ML 59762374401 PFIZER, INC. yGLYBURID MCR TAB 1.5MG 59762378101 PFIZER, INC. yGLYBURID MCR TAB 3MG 59762378201 PFIZER, INC. yGLYBURID MCR TAB 3MG 59762378203 PFIZER, INC. yGLYBURID MCR TAB 6MG 59762378301 PFIZER, INC. yGLYBURID MCR TAB 6MG 59762378302 PFIZER, INC. yGLYBURID MCR TAB 6MG 59762378303 PFIZER, INC. yMEDROXYPR AC INJ 150MG/ML 59762453701 PFIZER, INC. yMEDROXYPR AC INJ 150MG/ML 59762453702 PFIZER, INC. yMEDROXYPR AC INJ 150MG/ML 59762453801 PFIZER, INC. ySERTRALINE TAB 50MG 59762490001 PFIZER, INC. ySERTRALINE TAB 50MG 59762490002 PFIZER, INC. ySERTRALINE TAB 50MG 59762490003 PFIZER, INC. ySERTRALINE TAB 50MG 59762490004 PFIZER, INC. ySERTRALINE TAB 50MG 59762490005 PFIZER, INC. ySERTRALINE TAB 100MG 59762491001 PFIZER, INC. ySERTRALINE TAB 100MG 59762491002 PFIZER, INC. ySERTRALINE TAB 100MG 59762491003 PFIZER, INC. ySERTRALINE TAB 100MG 59762491004 PFIZER, INC. ySERTRALINE TAB 100MG 59762491005 PFIZER, INC. ySERTRALINE CON 20MG/ML 59762494001 PFIZER, INC. ySERTRALINE TAB 25MG 59762496001 PFIZER, INC. ySULFASALAZIN TAB 500MG 59762500001 PFIZER, INC. ySULFASALAZIN TAB 500MG 59762500002 PFIZER, INC. yMISOPROSTOL TAB 100MCG 59762500701 PFIZER, INC. yMISOPROSTOL TAB 100MCG 59762500702 PFIZER, INC. yMISOPROSTOL TAB 200MCG 59762500801 PFIZER, INC. yMISOPROSTOL TAB 200MCG 59762500802 PFIZER, INC. yCLINDAMYCIN CRE 2% 59762500901 PFIZER, INC. yCLINDAMYCIN CAP 300MG 59762501001 PFIZER, INC. yCLINDAMYCIN CAP 300MG 59762501002 PFIZER, INC. ySPIRONOLACT TAB 25MG 59762501101 PFIZER, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SPIRONOLACT TAB 25MG 59762501102 PFIZER, INC. ySPIRONOLACT TAB 50MG 59762501201 PFIZER, INC. ySPIRONOLACT TAB 100MG 59762501301 PFIZER, INC. ySPIRONO/HCTZ TAB 25/25 59762501401 PFIZER, INC. yFLUCONAZOLE TAB 50MG 59762501501 PFIZER, INC. yFLUCONAZOLE TAB 100MG 59762501601 PFIZER, INC. yFLUCONAZOLE TAB 150MG 59762501701 PFIZER, INC. yFLUCONAZOLE TAB 200MG 59762501801 PFIZER, INC. yQUINAPRIL TAB 5MG 59762501901 PFIZER, INC. yQUINAPRIL TAB 10MG 59762502001 PFIZER, INC. yQUINAPRIL TAB 20MG 59762502101 PFIZER, INC. yQUINAPRIL TAB 40MG 59762502201 PFIZER, INC. yGABAPENTIN TAB 600MG 59762502301 PFIZER, INC. yGABAPENTIN TAB 800MG 59762502401 PFIZER, INC. yGABAPENTIN CAP 100MG 59762502601 PFIZER, INC. yGABAPENTIN CAP 300MG 59762502701 PFIZER, INC. yGABAPENTIN CAP 400MG 59762502801 PFIZER, INC. yFLUCONAZOLE SUS 40MG/ML 59762503001 PFIZER, INC. yGLIPIZIDE XL TAB 2.5MG 59762503101 PFIZER, INC. yGLIPIZIDE XL TAB 5MG 59762503201 PFIZER, INC. yGLIPIZIDE XL TAB 5MG 59762503202 PFIZER, INC. yGLIPIZIDE XL TAB 10MG 59762503301 PFIZER, INC. yGLIPIZIDE XL TAB 10MG 59762503302 PFIZER, INC. yFLUCONAZOLE/ INJ NACL 200 59762503402 PFIZER, INC. yFLUCONAZOLE/ INJ NACL 400 59762503502 PFIZER, INC. yFLUCONAZOLE/ INJ DEX 200 59762503602 PFIZER, INC. yFLUCONAZOLE/ INJ DEX 400 59762503702 PFIZER, INC. yIBUPROFEN TAB 400MG 59762737801 PFIZER, INC. yIBUPROFEN TAB 400MG 59762737802 PFIZER, INC. yIBUPROFEN TAB 600MG 59762737901 PFIZER, INC. yIBUPROFEN TAB 600MG 59762737902 PFIZER, INC. yIBUPROFEN TAB 800MG 59762738002 PFIZER, INC. yQV-ALLERGY SYP 00121024716 PHARMACEUTICAL ASSOCIATES, INC. yQUAL-TUSSIN DRO PED 00121034201 PHARMACEUTICAL ASSOCIATES, INC. yPSEUDOEPHEDR SYP 30MG/5ML 00121042104 PHARMACEUTICAL ASSOCIATES, INC. yMILK OF MAGN SUS 00121043115 PHARMACEUTICAL ASSOCIATES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MILK OF MAGN SUS 00121043130 PHARMACEUTICAL ASSOCIATES, INC. yMINERAL OIL 00121046230 PHARMACEUTICAL ASSOCIATES, INC. yPOT CHLORIDE LIQ 10% SF 00121046516 PHARMACEUTICAL ASSOCIATES, INC. yPOT CHLORIDE LIQ 20% SF 00121046615 PHARMACEUTICAL ASSOCIATES, INC. yPOT CHLORIDE LIQ 20% SF 00121046616 PHARMACEUTICAL ASSOCIATES, INC. yDIPHENHYDRAM ELX 12.5/5ML 00121048905 PHARMACEUTICAL ASSOCIATES, INC. yDIPHENHYDRAM ELX 12.5/5ML 00121048910 PHARMACEUTICAL ASSOCIATES, INC. yDIPHENHYDRAM ELX 12.5/5ML 00121048920 PHARMACEUTICAL ASSOCIATES, INC. yAPAP/CODEINE SOL 120-12/5 00121050404 PHARMACEUTICAL ASSOCIATES, INC. yAPAP/CODEINE SOL 120-12/5 00121050405 PHARMACEUTICAL ASSOCIATES, INC. yAPAP/CODEINE SOL 120-12/5 00121050410 PHARMACEUTICAL ASSOCIATES, INC. yAPAP/CODEINE SOL 120-12/5 00121050412 PHARMACEUTICAL ASSOCIATES, INC. yAPAP/CODEINE SOL 120-12/5 00121050415 PHARMACEUTICAL ASSOCIATES, INC. yAPAP/CODEINE SOL 120-12/5 00121050416 PHARMACEUTICAL ASSOCIATES, INC. yMILK OF MAGN SUS 00121052710 PHARMACEUTICAL ASSOCIATES, INC. yPHENOBARB ELX 20MG/5ML 00121053105 PHARMACEUTICAL ASSOCIATES, INC. yPHENOBARB ELX 20MG/5ML 00121053107 PHARMACEUTICAL ASSOCIATES, INC. yPHENOBARB ELX 20MG/5ML 00121053115 PHARMACEUTICAL ASSOCIATES, INC. yCHLORAL HYDR SYP 500/5ML 00121053205 PHARMACEUTICAL ASSOCIATES, INC. yCHLORAL HYDR SYP 500/5ML 00121053216 PHARMACEUTICAL ASSOCIATES, INC. yDOCUSATE SOD LIQ 50MG/5ML 00121054410 PHARMACEUTICAL ASSOCIATES, INC. yDOCUSATE SOD LIQ 50MG/5ML 00121054416 PHARMACEUTICAL ASSOCIATES, INC. yDOCUSATE SOD LIQ 50MG/5ML 00121054425 PHARMACEUTICAL ASSOCIATES, INC. yPROMETH/COD SYP 6.25-10 00121054705 PHARMACEUTICAL ASSOCIATES, INC. yMETOCLOPRAM SOL 5MG/5ML 00121057616 PHARMACEUTICAL ASSOCIATES, INC. yLACTULOSE SOL 10GM/15 00121057708 PHARMACEUTICAL ASSOCIATES, INC. yLACTULOSE SOL 10GM/15 00121057716 PHARMACEUTICAL ASSOCIATES, INC. yLACTULOSE SOL 10GM/15 00121057732 PHARMACEUTICAL ASSOCIATES, INC. yHALOPERIDOL CON 2MG/ML 00121058104 PHARMACEUTICAL ASSOCIATES, INC. yHALOPERIDOL CON 2MG/ML 00121058105 PHARMACEUTICAL ASSOCIATES, INC. yCITRIC ACID/ SOL SOD CITR 00121059515 PHARMACEUTICAL ASSOCIATES, INC. yCITRIC ACID/ SOL SOD CITR 00121059516 PHARMACEUTICAL ASSOCIATES, INC. yCITRIC ACID/ SOL SOD CITR 00121059530 PHARMACEUTICAL ASSOCIATES, INC. yALUM HYDROX SUS 600/5ML 00121060112 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCOD/GG SYP 5-100/5 00121060910 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCOD/GG SYP 5-100/5 00121060916 PHARMACEUTICAL ASSOCIATES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SORE THROAT LIQ CHR SPY 00121062806 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SYP DM 00121063804 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SYP DM 00121063805 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SYP DM 00121063808 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SYP DM 00121063810 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SYP DM 00121063816 PHARMACEUTICAL ASSOCIATES, INC. yAMANTADINE SYP 50MG/5ML 00121064610 PHARMACEUTICAL ASSOCIATES, INC. yAMANTADINE SYP 50MG/5ML 00121064616 PHARMACEUTICAL ASSOCIATES, INC. yCIMETIDINE SOL 300/5ML 00121064908 PHARMACEUTICAL ASSOCIATES, INC. yCIMETIDINE SOL 300/5ML 00121064916 PHARMACEUTICAL ASSOCIATES, INC. yFLUPHENAZINE CON 5MG/ML 00121065304 PHARMACEUTICAL ASSOCIATES, INC. yFLUPHENAZINE ELX 2.5/5ML 00121065402 PHARMACEUTICAL ASSOCIATES, INC. yFLUPHENAZINE ELX 2.5/5ML 00121065416 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCODONE/ SOL APAP 00121065504 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCODONE/ SOL APAP 00121065516 PHARMACEUTICAL ASSOCIATES, INC. yACETAMIN SOL 160/5ML 00121065705 PHARMACEUTICAL ASSOCIATES, INC. yACETAMIN SOL 160/5ML 00121065711 PHARMACEUTICAL ASSOCIATES, INC. yACETAMIN SOL 160/5ML 00121065721 PHARMACEUTICAL ASSOCIATES, INC. yTRIHEXYPHEN ELX 0.4MG/ML 00121065810 PHARMACEUTICAL ASSOCIATES, INC. yTRIHEXYPHEN ELX 0.4MG/ML 00121065812 PHARMACEUTICAL ASSOCIATES, INC. yTRIHEXYPHEN ELX 0.4MG/ML 00121065816 PHARMACEUTICAL ASSOCIATES, INC. ySORBITOL SOL 70% 00121065916 PHARMACEUTICAL ASSOCIATES, INC. ySORBITOL SOL 70% 00121065930 PHARMACEUTICAL ASSOCIATES, INC. yETHOSUXIMIDE SOL 250/5ML 00121067016 PHARMACEUTICAL ASSOCIATES, INC. yOXYBUTYNIN SYP 5MG/5ML 00121067105 PHARMACEUTICAL ASSOCIATES, INC. yOXYBUTYNIN SYP 5MG/5ML 00121067116 PHARMACEUTICAL ASSOCIATES, INC. yVALPROIC ACD SYP 250/5ML 00121067516 PHARMACEUTICAL ASSOCIATES, INC. yK CITRATE SOL CITR ACD 00121067616 PHARMACEUTICAL ASSOCIATES, INC. yTRICITRATES SYP 00121067716 PHARMACEUTICAL ASSOCIATES, INC. yNORTRIPTYLIN SOL 10MG/5ML 00121067816 PHARMACEUTICAL ASSOCIATES, INC. yGG/CODEINE SYP 100-10/5 00121068305 PHARMACEUTICAL ASSOCIATES, INC. yQUAL-TUSSIN SYP DC 00121068416 PHARMACEUTICAL ASSOCIATES, INC. yPREDNISOLONE SYP 15MG/5ML 00121068705 PHARMACEUTICAL ASSOCIATES, INC. yPREDNISOLONE SYP 15MG/5ML 00121068708 PHARMACEUTICAL ASSOCIATES, INC. yPREDNISOLONE SYP 15MG/5ML 00121068716 PHARMACEUTICAL ASSOCIATES, INC. yQUAL-TUSSIN SYP 00121070116 PHARMACEUTICAL ASSOCIATES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUOXETINE SOL 20MG/5ML 00121072104 PHARMACEUTICAL ASSOCIATES, INC. yALUM HYDROX SUS 320/5ML 00121073312 PHARMACEUTICAL ASSOCIATES, INC. yALUM HYDROX SUS 320/5ML 00121073316 PHARMACEUTICAL ASSOCIATES, INC. yALUM HYDROX SUS 320/5ML 00121073330 PHARMACEUTICAL ASSOCIATES, INC. yDOCUSATE SOD SYP 20MG/5ML 00121074316 PHARMACEUTICAL ASSOCIATES, INC. yDOCUSATE SOD SYP 20MG/5ML 00121074325 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SOL 100/5ML 00121074404 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SOL 100/5ML 00121074408 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SOL 100/5ML 00121074416 PHARMACEUTICAL ASSOCIATES, INC. ySUCRALFATE SUS 1GM/10ML 00121074710 PHARMACEUTICAL ASSOCIATES, INC. yZANTAC SYP 75MG/5ML 00121075210 PHARMACEUTICAL ASSOCIATES, INC. yPREDNISOLONE SOL 15MG/5ML 00121075908 PHARMACEUTICAL ASSOCIATES, INC. yCALCIUM CARB SUS 1250/5ML 00121076616 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN/ LIQ CODEINE 00121077504 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN/ LIQ CODEINE 00121077516 PHARMACEUTICAL ASSOCIATES, INC. yMETOCLOPRAM SOL 10MG 00121157610 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SOL 100/5ML 00121174405 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SOL 100/5ML 00121174410 PHARMACEUTICAL ASSOCIATES, INC. yGUAIFENESIN SOL 100/5ML 00121174415 PHARMACEUTICAL ASSOCIATES, INC. yMAG-AL LIQ 00121176030 PHARMACEUTICAL ASSOCIATES, INC. yMAG-AL PLUS LIQ 00121176130 PHARMACEUTICAL ASSOCIATES, INC. yMAG-AL PLUS LIQ XS 00121176230 PHARMACEUTICAL ASSOCIATES, INC. yLACTULOSE SOL 10GM/15 00121457715 PHARMACEUTICAL ASSOCIATES, INC. yLACTULOSE SOL 10GM/15 00121457730 PHARMACEUTICAL ASSOCIATES, INC. yLACTULOSE SOL 10GM/15 00121457735 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCODONE/ SOL APAP 00121465505 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCODONE/ SOL APAP 00121465510 PHARMACEUTICAL ASSOCIATES, INC. yHYDROCODONE/ SOL APAP 00121465515 PHARMACEUTICAL ASSOCIATES, INC. yVALPROIC ACD SYP 250/5ML 00121467505 PHARMACEUTICAL ASSOCIATES, INC. yFLUOXETINE SOL 20MG/5ML 00121472105 PHARMACEUTICAL ASSOCIATES, INC. yMEGESTROL AC SUS 400MG/10 00121477610 PHARMACEUTICAL ASSOCIATES, INC. yTEMOVATE OIN 0.05% 00462016215 PHARMADERM yTEMOVATE OIN 0.05% 00462016230 PHARMADERM yTEMOVATE CRE 0.05% 00462016330 PHARMADERM yTEMOVATE CRE 0.05% 00462016360 PHARMADERM yACLOVATE OIN 0.05% 00462026460 PHARMADERM y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLINDAMAX CRE 2% 00462027740 PHARMADERM yTEMOVATE GEL 0.05% 00462029360 PHARMADERM yTEMOVATE E CRE 0.05%EML 00462030160 PHARMADERM yCUTIVATE OIN 0.005% 00462033315 PHARMADERM yCUTIVATE OIN 0.005% 00462033330 PHARMADERM yZAZOLE CRE 0.4% 00462034646 PHARMADERM yZAZOLE SUP 80MG 00462034803 PHARMADERM yOXISTAT LOT 1% 00462035930 PHARMADERM yCLINDAMAX GEL 1% 00462039030 PHARMADERM yCLINDAMAX GEL 1% 00462039060 PHARMADERM yCLINDAMAX LOT 10MG/ML 00462039160 PHARMADERM yLOKARA LOT 0.05% 00462039202 PHARMADERM yLOKARA LOT 0.05% 00462039204 PHARMADERM yAPEXICON OIN 0.05% 00462039430 PHARMADERM yAPEXICON OIN 0.05% 00462039460 PHARMADERM yAPEXICON E CRE 0.05% 00462039530 PHARMADERM yAPEXICON E CRE 0.05% 00462039560 PHARMADERM yALPHATREX GEL 0.05% 00462041815 PHARMADERM yALPHATREX GEL 0.05% 00462041850 PHARMADERM yNOVASTART TAB 66663009201 PHARMELLE, LLC yNOVANATAL TAB 66663010201 PHARMELLE, LLC yAVC CRE 15% 66663010304 PHARMELLE, LLC yMIGRATEN CAP 66663011201 PHARMELLE, LLC yURELLE TAB 66663021901 PHARMELLE, LLC yNATELLE TAB 66663031701 PHARMELLE, LLC yNATELLE TAB PREFER 66663033001 PHARMELLE, LLC yRECTAGEL HC GEL 66663035705 PHARMELLE, LLC yFEMTABS TAB 66663051701 PHARMELLE, LLC yNATELLE EZ TAB 66663066801 PHARMELLE, LLC yPYRELLE H.B. TAB 66663070201 PHARMELLE, LLC yNATELLE C TAB 66663072401 PHARMELLE, LLC yFERRETTS TAB 325MG 00813001206 PHARMICS INC. yO-CAL FA TAB 00813003833 PHARMICS INC. yPHARMAFLUR CHW 0.5MG 00813006510 PHARMICS INC. yPHARMAFLUR CHW 2.2MG 00813006610 PHARMICS INC. yB-SCORBIC TAB 00813007001 PHARMICS INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SOLUVITE F DRO 0.25MG/1 00813007757 PHARMICS INC. yO-CAL TAB PRENATAL 00813020201 PHARMICS INC. yTRI-OTIC SOL 00813039311 PHARMICS INC. yFEM PH GEL 00813079955 PHARMICS INC. yFERRETTS IPS SOL 00813200408 PHARMICS INC. yO-CAL FA TAB 00813931601 PHARMICS INC. yVIDAZA INJ 100MG 67211010201 PHARMION CORPORATION yINNOHEP INJ 20000/ML 67211034208 PHARMION CORPORATION yINNOHEP INJ 20000/ML 67211034253 PHARMION CORPORATION yHYDROXYZ HCL TAB 10MG 50111030701 PLIVA, INC. yHYDROXYZ HCL TAB 10MG 50111030702 PLIVA, INC. yHYDROXYZ HCL TAB 10MG 50111030703 PLIVA, INC. yHYDROXYZ HCL TAB 25MG 50111030801 PLIVA, INC. yHYDROXYZ HCL TAB 25MG 50111030802 PLIVA, INC. yHYDROXYZ HCL TAB 25MG 50111030803 PLIVA, INC. yHYDROXYZ HCL TAB 50MG 50111030901 PLIVA, INC. yHYDROXYZ HCL TAB 50MG 50111030902 PLIVA, INC. yHYDROXYZ HCL TAB 50MG 50111030903 PLIVA, INC. yCYPROHEPTAD TAB 4MG 50111031401 PLIVA, INC. yCYPROHEPTAD TAB 4MG 50111031403 PLIVA, INC. yBETHANECHOL TAB 5MG 50111032301 PLIVA, INC. yBETHANECHOL TAB 10MG 50111032401 PLIVA, INC. yBETHANECHOL TAB 25MG 50111032501 PLIVA, INC. yBETHANECHOL TAB 50MG 50111032601 PLIVA, INC. yHYDRALAZINE TAB 25MG 50111032701 PLIVA, INC. yHYDRALAZINE TAB 25MG 50111032703 PLIVA, INC. yHYDRALAZINE TAB 50MG 50111032801 PLIVA, INC. yHYDRALAZINE TAB 50MG 50111032803 PLIVA, INC. yMETRONIDAZOL TAB 250MG 50111033301 PLIVA, INC. yMETRONIDAZOL TAB 250MG 50111033302 PLIVA, INC. yMETRONIDAZOL TAB 250MG 50111033306 PLIVA, INC. yMETRONIDAZOL TAB 500MG 50111033401 PLIVA, INC. yMETRONIDAZOL TAB 500MG 50111033402 PLIVA, INC. yCHLORTHALID TAB 50MG 50111036301 PLIVA, INC. yCHLORTHALID TAB 50MG 50111036303 PLIVA, INC. yCHLORTHALID TAB 100MG 50111036401 PLIVA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHLORPROPAM TAB 100MG 50111037201 PLIVA, INC. yCHLORPROPAM TAB 250MG 50111037301 PLIVA, INC. yCHLORPROPAM TAB 250MG 50111037303 PLIVA, INC. ySALSALATE TAB 500MG 50111039001 PLIVA, INC. ySALSALATE TAB 500MG 50111039002 PLIVA, INC. ySALSALATE TAB 750MG 50111039101 PLIVA, INC. ySALSALATE TAB 750MG 50111039102 PLIVA, INC. yBENZTROPINE TAB 0.5MG 50111039301 PLIVA, INC. yBENZTROPINE TAB 1MG 50111039401 PLIVA, INC. yBENZTROPINE TAB 1MG 50111039403 PLIVA, INC. yBENZTROPINE TAB 2MG 50111039501 PLIVA, INC. yBENZTROPINE TAB 2MG 50111039503 PLIVA, INC. yHYDRALAZINE TAB 100MG 50111039701 PLIVA, INC. yHYDRALAZINE TAB 10MG 50111039801 PLIVA, INC. yHYDRALAZINE TAB 10MG 50111039803 PLIVA, INC. yMETOCLOPRAM TAB 10MG 50111043001 PLIVA, INC. yMETOCLOPRAM TAB 10MG 50111043002 PLIVA, INC. yMETOCLOPRAM TAB 10MG 50111043003 PLIVA, INC. yTRAZODONE TAB 50MG 50111043301 PLIVA, INC. yTRAZODONE TAB 50MG 50111043302 PLIVA, INC. yTRAZODONE TAB 50MG 50111043303 PLIVA, INC. yTRAZODONE TAB 100MG 50111043401 PLIVA, INC. yTRAZODONE TAB 100MG 50111043402 PLIVA, INC. yTRAZODONE TAB 100MG 50111043403 PLIVA, INC. yTRAZODONE TAB 150MG 50111044101 PLIVA, INC. yTRAZODONE TAB 150MG 50111044102 PLIVA, INC. yOXYBUTYNIN TAB 5MG 50111045601 PLIVA, INC. yOXYBUTYNIN TAB 5MG 50111045602 PLIVA, INC. yOXYBUTYNIN TAB 5MG 50111045603 PLIVA, INC. yTHEOPHYLLINE TAB 300MG CR 50111045901 PLIVA, INC. yTHEOPHYLLINE TAB 300MG CR 50111045902 PLIVA, INC. yTHEOPHYLLINE TAB 300MG CR 50111045903 PLIVA, INC. yPROPRANOLOL TAB 10MG 50111046701 PLIVA, INC. yPROPRANOLOL TAB 10MG 50111046703 PLIVA, INC. yPROPRANOLOL TAB 20MG 50111046801 PLIVA, INC. yPROPRANOLOL TAB 20MG 50111046803 PLIVA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROPRANOLOL TAB 40MG 50111046901 PLIVA, INC. yPROPRANOLOL TAB 40MG 50111046903 PLIVA, INC. yPROPRANOLOL TAB 60MG 50111047001 PLIVA, INC. yPROPRANOLOL TAB 80MG 50111047101 PLIVA, INC. yPROPRANOLOL TAB 80MG 50111047102 PLIVA, INC. yPROPRAN/HCTZ TAB 40/25 50111047301 PLIVA, INC. yPROPRAN/HCTZ TAB 80/25 50111047401 PLIVA, INC. yTHEOPHYLLINE TAB 200MG CR 50111048201 PLIVA, INC. yTHEOPHYLLINE TAB 200MG CR 50111048202 PLIVA, INC. yTHEOPHYLLINE TAB 200MG CR 50111048203 PLIVA, INC. yTHEOPHYLLINE TAB 100MG CR 50111048301 PLIVA, INC. yTHEOPHYLLINE TAB 100MG CR 50111048302 PLIVA, INC. yTRIAMT/HCTZ TAB 75-50MG 50111050501 PLIVA, INC. yTRIAMT/HCTZ TAB 75-50MG 50111050502 PLIVA, INC. yMETOCLOPRAM TAB 5MG 50111051701 PLIVA, INC. yMETOCLOPRAM TAB 5MG 50111051702 PLIVA, INC. yTHEOPHYLLINE TAB 450MG ER 50111051801 PLIVA, INC. yCHO MAG TRIS TAB 500MG 50111052801 PLIVA, INC. yCHO MAG TRIS TAB 750MG 50111052901 PLIVA, INC. yCHO MAG TRIS TAB 750MG 50111052902 PLIVA, INC. yCHO MAG TRIS TAB 1000MG 50111053001 PLIVA, INC. yTRIAMT/HCTZ TAB 37.5-25 50111053401 PLIVA, INC. yTRIAMT/HCTZ TAB 37.5-25 50111053402 PLIVA, INC. yDICLOFENAC TAB 50MG DR 50111054601 PLIVA, INC. yDICLOFENAC TAB 50MG DR 50111054602 PLIVA, INC. yDICLOFENAC TAB 50MG DR 50111054603 PLIVA, INC. yDICLOFENAC TAB 50MG DR 50111054604 PLIVA, INC. yDICLOFENAC TAB 75MG DR 50111054701 PLIVA, INC. yDICLOFENAC TAB 75MG DR 50111054702 PLIVA, INC. yDICLOFENAC TAB 75MG DR 50111054703 PLIVA, INC. yDICLOFENAC TAB 75MG DR 50111054704 PLIVA, INC. yCIMETIDINE TAB 300MG 50111055001 PLIVA, INC. yCIMETIDINE TAB 300MG 50111055002 PLIVA, INC. yCIMETIDINE TAB 300MG 50111055003 PLIVA, INC. yCIMETIDINE TAB 400MG 50111055101 PLIVA, INC. yCIMETIDINE TAB 400MG 50111055102 PLIVA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIMETIDINE TAB 400MG 50111055103 PLIVA, INC. yCIMETIDINE TAB 400MG 50111055104 PLIVA, INC. yCIMETIDINE TAB 800MG 50111055201 PLIVA, INC. yCIMETIDINE TAB 800MG 50111055202 PLIVA, INC. yCIMETIDINE TAB 800MG 50111055210 PLIVA, INC. yCYCLOBENZAPR TAB 10MG 50111056301 PLIVA, INC. yCYCLOBENZAPR TAB 10MG 50111056302 PLIVA, INC. yCYCLOBENZAPR TAB 10MG 50111056303 PLIVA, INC. yKETOROLAC TAB 10MG 50111060801 PLIVA, INC. yPENTOXIFYLLI TAB 400MG ER 50111060901 PLIVA, INC. yPENTOXIFYLLI TAB 400MG ER 50111060902 PLIVA, INC. yNAPROXEN DR TAB 375MG 50111061401 PLIVA, INC. yNAPROXEN DR TAB 500MG 50111061501 PLIVA, INC. yTRAMADOL HCL TAB 50MG 50111061601 PLIVA, INC. yTRAMADOL HCL TAB 50MG 50111061602 PLIVA, INC. yTRAMADOL HCL TAB 50MG 50111061603 PLIVA, INC. yKETOCONAZOLE TAB 200MG 50111062101 PLIVA, INC. yKETOCONAZOLE TAB 200MG 50111062102 PLIVA, INC. yFLUOXETINE CAP 10MG 50111064701 PLIVA, INC. yFLUOXETINE CAP 10MG 50111064702 PLIVA, INC. yFLUOXETINE CAP 10MG 50111064703 PLIVA, INC. yFLUOXETINE CAP 20MG 50111064801 PLIVA, INC. yFLUOXETINE CAP 20MG 50111064802 PLIVA, INC. yFLUOXETINE CAP 20MG 50111064803 PLIVA, INC. yFLUOXETINE CAP 20MG 50111064844 PLIVA, INC. yDOXAZOSIN TAB 1MG 50111065101 PLIVA, INC. yDOXAZOSIN TAB 1MG 50111065102 PLIVA, INC. yDOXAZOSIN TAB 2MG 50111065201 PLIVA, INC. yDOXAZOSIN TAB 2MG 50111065202 PLIVA, INC. yDOXAZOSIN TAB 4MG 50111065301 PLIVA, INC. yDOXAZOSIN TAB 4MG 50111065302 PLIVA, INC. yDOXAZOSIN TAB 8MG 50111065401 PLIVA, INC. yDOXAZOSIN TAB 8MG 50111065402 PLIVA, INC. yFLUCONAZOLE TAB 50MG 50111067510 PLIVA, INC. yFLUCONAZOLE TAB 100MG 50111067610 PLIVA, INC. yFLUCONAZOLE TAB 150MG 50111067750 PLIVA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUCONAZOLE TAB 200MG 50111067801 PLIVA, INC. yFLUCONAZOLE TAB 200MG 50111067810 PLIVA, INC. yPROPAFENONE TAB 150MG 50111070801 PLIVA, INC. yPROPAFENONE TAB 225MG 50111070901 PLIVA, INC. yPROPAFENONE TAB 300MG 50111071001 PLIVA, INC. yAZITHROMYCIN SUS 200/5ML 50111076728 PLIVA, INC. yAZITHROMYCIN TAB 250MG 50111078710 PLIVA, INC. yAZITHROMYCIN TAB 250MG 50111078752 PLIVA, INC. yAZITHROMYCIN TAB 250MG 50111078766 PLIVA, INC. yAZITHROMYCIN TAB 500MG 50111078810 PLIVA, INC. yAZITHROMYCIN TAB 500MG 50111078852 PLIVA, INC. yAZITHROMYCIN TAB 500MG 50111078867 PLIVA, INC. yAZITHROMYCIN TAB 600MG 50111078910 PLIVA, INC. yPROPO-N/APAP TAB 100-500 50111079001 PLIVA, INC. yAZITHROMYCIN SUS 200/5ML 50111079120 PLIVA, INC. yAZITHROMYCIN SUS 200/5ML 50111079222 PLIVA, INC. yAZITHROMYCIN SUS 100/5ML 50111079320 PLIVA, INC. yONDANSETRON SOL HCL 50111081942 PLIVA, INC. yCYCLOBENZAPR TAB 5MG 50111082001 PLIVA, INC. yBENZONATATE CAP 100MG 50111085101 PLIVA, INC. yBENZONATATE CAP 100MG 50111085102 PLIVA, INC. yVALPROIC ACD CAP 250MG 50111085201 PLIVA, INC. yVALPROIC ACD CAP 250MG 50111085202 PLIVA, INC. yMETRONIDAZOL CAP 375MG 50111088405 PLIVA, INC. yCYCLOSPORINE SOL MODIFIED 50111088542 PLIVA, INC. yHYDROCHLOROT TAB 25MG 50111088601 PLIVA, INC. yHYDROCHLOROT TAB 25MG 50111088603 PLIVA, INC. yHYDROCHLOROT TAB 50MG 50111088701 PLIVA, INC. yHYDROCHLOROT TAB 50MG 50111088703 PLIVA, INC. yETHOSUXIMIDE CAP 250MG 50111090101 PLIVA, INC. yCYCLOSPORINE CAP MOD 25MG 50111090943 PLIVA, INC. yTORSEMIDE TAB 5MG 50111091501 PLIVA, INC. yTORSEMIDE TAB 10MG 50111091601 PLIVA, INC. yTORSEMIDE TAB 20MG 50111091701 PLIVA, INC. yTORSEMIDE TAB 20MG 50111091703 PLIVA, INC. yTORSEMIDE TAB 100MG 50111091801 PLIVA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CYCLOSPORINE CAP MD 100MG 50111092043 PLIVA, INC. yONDANSETRON TAB 4MG ODT 50111094543 PLIVA, INC. yONDANSETRON TAB 8MG ODT 50111094643 PLIVA, INC. yONDANSETRON TAB 8MG ODT 50111094669 PLIVA, INC. yCARBOPLATIN INJ 50MG 50111096576 PLIVA, INC. yCARBOPLATIN INJ 150MG 50111096676 PLIVA, INC. yCARBOPLATIN INJ 450MG 50111096776 PLIVA, INC. yCLORAZ DIPOT TAB 3.75MG 50111098601 PLIVA, INC. yCLORAZ DIPOT TAB 3.75MG 50111098602 PLIVA, INC. yCLORAZ DIPOT TAB 7.5MG 50111098701 PLIVA, INC. yCLORAZ DIPOT TAB 7.5MG 50111098702 PLIVA, INC. yCLORAZ DIPOT TAB 15MG 50111098801 PLIVA, INC. yNITROGLYCER SUB 0.4MG 50111098901 PLIVA, INC. yNITROGLYCER SUB 0.4MG 50111098959 PLIVA, INC. yVITAMIN D CAP 50000UNT 50111099001 PLIVA, INC. yNITROGLYCER SUB 0.3MG 50111099201 PLIVA, INC. ySHERI-B-12 LIQ 50991002216 POLY PHARMACEUTICAL CO., INC. yPOLY-HIST TAB FORTE 50991010101 POLY PHARMACEUTICAL CO., INC. yPOLY HIST DM LIQ 50991012616 POLY PHARMACEUTICAL CO., INC. yDILEX-G LIQ 100-100 50991020016 POLY PHARMACEUTICAL CO., INC. yPOLY HIST TAB FORTE 50991020101 POLY PHARMACEUTICAL CO., INC. yDILEX-G 200 SYP 50991021416 POLY PHARMACEUTICAL CO., INC. yDECONEX TAB 30-900MG 50991030601 POLY PHARMACEUTICAL CO., INC. yPOLY-TUSSIN SYP DM 50991032016 POLY PHARMACEUTICAL CO., INC. yPOLY-TUSSIN LIQ XP 50991032216 POLY PHARMACEUTICAL CO., INC. yDILEX-G TAB 200-200 50991040001 POLY PHARMACEUTICAL CO., INC. yPOLY-VENT TAB 90/650MG 50991040801 POLY PHARMACEUTICAL CO., INC. yDILEX-G 400 TAB 50991041301 POLY PHARMACEUTICAL CO., INC. yFLEXTRA CAP 50991043601 POLY PHARMACEUTICAL CO., INC. yPOLY-TUSSIN SYP HD 50991060316 POLY PHARMACEUTICAL CO., INC. yFLEXTRA TAB 650 50991065001 POLY PHARMACEUTICAL CO., INC. yPOLY-TUSSIN SYP 50991070716 POLY PHARMACEUTICAL CO., INC. yPOLY-TUSSIN SYP COUGH 50991072716 POLY PHARMACEUTICAL CO., INC. yFLEXTRA DS TAB 50991083001 POLY PHARMACEUTICAL CO., INC. yPOLY-VENT JR TAB 45/650 50991090701 POLY PHARMACEUTICAL CO., INC. yPOLY-TUSS XP SOL EXPECT 50991092516 POLY PHARMACEUTICAL CO., INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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P-TEX SUS 10MG/5ML 50991092716 POLY PHARMACEUTICAL CO., INC. yCILOSTAZOL TAB 50MG 66993000860 PRASCO LABORATORIES yCILOSTAZOL TAB 100MG 66993000960 PRASCO LABORATORIES yFEXOFENADINE TAB 30MG 66993010602 PRASCO LABORATORIES yFEXOFENADINE TAB 60MG 66993010702 PRASCO LABORATORIES yFEXOFENADINE TAB 60MG 66993010704 PRASCO LABORATORIES yFEXOFENADINE TAB 180MG 66993010902 PRASCO LABORATORIES yFEXOFENADINE TAB 180MG 66993010904 PRASCO LABORATORIES yDRIHIST TAB SR 66993011002 PRASCO LABORATORIES yAMDRY-D TAB 120-2.5 66993012060 PRASCO LABORATORIES yAMDRY-C TAB 66993012402 PRASCO LABORATORIES yLEFLUNOMIDE TAB 10MG 66993016030 PRASCO LABORATORIES yLEFLUNOMIDE TAB 20MG 66993016130 PRASCO LABORATORIES yGLIMEPIRIDE TAB 1MG 66993016202 PRASCO LABORATORIES yGLIMEPIRIDE TAB 2MG 66993016302 PRASCO LABORATORIES yGLIMEPIRIDE TAB 4MG 66993016402 PRASCO LABORATORIES yBROMPLEX DM SYP 66993022057 PRASCO LABORATORIES yBROMPLEX HD SOL 30-2-1.7 66993022255 PRASCO LABORATORIES yBROMPLEX HD SOL 30-2-1.7 66993022257 PRASCO LABORATORIES yGUAIFENESIN TAB DM 66993031202 PRASCO LABORATORIES yWELLBID-D TAB 40-600MG 66993031502 PRASCO LABORATORIES yWELLBID-D TAB 1200 66993031602 PRASCO LABORATORIES yGG/PE TAB 1200-25 66993032502 PRASCO LABORATORIES yPE/GG TAB 25-900 66993032602 PRASCO LABORATORIES yGG-PE TAB 900-30MG 66993032702 PRASCO LABORATORIES yPE/GG TAB 30-1200 66993032802 PRASCO LABORATORIES yPSE/GG TAB 120/1200 66993033202 PRASCO LABORATORIES yHYOSCYAMINE TAB 0.15MG 66993040202 PRASCO LABORATORIES yFOLIC ACID TAB 1MG 66993042505 PRASCO LABORATORIES yWELLTUSS HC LIQ 66993050057 PRASCO LABORATORIES yWELLTUSS EXP SYP 66993050157 PRASCO LABORATORIES yHYTAN SUS 66993050255 PRASCO LABORATORIES yK-TAN 4 SUS 66993052255 PRASCO LABORATORIES yTRIOTANN SUS PED 66993053057 PRASCO LABORATORIES yR-TANNA TAB 9-25MG 66993053202 PRASCO LABORATORIES yR-TANNA TAB 9-25MG 66993053402 PRASCO LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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R-TANNA SUS PEDI 66993053757 PRASCO LABORATORIES yC-TANNA 12 SUS 4-30MG/5 66993055057 PRASCO LABORATORIES yC-TANNA 12D SUS 66993055355 PRASCO LABORATORIES yMIGRIN-A CAP 66993060102 PRASCO LABORATORIES ySOLIA TAB 66993061128 PRASCO LABORATORIES yCESIA PAK 66993061528 PRASCO LABORATORIES yMIRTAZAPINE TAB 15MG ODT 66993070930 PRASCO LABORATORIES yMIRTAZAPINE TAB 30MG ODT 66993071130 PRASCO LABORATORIES yMIRTAZAPINE TAB 45MG ODT 66993071230 PRASCO LABORATORIES yPROCHLORPER TAB 5MG 66993080502 PRASCO LABORATORIES yPROCHLORPER TAB 10MG 66993081002 PRASCO LABORATORIES yPROCHLORPER TAB 10MG 66993081005 PRASCO LABORATORIES yMETHYLPRED TAB 4MG 66993084002 PRASCO LABORATORIES yMETHYLPRED PAK 4MG 66993084021 PRASCO LABORATORIES yMETHYLPRED TAB 8MG 66993084225 PRASCO LABORATORIES yPRASCION AV EMU 10-5% 66993090008 PRASCO LABORATORIES yPRASCION EMU 66993090206 PRASCO LABORATORIES yPRASCION EMU 66993090212 PRASCO LABORATORIES yPRASCION FC PAD 10-5% 66993090530 PRASCO LABORATORIES yALERA EMU 66993090917 PRASCO LABORATORIES yESSIAN TAB 66993092002 PRASCO LABORATORIES yESSIAN H.S. TAB 66993092102 PRASCO LABORATORIES yRANITIDINE SYP 75MG/5ML 68094020558 PRECISION DOSE, INC. yCHLD IBUPROF SUS 100/5ML 68094050361 PRECISION DOSE, INC. yCHLD IBUPROF SUS 100/5ML 68094050362 PRECISION DOSE, INC. yTINDAMAX TAB 250MG 66378025040 PRESUTTI LABORATORIES, INC. yTINDAMAX TAB 500MG 66378050020 PRESUTTI LABORATORIES, INC. yTINDAMAX TAB 500MG 66378050060 PRESUTTI LABORATORIES, INC. yPROVIL TAB 200MG 62107000201 PRIME MARKETING LLC yPROVIL TAB 200MG 62107000250 PRIME MARKETING LLC yCAPREX CRE 0.025% 62107000302 PRIME MARKETING LLC yCAPREX + CRE 0.075% 62107000402 PRIME MARKETING LLC yACTANOL TAB 2.5-60MG 62107000501 PRIME MARKETING LLC yACTANOL TAB 2.5-60MG 62107000524 PRIME MARKETING LLC ySUDOPHED TAB 30MG 62107000601 PRIME MARKETING LLC ySUDOPHED TAB 30MG 62107000624 PRIME MARKETING LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NEOPORACIN OIN 62107000703 PRIME MARKETING LLC yNEOPORACIN OIN 62107000715 PRIME MARKETING LLC yTOLNAFTIN CRE 1% 62107000815 PRIME MARKETING LLC yH.E.A.R. SOL 6.5% OT 62107000984 PRIME MARKETING LLC yHYDROCORT CRE 1% 62107001003 PRIME MARKETING LLC yBACTERICIN OIN 500/GM 62107001103 PRIME MARKETING LLC yBACTERICIN OIN 500/GM 62107001115 PRIME MARKETING LLC yIMPERIM TAB 2MG 62107001212 PRIME MARKETING LLC yLIQ ANTACID SUS MINT CRM 62107002011 PRIME MARKETING LLC yLIQ ANTACID SUS X-STR 62107002111 PRIME MARKETING LLC yMILANTEX SUS ORIGINAL 62107002211 PRIME MARKETING LLC yMILANTEX SUS X-STR 62107002311 PRIME MARKETING LLC yMILK OF MAGN SUS MINT 62107002411 PRIME MARKETING LLC yASPIRIN TAB 325MG 62107002507 PRIME MARKETING LLC yASPIRIN TAB 325MG 62107002532 PRIME MARKETING LLC yCHILD ASA LS CHW 81MG 62107002636 PRIME MARKETING LLC yASPIR-81 TAB 81MG EC 62107002726 PRIME MARKETING LLC yASPIR-81 TAB 81MG EC 62107002732 PRIME MARKETING LLC yECPIRIN TAB 325MG EC 62107002801 PRIME MARKETING LLC yECPIRIN TAB 325MG EC 62107002832 PRIME MARKETING LLC yBUFPIRIN TAB 325MG 62107002901 PRIME MARKETING LLC yDUCODYL TAB 5MG EC 62107003001 PRIME MARKETING LLC yDUCODYL TAB 5MG EC 62107003010 PRIME MARKETING LLC ySENNO TAB 8.6MG 62107003101 PRIME MARKETING LLC yDOCUSIL CAP 100MG 62107003301 PRIME MARKETING LLC yDOCUSIL CAP 100MG 62107003310 PRIME MARKETING LLC yDOCUSIL PLUS CAP 100-30 62107003401 PRIME MARKETING LLC yDOCUSIL PLUS CAP 100-30 62107003410 PRIME MARKETING LLC yMETAFIBER POW 48.57% 62107003528 PRIME MARKETING LLC yMETAFIBER POW 30.9% 62107003628 PRIME MARKETING LLC yMETAFIBER POW 58.6% 62107003740 PRIME MARKETING LLC yTHERA-M TAB 62107003805 PRIME MARKETING LLC yTHERA-M TAB 62107003813 PRIME MARKETING LLC yONCE DAILY TAB 62107003901 PRIME MARKETING LLC yONCE DAILY TAB 62107003910 PRIME MARKETING LLC yONCE DAILY TAB IRON 62107004001 PRIME MARKETING LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ONCE DAILY TAB IRON 62107004010 PRIME MARKETING LLC yCOMPLETE TAB 62107004113 PRIME MARKETING LLC yCALCIUM 600 TAB 62107004206 PRIME MARKETING LLC yCOMPLETE TAB SENIOR 62107004506 PRIME MARKETING LLC yVITAMIN C TAB 500MG 62107004601 PRIME MARKETING LLC yVITAMIN C TAB 500MG 62107004610 PRIME MARKETING LLC yCHILD CHEW CHW VITAMINS 62107004701 PRIME MARKETING LLC yCHILD CHEW CHW VITAMINS 62107004710 PRIME MARKETING LLC yCHILD CHEW CHW IRON 62107004801 PRIME MARKETING LLC yCHILD CHEW CHW IRON 62107004810 PRIME MARKETING LLC yOYSTER SHELL TAB 500MG 62107004901 PRIME MARKETING LLC yOYSTER SHELL TAB 500MG 62107004905 PRIME MARKETING LLC yTACTINAL TAB 500MG 62107005001 PRIME MARKETING LLC yTACTINAL TAB 500MG 62107005010 PRIME MARKETING LLC yTACTINAL TAB 500MG 62107005101 PRIME MARKETING LLC yTACTINAL TAB 500MG 62107005110 PRIME MARKETING LLC yTACTINAL TAB 325MG 62107005201 PRIME MARKETING LLC yTACTINAL TAB 325MG 62107005210 PRIME MARKETING LLC yTACTINAL CHW CHILDREN 62107005330 PRIME MARKETING LLC yFERRONATE TAB 325MG 62107005801 PRIME MARKETING LLC yVITAMIN B-1 TAB 100MG 62107005901 PRIME MARKETING LLC yVITAMIN B-1 TAB 50MG 62107006001 PRIME MARKETING LLC yVITAMIN B-6 TAB 100MG 62107006101 PRIME MARKETING LLC yPRENATAL TAB LOW IRON 62107006301 PRIME MARKETING LLC yVITAMIN E CAP 400UNIT 62107006401 PRIME MARKETING LLC yTHERA TAB 62107006601 PRIME MARKETING LLC yTHERA TAB 62107006605 PRIME MARKETING LLC yOYSTER SHELL TAB D/500MG 62107007506 PRIME MARKETING LLC yMETAFIBER POW 30.9% 62107007804 PRIME MARKETING LLC yMETAFIBER POW REGULAR 62107007904 PRIME MARKETING LLC yPRO-HYO TAB 0.25MG 66594055501 PRO-PHARMA LLC yMACRODANTIN CAP 25MG 00149000705 PROCTER & GAMBLE PHARMACEUTICALS, INC. yMACRODANTIN CAP 50MG 00149000805 PROCTER & GAMBLE PHARMACEUTICALS, INC. yMACRODANTIN CAP 100MG 00149000905 PROCTER & GAMBLE PHARMACEUTICALS, INC. yDANTRIUM CAP 25MG 00149003005 PROCTER & GAMBLE PHARMACEUTICALS, INC. yDANTRIUM CAP 50MG 00149003105 PROCTER & GAMBLE PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DANTRIUM CAP 100MG 00149003305 PROCTER & GAMBLE PHARMACEUTICALS, INC. yDIDRONEL TAB 200MG 00149040560 PROCTER & GAMBLE PHARMACEUTICALS, INC. yDIDRONEL TAB 400MG 00149040660 PROCTER & GAMBLE PHARMACEUTICALS, INC. yACTONEL TAB 30MG 00149047001 PROCTER & GAMBLE PHARMACEUTICALS, INC. yACTONEL TAB 5MG 00149047101 PROCTER & GAMBLE PHARMACEUTICALS, INC. yACTONEL TAB 5MG 00149047103 PROCTER & GAMBLE PHARMACEUTICALS, INC. yACTONEL TAB 35MG 00149047201 PROCTER & GAMBLE PHARMACEUTICALS, INC. yACTONEL WITH TAB CALCIUM 00149047501 PROCTER & GAMBLE PHARMACEUTICALS, INC. yMACROBID CAP 100MG 00149071001 PROCTER & GAMBLE PHARMACEUTICALS, INC. yDANTRIUM IV INJ 20MG 00149073402 PROCTER & GAMBLE PHARMACEUTICALS, INC. yASACOL TAB 400MG DR 00149075215 PROCTER & GAMBLE PHARMACEUTICALS, INC. yLORTUSS HC LIQ 66869010910 PROETHIC PHARMACEUTICALS, INC. yPEDIATAN SUS 8MG/5ML 66869011610 PROETHIC PHARMACEUTICALS, INC. yFOLTRATE TAB 66869012210 PROETHIC PHARMACEUTICALS, INC. yDURATAN DM SUS 66869015210 PROETHIC PHARMACEUTICALS, INC. yDURATAN SUS FORTE 66869015410 PROETHIC PHARMACEUTICALS, INC. yALLERTAN SUS 66869016210 PROETHIC PHARMACEUTICALS, INC. yPEDIATAN D SUS 66869020110 PROETHIC PHARMACEUTICALS, INC. yUDAMIN TAB 66869022010 PROETHIC PHARMACEUTICALS, INC. yDURADEX TAB FORTE 66869031610 PROETHIC PHARMACEUTICALS, INC. yDURAHIST TAB 66869042410 PROETHIC PHARMACEUTICALS, INC. yDURAHIST PE TAB 66869042510 PROETHIC PHARMACEUTICALS, INC. yDURATAN PE SUS 66869043010 PROETHIC PHARMACEUTICALS, INC. yDURAPHEN DM TAB 66869061420 PROETHIC PHARMACEUTICALS, INC. yDURADEX TAB 66869061610 PROETHIC PHARMACEUTICALS, INC. yDURAMAX TAB 66869062610 PROETHIC PHARMACEUTICALS, INC. yDURAPHEN TAB 1000 66869066910 PROETHIC PHARMACEUTICALS, INC. yDURAPHEN II TAB DM 66869071510 PROETHIC PHARMACEUTICALS, INC. yLORTUSS DM LIQ 66869072110 PROETHIC PHARMACEUTICALS, INC. yDURAFLU TAB 66869072330 PROETHIC PHARMACEUTICALS, INC. yPROHIST DM DRO 66869080110 PROETHIC PHARMACEUTICALS, INC. yDURAPHEN TAB FORTE 66869080510 PROETHIC PHARMACEUTICALS, INC. yUDAMIN SP TAB 66869082010 PROETHIC PHARMACEUTICALS, INC. yDURAPHEN II TAB 66869082210 PROETHIC PHARMACEUTICALS, INC. yDURABAC CAP 66869082610 PROETHIC PHARMACEUTICALS, INC. yDURABAC TAB FORTE 66869082710 PROETHIC PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROHIST SYP 66869085110 PROETHIC PHARMACEUTICALS, INC. yRIDAURA CAP 3MG 65483009306 PROMETHEUS LABORATORIES, INC. yTRANDATE IV INJ 5MG/ML 65483035502 PROMETHEUS LABORATORIES, INC. yTRANDATE IV INJ 5MG/ML 65483035504 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 100MG 65483039110 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 100MG 65483039111 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 100MG 65483039150 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 200MG 65483039210 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 200MG 65483039222 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 200MG 65483039250 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 300MG 65483039310 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 300MG 65483039333 PROMETHEUS LABORATORIES, INC. yTRANDATE TAB 300MG 65483039350 PROMETHEUS LABORATORIES, INC. yHELIDAC MIS 65483049514 PROMETHEUS LABORATORIES, INC. yIMURAN TAB 50MG 65483059010 PROMETHEUS LABORATORIES, INC. yZYLOPRIM TAB 100MG 65483099110 PROMETHEUS LABORATORIES, INC. yZYLOPRIM TAB 300MG 65483099310 PROMETHEUS LABORATORIES, INC. yZYLOPRIM TAB 300MG 65483099350 PROMETHEUS LABORATORIES, INC. yMETFORMIN TAB 500MG 20091053101 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 500MG 20091053105 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 500MG 20091053110 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 850MG 20091053301 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 850MG 20091053305 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 850MG 20091053310 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 1000MG 20091053501 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 1000MG 20091053505 PROVIDENT PHARMACEUTICAL, INC. yMETFORMIN TAB 1000MG 20091053510 PROVIDENT PHARMACEUTICAL, INC. yMS CONTIN TAB 200MG CR 00034051310 PURDUE FREDERICK COMPANY yMS CONTIN TAB 200MG CR 00034051312 PURDUE FREDERICK COMPANY yMS CONTIN TAB 30MG CR 00034051510 PURDUE FREDERICK COMPANY yMS CONTIN TAB 30MG CR 00034051512 PURDUE FREDERICK COMPANY yMS CONTIN TAB 30MG CR 00034051545 PURDUE FREDERICK COMPANY yMS CONTIN TAB 30MG CR 00034051550 PURDUE FREDERICK COMPANY yMS CONTIN TAB 30MG CR 00034051590 PURDUE FREDERICK COMPANY yMS CONTIN TAB 60MG CR 00034051610 PURDUE FREDERICK COMPANY yMS CONTIN TAB 60MG CR 00034051612 PURDUE FREDERICK COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MS CONTIN TAB 60MG CR 00034051690 PURDUE FREDERICK COMPANY yMS CONTIN TAB 100MG CR 00034051710 PURDUE FREDERICK COMPANY yMS CONTIN TAB 100MG CR 00034051712 PURDUE FREDERICK COMPANY yMS CONTIN TAB 100MG CR 00034051790 PURDUE FREDERICK COMPANY yMSIR TAB 15MG 00034051810 PURDUE FREDERICK COMPANY yMSIR TAB 30MG 00034051910 PURDUE FREDERICK COMPANY yTRILISATE LIQ 500/5ML 00034052080 PURDUE FREDERICK COMPANY yMSIR SOL 10MG/5ML 00034052102 PURDUE FREDERICK COMPANY yMSIR CAP 15MG 00034102510 PURDUE FREDERICK COMPANY yMSIR CAP 30MG 00034102610 PURDUE FREDERICK COMPANY ySENOKOT GRA 00034110020 PURDUE FREDERICK COMPANY ySENOKOT GRA 00034110060 PURDUE FREDERICK COMPANY ySENOKOT GRA 00034110084 PURDUE FREDERICK COMPANY ySENOKOT TAB 8.6MG 00034120050 PURDUE FREDERICK COMPANY ySENOKOT TAB 8.6MG 00034120080 PURDUE FREDERICK COMPANY ySENOKOT TAB 8.6MG 00034120081 PURDUE FREDERICK COMPANY ySENOKOT TAB 8.6MG 00034120091 PURDUE FREDERICK COMPANY ySENOKOT XTRA TAB 17MG 00034120112 PURDUE FREDERICK COMPANY ySENOKOT XTRA TAB 17MG 00034120163 PURDUE FREDERICK COMPANY ySENOKOT S TAB 8.6-50MG 00034121081 PURDUE FREDERICK COMPANY ySENOKOT S TAB 8.6-50MG 00034121091 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210001 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210002 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210040 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210080 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210087 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210088 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210089 PURDUE FREDERICK COMPANY yBETADINE SOL 10% 00034210090 PURDUE FREDERICK COMPANY yBETADINE MIS PREPSTCK 00034212110 PURDUE FREDERICK COMPANY yBETADINE MIS SWABSTCK 00034213001 PURDUE FREDERICK COMPANY yBETADINE MIS SWABSTCK 00034213003 PURDUE FREDERICK COMPANY yBETADINE MIS SWAB AID 00034213580 PURDUE FREDERICK COMPANY yBETADINE SRG SOL 7.5% 00034220001 PURDUE FREDERICK COMPANY yBETADINE SRG SOL 7.5% 00034220004 PURDUE FREDERICK COMPANY yBETADINE SRG SOL 7.5% 00034220088 PURDUE FREDERICK COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETADINE SRG SOL 7.5% 00034220089 PURDUE FREDERICK COMPANY yBETADINE SRG SOL 7.5% 00034220090 PURDUE FREDERICK COMPANY yBETADINE AER 5% SPRAY 00034231033 PURDUE FREDERICK COMPANY yBETADINE RTU SOL 0.3% 00034231964 PURDUE FREDERICK COMPANY yBETADINE SOL MOUTHWSH 00034233060 PURDUE FREDERICK COMPANY yBETADINE SKN SOL 7.5% CLR 00034235040 PURDUE FREDERICK COMPANY yBETADINE SKN SOL 7.5% CLR 00034235049 PURDUE FREDERICK COMPANY yBETASEPT LIQ 4% 00034340401 PURDUE FREDERICK COMPANY yBETASEPT LIQ 4% 00034340440 PURDUE FREDERICK COMPANY yBETASEPT LIQ 4% 00034340487 PURDUE FREDERICK COMPANY yBETASEPT LIQ 4% 00034340489 PURDUE FREDERICK COMPANY yBETASEPT LIQ 4% 00034340490 PURDUE FREDERICK COMPANY yBETASEPT LIQ 4% 00034340498 PURDUE FREDERICK COMPANY yUNIPHYL TAB 400MG CR 00034700470 PURDUE FREDERICK COMPANY yUNIPHYL TAB 400MG CR 00034700480 PURDUE FREDERICK COMPANY yUNIPHYL TAB 600MG CR 00034700680 PURDUE FREDERICK COMPANY yT-PHYL TAB 200MG CR 00034710280 PURDUE FREDERICK COMPANY yOXYCONTIN TAB 10MG CR 59011010010 PURDUE PHARMA, L.P. yOXYCONTIN TAB 10MG CR 59011010025 PURDUE PHARMA, L.P. yOXYCONTIN TAB 20MG CR 59011010310 PURDUE PHARMA, L.P. yOXYCONTIN TAB 20MG CR 59011010325 PURDUE PHARMA, L.P. yOXYCONTIN TAB 40MG CR 59011010510 PURDUE PHARMA, L.P. yOXYCONTIN TAB 40MG CR 59011010525 PURDUE PHARMA, L.P. yOXYCONTIN TAB 80MG CR 59011010710 PURDUE PHARMA, L.P. yOXYCONTIN TAB 80MG CR 59011010725 PURDUE PHARMA, L.P. yOXYCONTIN TAB 160MG CR 59011010910 PURDUE PHARMA, L.P. yOXYCONTIN TAB 160MG CR 59011010925 PURDUE PHARMA, L.P. yOXYIR CAP 5MG 59011020110 PURDUE PHARMA, L.P. yOXYFAST CON 20MG/ML 59011022520 PURDUE PHARMA, L.P. yPALLADONE CAP 12MG 59011031260 PURDUE PHARMA, L.P. yPALLADONE CAP 16MG 59011031360 PURDUE PHARMA, L.P. yPALLADONE CAP 24MG 59011031460 PURDUE PHARMA, L.P. yPALLADONE CAP 32MG 59011031560 PURDUE PHARMA, L.P. yCHIROCAINE INJ 0.25% 59011099710 PURDUE PHARMA, L.P. yCHIROCAINE INJ 0.25% 59011099730 PURDUE PHARMA, L.P. yCHIROCAINE INJ 0.5% 59011099810 PURDUE PHARMA, L.P. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CHIROCAINE INJ 0.5% 59011099830 PURDUE PHARMA, L.P. yCHIROCAINE INJ 0.75% 59011099910 PURDUE PHARMA, L.P. yCHIROCAINE INJ 0.75% 59011099930 PURDUE PHARMA, L.P. yUNIPHYL TAB 400MG CR 67781025101 PURDUE PHARMCEUTICAL PRODUCTS, L.P. yUNIPHYL TAB 400MG CR 67781025105 PURDUE PHARMCEUTICAL PRODUCTS, L.P. yUNIPHYL TAB 600MG CR 67781025201 PURDUE PHARMCEUTICAL PRODUCTS, L.P. yCOLACE CAP 100MG 67618010110 PURDUE PRODUCTS, L.P. yCOLACE CAP 100MG 67618010130 PURDUE PRODUCTS, L.P. yCOLACE CAP 100MG 67618010152 PURDUE PRODUCTS, L.P. yCOLACE CAP 100MG 67618010160 PURDUE PRODUCTS, L.P. yCOLACE SYP 60/15ML 67618010316 PURDUE PRODUCTS, L.P. ySLOW-MAG TAB 67618010760 PURDUE PRODUCTS, L.P. yMINERAL OIL 67618010806 PURDUE PRODUCTS, L.P. yMINERAL OIL 67618010816 PURDUE PRODUCTS, L.P. ySENOKOT TAB 8.6MG 67618030010 PURDUE PRODUCTS, L.P. ySENOKOT TAB 8.6MG 67618030020 PURDUE PRODUCTS, L.P. ySENOKOT TAB 8.6MG 67618030050 PURDUE PRODUCTS, L.P. ySENOKOT S TAB 8.6-50MG 67618031001 PURDUE PRODUCTS, L.P. ySENOKOT S TAB 8.6-50MG 67618031030 PURDUE PRODUCTS, L.P. ySENOKOT S TAB 8.6-50MG 67618031060 PURDUE PRODUCTS, L.P. yANTACID PLUS CHW 00603001121 QUALITEST PHARMACEUTICALS, INC. yASPIRIN CHLD CHW 81MG 00603002436 QUALITEST PHARMACEUTICALS, INC. yASA LOW DOSE TAB 81MG EC 00603002522 QUALITEST PHARMACEUTICALS, INC. yASA LOW DOSE TAB 81MG EC 00603002532 QUALITEST PHARMACEUTICALS, INC. yASPIRIN TAB 325MG 00603003121 QUALITEST PHARMACEUTICALS, INC. yASPIRIN TAB 325MG 00603003125 QUALITEST PHARMACEUTICALS, INC. yAZO-SEPTIC TAB 95MG 00603004816 QUALITEST PHARMACEUTICALS, INC. yBISACODYL TAB 5MG EC 00603005435 QUALITEST PHARMACEUTICALS, INC. yCALC ANTACID CHW 500MG 00603009526 QUALITEST PHARMACEUTICALS, INC. yCAL ANTACID CHW 750MG XS 00603009627 QUALITEST PHARMACEUTICALS, INC. yCORRECTIVE TAB 5MG EC 00603012916 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LACE CAP 100MG 00603014521 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LACE CAP 100MG 00603014621 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LACE CAP 100MG 00603014632 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LAX TAB 8.6-50MG 00603014821 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LAX TAB 8.6-50MG 00603014832 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ASPIRIN TAB 325MG EC 00603016621 QUALITEST PHARMACEUTICALS, INC. yEC ASPIRIN TAB 325MG 00603016702 QUALITEST PHARMACEUTICALS, INC. yEC ASPIRIN TAB 325MG 00603016721 QUALITEST PHARMACEUTICALS, INC. yEC ASPIRIN TAB 325MG 00603016732 QUALITEST PHARMACEUTICALS, INC. yFIBERTAB TAB 625MG 00603018102 QUALITEST PHARMACEUTICALS, INC. yFIBERTAB TAB 625MG 00603018120 QUALITEST PHARMACEUTICALS, INC. yFOAM ANTACID CHW 80-20MG 00603018621 QUALITEST PHARMACEUTICALS, INC. yFOAM ANTACID CHW ES 00603018721 QUALITEST PHARMACEUTICALS, INC. yMAG OXIDE TAB 400MG 00603020922 QUALITEST PHARMACEUTICALS, INC. yMYTAB GAS CHW 80MG 00603021021 QUALITEST PHARMACEUTICALS, INC. yMYTAB GAS CHW 125MG XS 00603021120 QUALITEST PHARMACEUTICALS, INC. yMAG OXIDE TAB 420MG 00603021321 QUALITEST PHARMACEUTICALS, INC. yPINK BISMUTH CHW 262MG 00603023516 QUALITEST PHARMACEUTICALS, INC. yQ-DRYL CAP 25MG 00603024018 QUALITEST PHARMACEUTICALS, INC. yQ-GESIC TAB 00603025521 QUALITEST PHARMACEUTICALS, INC. yQ-PAP TAB 325MG 00603026321 QUALITEST PHARMACEUTICALS, INC. yQ-PAP TAB 325MG 00603026332 QUALITEST PHARMACEUTICALS, INC. yQ-PAP EX STR TAB 500MG 00603026521 QUALITEST PHARMACEUTICALS, INC. yQ-PAP EX STR TAB 500MG 00603026532 QUALITEST PHARMACEUTICALS, INC. yQ-PAP EX STR TAB 500MG 00603026821 QUALITEST PHARMACEUTICALS, INC. yQ-PAP EX STR TAB 500MG 00603026832 QUALITEST PHARMACEUTICALS, INC. ySENNA LAX TAB 8.6MG 00603028021 QUALITEST PHARMACEUTICALS, INC. ySENNA LAX TAB 8.6MG 00603028032 QUALITEST PHARMACEUTICALS, INC. ySENNALAX-S TAB 8.6-50MG 00603028121 QUALITEST PHARMACEUTICALS, INC. ySENNALAX-S TAB 8.6-50MG 00603028132 QUALITEST PHARMACEUTICALS, INC. ySUR-Q-LAX CAP 240MG 00603030621 QUALITEST PHARMACEUTICALS, INC. yVITAMIN C TAB 500MG 00603032521 QUALITEST PHARMACEUTICALS, INC. yVITAMIN C TAB 500MG 00603032532 QUALITEST PHARMACEUTICALS, INC. yVITAMIN E CAP 400UNIT 00603033121 QUALITEST PHARMACEUTICALS, INC. yVITAMIN E CAP 400UNIT 00603033123 QUALITEST PHARMACEUTICALS, INC. yVITAMIN E CAP 400UNIT 00603033132 QUALITEST PHARMACEUTICALS, INC. ySEA SOFT SPR 0.65% 00603038046 QUALITEST PHARMACEUTICALS, INC. yVISION CLEAR SOL 0.05% OP 00603039073 QUALITEST PHARMACEUTICALS, INC. yVITAMIN A&D OIN 00603041054 QUALITEST PHARMACEUTICALS, INC. yBACITRACIN OIN 500/GM 00603044150 QUALITEST PHARMACEUTICALS, INC. yGLYCERIN SUP 3GM 00603051119 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GLYCERIN SUP 3GM 00603051121 QUALITEST PHARMACEUTICALS, INC. yGLYCERIN SUP 3GM 00603051135 QUALITEST PHARMACEUTICALS, INC. yGLYCERIN SUP 1.5GM 00603051235 QUALITEST PHARMACEUTICALS, INC. yHEMORRHOIDAL OIN 00603052052 QUALITEST PHARMACEUTICALS, INC. yHEMORRHOIDAL SUP 00603052411 QUALITEST PHARMACEUTICALS, INC. yHYDROCORT AC CRE 1% 00603053450 QUALITEST PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 00603053550 QUALITEST PHARMACEUTICALS, INC. yLUBRICATING GEL 00603057954 QUALITEST PHARMACEUTICALS, INC. yPOVIDONE-IOD OIN 10% 00603059950 QUALITEST PHARMACEUTICALS, INC. yQ-NAFTATE CRE 1% 00603061873 QUALITEST PHARMACEUTICALS, INC. ySANI-CLENS PAD 00603062521 QUALITEST PHARMACEUTICALS, INC. yTRIPLE ANTIB OIN 00603064450 QUALITEST PHARMACEUTICALS, INC. yTRIXAICIN CRE 0.025% 00603064888 QUALITEST PHARMACEUTICALS, INC. yTRIXAICIN HP CRE 0.075% 00603064988 QUALITEST PHARMACEUTICALS, INC. yANTACID SUS 00603069457 QUALITEST PHARMACEUTICALS, INC. yANTACID M SUS 00603071257 QUALITEST PHARMACEUTICALS, INC. yANTACID M SUS MAX ST 00603071557 QUALITEST PHARMACEUTICALS, INC. yCODITUSS DM SYP 00603072854 QUALITEST PHARMACEUTICALS, INC. yCODITUSS DM SYP 00603072858 QUALITEST PHARMACEUTICALS, INC. yDAY-TIME LIQ 00603074055 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LACE LIQ 150/15ML 00603074658 QUALITEST PHARMACEUTICALS, INC. yDOC-Q-LACE SYP 60/15ML 00603074758 QUALITEST PHARMACEUTICALS, INC. yDISPOSABLE ENE 00603075291 QUALITEST PHARMACEUTICALS, INC. yMILK OF MAGN SUS 400/5ML 00603078757 QUALITEST PHARMACEUTICALS, INC. yMILK OF MAGN SUS 400/5ML 00603078758 QUALITEST PHARMACEUTICALS, INC. yMILK OF MAGN SUS MINT 00603078857 QUALITEST PHARMACEUTICALS, INC. yNITE-TIME LIQ COLD/FLU 00603080255 QUALITEST PHARMACEUTICALS, INC. yNITE TIME LIQ 00603080555 QUALITEST PHARMACEUTICALS, INC. yNITE TIME LIQ CHERRY 00603080655 QUALITEST PHARMACEUTICALS, INC. yNITE TIME LIQ CHERRY 00603080663 QUALITEST PHARMACEUTICALS, INC. yORALSEPTIC SPR CHERRY 00603081155 QUALITEST PHARMACEUTICALS, INC. yORALSEPTIC SPR MENTHOL 00603081255 QUALITEST PHARMACEUTICALS, INC. yQ-DRYL LIQ 00603082354 QUALITEST PHARMACEUTICALS, INC. yQ-DRYL LIQ 00603082358 QUALITEST PHARMACEUTICALS, INC. yQ-DRYL LIQ 00603082381 QUALITEST PHARMACEUTICALS, INC. yQ-DRYL LIQ 00603082394 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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Q-PAP INFANT DRO 80/0.8ML 00603083873 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603083954 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603083958 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603083994 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603084054 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603084058 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603084060 QUALITEST PHARMACEUTICALS, INC. yQ-PAP LIQ 160/5ML 00603084094 QUALITEST PHARMACEUTICALS, INC. yQ-PAP CHILD SUS BUB GUM 00603084154 QUALITEST PHARMACEUTICALS, INC. yQ-PAP CHILD SUS CHERRY 00603084254 QUALITEST PHARMACEUTICALS, INC. yQ-PAP CHILD SUS GRAPE 00603084354 QUALITEST PHARMACEUTICALS, INC. yQ-TAPP ELX 1-15/5ML 00603085154 QUALITEST PHARMACEUTICALS, INC. yQ-TAPP ELX 1-15/5ML 00603085156 QUALITEST PHARMACEUTICALS, INC. yQ-TAPP ELX 1-15/5ML 00603085181 QUALITEST PHARMACEUTICALS, INC. yQ-TAPP ELX 1-15/5ML 00603085194 QUALITEST PHARMACEUTICALS, INC. yQ-TAPP DM ELX 00603085254 QUALITEST PHARMACEUTICALS, INC. yQ-TAPP DM ELX 00603085294 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP DM 00603085554 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP DM 00603085556 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP DM 00603085558 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP DM 00603085581 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP DM 00603085594 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP 100/5ML 00603085754 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP 100/5ML 00603085756 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP 100/5ML 00603085758 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP 100/5ML 00603085781 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN SYP 100/5ML 00603085794 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN PE SYP PE -AF 00603085954 QUALITEST PHARMACEUTICALS, INC. yQUENALIN SYP 12.5/5ML 00603086054 QUALITEST PHARMACEUTICALS, INC. yQ-TUSSIN CF LIQ 00603086154 QUALITEST PHARMACEUTICALS, INC. ySIMETHICONE DRO 40/0.6ML 00603089450 QUALITEST PHARMACEUTICALS, INC. ySORBITOL SOL 70% 00603090058 QUALITEST PHARMACEUTICALS, INC. yVEG LAXATIVE POW 68% 00603098789 QUALITEST PHARMACEUTICALS, INC. yVEG LAXATIVE POW 68% SF 00603098863 QUALITEST PHARMACEUTICALS, INC. yVEG LAXATIVE POW 68% 00603098989 QUALITEST PHARMACEUTICALS, INC. yVEG LAXATIVE POW SF ORAN 00603099063 QUALITEST PHARMACEUTICALS, INC. y

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ALBUTEROL SYP 2MG/5ML 00603100758 QUALITEST PHARMACEUTICALS, INC. yAMANTADINE SYP 50MG/5ML 00603101058 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE SOL 120-12/5 00603102058 QUALITEST PHARMACEUTICALS, INC. yBELLA ALK/PB ELX 00603103058 QUALITEST PHARMACEUTICALS, INC. yBROMOPHED DX SYP 00603104458 QUALITEST PHARMACEUTICALS, INC. yCARDEC SYP 4-45MG/5 00603106354 QUALITEST PHARMACEUTICALS, INC. yCARDEC SYP 4-45MG/5 00603106358 QUALITEST PHARMACEUTICALS, INC. yCARDEC DM SYP 00603106554 QUALITEST PHARMACEUTICALS, INC. yCARDEC DM SYP 00603106558 QUALITEST PHARMACEUTICALS, INC. yCARDEC DRO 00603106645 QUALITEST PHARMACEUTICALS, INC. yCARDEC SYP 4-12.5MG 00603106754 QUALITEST PHARMACEUTICALS, INC. yCARDEC SYP 4-12.5MG 00603106758 QUALITEST PHARMACEUTICALS, INC. yCARDEC DM DRO 00603106845 QUALITEST PHARMACEUTICALS, INC. yCARDEC DM SYP 00603106954 QUALITEST PHARMACEUTICALS, INC. yCARDEC DM SYP 00603106958 QUALITEST PHARMACEUTICALS, INC. yCHERATUSSIN SYP AC 00603107554 QUALITEST PHARMACEUTICALS, INC. yCHERATUSSIN SYP AC 00603107556 QUALITEST PHARMACEUTICALS, INC. yCHERATUSSIN SYP AC 00603107558 QUALITEST PHARMACEUTICALS, INC. yCHERATUSSIN SOL DAC 00603107858 QUALITEST PHARMACEUTICALS, INC. yCHLORAL HYDR SYP 500/5ML 00603108858 QUALITEST PHARMACEUTICALS, INC. yCLEMASTINE SYP 0.5/5ML 00603109654 QUALITEST PHARMACEUTICALS, INC. yCODAFED SYP EXPECT 00603110758 QUALITEST PHARMACEUTICALS, INC. yCODITUSS DH SYP 00603111154 QUALITEST PHARMACEUTICALS, INC. yCODITUSS DH SYP 00603111158 QUALITEST PHARMACEUTICALS, INC. yDICYCLOMINE SOL 10MG/5ML 00603116158 QUALITEST PHARMACEUTICALS, INC. yDRITUSS DM ELX 200-20/5 00603118158 QUALITEST PHARMACEUTICALS, INC. yDRITUSS HD ELX 00603118258 QUALITEST PHARMACEUTICALS, INC. yDYPHYLLIN-GG ELX 100-100 00603119058 QUALITEST PHARMACEUTICALS, INC. ySOD FLUORIDE DRO 0.5MG/ML 00603124447 QUALITEST PHARMACEUTICALS, INC. yGEVRATONIC LIQ 00603125658 QUALITEST PHARMACEUTICALS, INC. yGRANUL-DERM AER 00603127054 QUALITEST PHARMACEUTICALS, INC. yGUAIFEN-C LIQ 00603127658 QUALITEST PHARMACEUTICALS, INC. yHC TUSSIVE SYP 00603128454 QUALITEST PHARMACEUTICALS, INC. yHC TUSSIVE SYP 00603128458 QUALITEST PHARMACEUTICALS, INC. yHC TUSSIVE SYP 00603128460 QUALITEST PHARMACEUTICALS, INC. yHC TUSSIVE-D SOL 60-5/5ML 00603128558 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HALOPERIDOL CON 2MG/ML 00603129054 QUALITEST PHARMACEUTICALS, INC. yHYDROCODONE/ SOL APAP 00603129558 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL SYP 10MG/5ML 00603131058 QUALITEST PHARMACEUTICALS, INC. yHYOSCYAMINE DRO 0.125/ML 00603131473 QUALITEST PHARMACEUTICALS, INC. yHYOSCYAMINE ELX 0.125/5 00603131558 QUALITEST PHARMACEUTICALS, INC. yIOPHEN-NR LIQ 100/5ML 00603132858 QUALITEST PHARMACEUTICALS, INC. yIOPHEN C-NR LIQ 10-100/5 00603132958 QUALITEST PHARMACEUTICALS, INC. yIOPHEN DM-NR LIQ 10-100/5 00603133058 QUALITEST PHARMACEUTICALS, INC. yL-TONIC ELX 00603136558 QUALITEST PHARMACEUTICALS, INC. yLACTULOSE SOL 10GM/15 00603137856 QUALITEST PHARMACEUTICALS, INC. yLACTULOSE SOL 10GM/15 00603137858 QUALITEST PHARMACEUTICALS, INC. yLACTULOSE SOL 10GM/15 00603137859 QUALITEST PHARMACEUTICALS, INC. yLACTULOSE SOL 10GM/15 00603137865 QUALITEST PHARMACEUTICALS, INC. yMETAPROTEREN SYP 10MG/5ML 00603142258 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM SOL 5MG/5ML 00603143558 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FL DRO 0.25MG 00603144947 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FL DRO 0.5MG/ML 00603145047 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FE DRO FL 0.25 00603145247 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FE DRO /FL 0.5 00603145347 QUALITEST PHARMACEUTICALS, INC. yNYSTATIN SUS 100000 00603148149 QUALITEST PHARMACEUTICALS, INC. yNYSTATIN SUS 100000 00603148158 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN SYP 5MG/5ML 00603149158 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB ELX 20MG/5ML 00603150858 QUALITEST PHARMACEUTICALS, INC. yPHENYLHIST LIQ DH 00603152054 QUALITEST PHARMACEUTICALS, INC. yPHENYLHIST LIQ DH 00603152058 QUALITEST PHARMACEUTICALS, INC. yPHENYLHISTIN SOL EXPECT 00603152154 QUALITEST PHARMACEUTICALS, INC. yPHENYLHISTIN SOL EXPECT 00603152158 QUALITEST PHARMACEUTICALS, INC. yPOT CHLORIDE LIQ 10% 00603153258 QUALITEST PHARMACEUTICALS, INC. yPOT CHLORIDE LIQ 10% 00603153458 QUALITEST PHARMACEUTICALS, INC. yPOT CHLORIDE LIQ 10% 00603153460 QUALITEST PHARMACEUTICALS, INC. yPOT CHLORIDE LIQ 10% 00603153558 QUALITEST PHARMACEUTICALS, INC. yPOT CHLORIDE LIQ 20% 00603153658 QUALITEST PHARMACEUTICALS, INC. yPOVIDONE-IOD SOL 10% 00603155056 QUALITEST PHARMACEUTICALS, INC. yPOVIDONE-IOD SOL 10% 00603155058 QUALITEST PHARMACEUTICALS, INC. yPOVIDONE-IOD SOL 10% 00603155060 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE SYP 6.25/5ML 00603158454 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROMETHAZINE SYP 6.25/5ML 00603158458 QUALITEST PHARMACEUTICALS, INC. yPROMETH/COD SYP 6.25-10 00603158554 QUALITEST PHARMACEUTICALS, INC. yPROMETH/COD SYP 6.25-10 00603158558 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE SYP DM 00603158654 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE SYP DM 00603158658 QUALITEST PHARMACEUTICALS, INC. yPROMETH VC SYP PLAIN 00603158754 QUALITEST PHARMACEUTICALS, INC. yPROMETH VC SYP PLAIN 00603158758 QUALITEST PHARMACEUTICALS, INC. yPROMETH VC/ SYP CODEINE 00603158854 QUALITEST PHARMACEUTICALS, INC. yPROMETH VC/ SYP CODEINE 00603158858 QUALITEST PHARMACEUTICALS, INC. yQ-V TUSSIN SYP 00603160958 QUALITEST PHARMACEUTICALS, INC. yQUINDAL-HD SYP 00603162558 QUALITEST PHARMACEUTICALS, INC. yQUINTEX SYP 7.5-100 00603163558 QUALITEST PHARMACEUTICALS, INC. yQUINTEX HC LIQ 00603163658 QUALITEST PHARMACEUTICALS, INC. yR-TANNAMINE SUS PED 00603166154 QUALITEST PHARMACEUTICALS, INC. yR-TANNAMINE SUS PED 00603166158 QUALITEST PHARMACEUTICALS, INC. yTRIVIT/FLUOR DRO 0.25MG 00603178547 QUALITEST PHARMACEUTICALS, INC. yTRIVIT/FLUOR DRO 0.5MG 00603178647 QUALITEST PHARMACEUTICALS, INC. yTRI-VIT/FE DRO FL 0.25 00603178747 QUALITEST PHARMACEUTICALS, INC. yTUSSICLR DH SYP 3.5-100 00603179958 QUALITEST PHARMACEUTICALS, INC. yVALPROIC ACD SYP 250/5ML 00603184058 QUALITEST PHARMACEUTICALS, INC. yVALPROIC ACD SYP 250/5ML 00603184158 QUALITEST PHARMACEUTICALS, INC. yVI-Q-TUSS SYP 5-100/5 00603185354 QUALITEST PHARMACEUTICALS, INC. yVI-Q-TUSS SYP 5-100/5 00603185358 QUALITEST PHARMACEUTICALS, INC. yALLOPURINOL TAB 100MG 00603211521 QUALITEST PHARMACEUTICALS, INC. yALLOPURINOL TAB 100MG 00603211532 QUALITEST PHARMACEUTICALS, INC. yALLOPURINOL TAB 300MG 00603211621 QUALITEST PHARMACEUTICALS, INC. yALLOPURINOL TAB 300MG 00603211628 QUALITEST PHARMACEUTICALS, INC. yALLOPURINOL TAB 300MG 00603211632 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 10MG 00603221221 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 10MG 00603221232 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 25MG 00603221321 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 25MG 00603221332 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 50MG 00603221421 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 50MG 00603221432 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 75MG 00603221521 QUALITEST PHARMACEUTICALS, INC. yAMITRIPTYLIN TAB 100MG 00603221621 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMITRIPTYLIN TAB 150MG 00603221721 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-15MG 00603233721 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233802 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233804 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233816 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233819 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233820 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233821 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233822 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 00603233832 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-60MG 00603233921 QUALITEST PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-60MG 00603233928 QUALITEST PHARMACEUTICALS, INC. yASA/CODEINE TAB 325-30MG 00603236121 QUALITEST PHARMACEUTICALS, INC. yASA/CODEINE TAB 325-60MG 00603236221 QUALITEST PHARMACEUTICALS, INC. yBACLOFEN TAB 10MG 00603240621 QUALITEST PHARMACEUTICALS, INC. yBACLOFEN TAB 10MG 00603240628 QUALITEST PHARMACEUTICALS, INC. yBACLOFEN TAB 10MG 00603240632 QUALITEST PHARMACEUTICALS, INC. yBACLOFEN TAB 20MG 00603240721 QUALITEST PHARMACEUTICALS, INC. yBACLOFEN TAB 20MG 00603240728 QUALITEST PHARMACEUTICALS, INC. yBACLOFEN TAB 20MG 00603240732 QUALITEST PHARMACEUTICALS, INC. yBELLA ALK/PB TAB 16.2MG 00603241821 QUALITEST PHARMACEUTICALS, INC. yBELLA ALK/PB TAB 16.2MG 00603241832 QUALITEST PHARMACEUTICALS, INC. yBELLATAL ER TAB 00603241921 QUALITEST PHARMACEUTICALS, INC. yBELLASPAS TAB 00603242321 QUALITEST PHARMACEUTICALS, INC. yBELLASPAS TAB 00603242328 QUALITEST PHARMACEUTICALS, INC. yBENZONATATE CAP 100MG 00603242621 QUALITEST PHARMACEUTICALS, INC. yBENZONATATE CAP 100MG 00603242628 QUALITEST PHARMACEUTICALS, INC. yBISACODYL TAB 5MG EC 00603248121 QUALITEST PHARMACEUTICALS, INC. yBISACODYL TAB 5MG EC 00603248132 QUALITEST PHARMACEUTICALS, INC. yBISACODYL TAB 5MG EC 00603248221 QUALITEST PHARMACEUTICALS, INC. yBISACODYL TAB 5MG EC 00603248232 QUALITEST PHARMACEUTICALS, INC. yBUTAL/APAP TAB 50-325 00603254021 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF TAB 00603254421 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF TAB 00603254428 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF TAB 00603254432 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF TAB 00603254521 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BUT/APAP/CAF TAB 00603254528 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF CAP 00603254621 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF TAB 00603254721 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF TAB 00603254728 QUALITEST PHARMACEUTICALS, INC. yBUTALBITAL TAB CPD 00603254821 QUALITEST PHARMACEUTICALS, INC. yBUTALBITAL TAB CPD 00603254832 QUALITEST PHARMACEUTICALS, INC. yBUTALBITAL CAP CPD 00603255021 QUALITEST PHARMACEUTICALS, INC. yBUT/APAP/CAF CAP CODEINE 00603255321 QUALITEST PHARMACEUTICALS, INC. yCARISOPRODOL TAB 350MG 00603258221 QUALITEST PHARMACEUTICALS, INC. yCARISOPRODOL TAB 350MG 00603258228 QUALITEST PHARMACEUTICALS, INC. yCARISOPRODOL TAB 350MG 00603258232 QUALITEST PHARMACEUTICALS, INC. yCARISOPRODOL TAB ASA/COD 00603258421 QUALITEST PHARMACEUTICALS, INC. yCHLORD/CLIDI CAP 5-2.5MG 00603271421 QUALITEST PHARMACEUTICALS, INC. yCHLORD/CLIDI CAP 5-2.5MG 00603271432 QUALITEST PHARMACEUTICALS, INC. yCHLORPHENIR CAP 8MG ER 00603278421 QUALITEST PHARMACEUTICALS, INC. yCHLORPHENIR CAP 8MG ER 00603278432 QUALITEST PHARMACEUTICALS, INC. yCHLORPHENIR CAP 12MG TR 00603278521 QUALITEST PHARMACEUTICALS, INC. yCHLORPHENIR CAP 12MG TR 00603278532 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00603294802 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00603294816 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00603294820 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00603294821 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00603294828 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 0.5MG 00603294832 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00603294902 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00603294916 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00603294920 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00603294921 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00603294928 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 1MG 00603294932 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00603295002 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00603295016 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00603295020 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00603295021 QUALITEST PHARMACEUTICALS, INC. yCLONAZEPAM TAB 2MG 00603295028 QUALITEST PHARMACEUTICALS, INC. yCOLCHICINE TAB 0.6MG 00603305221 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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COLCHICINE TAB 0.6MG 00603305232 QUALITEST PHARMACEUTICALS, INC. yCORTISONE AC TAB 25MG 00603306221 QUALITEST PHARMACEUTICALS, INC. yDECONGESTINE CAP 8-120 TR 00603314321 QUALITEST PHARMACEUTICALS, INC. yDECONGESTINE CAP 8-120 TR 00603314328 QUALITEST PHARMACEUTICALS, INC. yDEXAMETHASON PAK 0.75MG 00603319111 QUALITEST PHARMACEUTICALS, INC. yDEXCHLORPHEN TAB 4MG CR 00603319821 QUALITEST PHARMACEUTICALS, INC. yDEXCHLORPHEN TAB 6MG CR 00603319921 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00603321316 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00603321320 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00603321321 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 2MG 00603321328 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321402 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321416 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321420 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321421 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321422 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321428 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 5MG 00603321432 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321502 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321516 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321520 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321521 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321522 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321528 QUALITEST PHARMACEUTICALS, INC. yDIAZEPAM TAB 10MG 00603321532 QUALITEST PHARMACEUTICALS, INC. yDICYCLOMINE CAP 10MG 00603326521 QUALITEST PHARMACEUTICALS, INC. yDICYCLOMINE CAP 10MG 00603326532 QUALITEST PHARMACEUTICALS, INC. yDICYCLOMINE TAB 20MG 00603326621 QUALITEST PHARMACEUTICALS, INC. yDIMENHYDRIN TAB 50MG 00603332721 QUALITEST PHARMACEUTICALS, INC. yDIMENHYDRIN TAB 50MG 00603332732 QUALITEST PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 25MG 00603333721 QUALITEST PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 25MG 00603333732 QUALITEST PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 50MG 00603333821 QUALITEST PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 50MG 00603333832 QUALITEST PHARMACEUTICALS, INC. yDOXYCYCL HYC CAP 50MG 00603348019 QUALITEST PHARMACEUTICALS, INC. yDOXYCYCL HYC CAP 100MG 00603348119 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DOXYCYCL HYC CAP 100MG 00603348128 QUALITEST PHARMACEUTICALS, INC. yDOXYCYCL HYC TAB 100MG 00603348219 QUALITEST PHARMACEUTICALS, INC. yDOXYCYCL HYC TAB 100MG 00603348228 QUALITEST PHARMACEUTICALS, INC. yDREXOPHED TAB 6-120 SR 00603350521 QUALITEST PHARMACEUTICALS, INC. yPOT CHLORIDE TAB 25MEQ EF 00603350816 QUALITEST PHARMACEUTICALS, INC. yFLUORIDE CHW 0.5MG 00603362232 QUALITEST PHARMACEUTICALS, INC. yFOLIC ACID TAB 1MG 00603371432 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00603373921 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00603373932 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 00603373934 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 00603374021 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 00603374032 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 00603374034 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 00603374121 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 00603374128 QUALITEST PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 00603374132 QUALITEST PHARMACEUTICALS, INC. yGUANFACINE TAB 1MG 00603377421 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00603385521 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00603385525 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT CAP 12.5MG 00603385532 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 00603385621 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 00603385632 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 00603385634 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 50MG 00603385721 QUALITEST PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 50MG 00603385732 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 2.5-500 00603388021 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388102 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388104 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388116 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388119 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388120 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388121 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388122 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388128 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-500MG 00603388132 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388202 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCO/APAP TAB 7.5-500 00603388204 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388216 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388220 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388221 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388222 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388228 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-500 00603388232 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-750 00603388321 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-750 00603388328 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-750 00603388332 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-650 00603388421 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-650 00603388428 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388502 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388504 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388516 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388520 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388521 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388522 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388528 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-650MG 00603388532 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10/660MG 00603388621 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10/660MG 00603388628 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-325MG 00603388721 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-325MG 00603388728 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-325MG 00603388732 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388802 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388804 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388816 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388820 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388821 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388822 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388828 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 10-500MG 00603388832 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 5-325MG 00603389021 QUALITEST PHARMACEUTICALS, INC. yHYDROCO/APAP TAB 7.5-325 00603389121 QUALITEST PHARMACEUTICALS, INC. yHYDROCOD/IBU TAB 7.5-200 00603389721 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCOD/IBU TAB 7.5-200 00603389728 QUALITEST PHARMACEUTICALS, INC. yHYDROMORPHON TAB 2MG 00603392521 QUALITEST PHARMACEUTICALS, INC. yHYDROMORPHON TAB 4MG 00603392621 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 10MG 00603396721 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 10MG 00603396728 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 10MG 00603396732 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 25MG 00603396821 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 25MG 00603396828 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 25MG 00603396832 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 50MG 00603396921 QUALITEST PHARMACEUTICALS, INC. yHYDROXYZ HCL TAB 50MG 00603396928 QUALITEST PHARMACEUTICALS, INC. yHYOSCYAMINE SUB 0.125MG 00603400221 QUALITEST PHARMACEUTICALS, INC. yHYOSCYAMINE TAB 0.125MG 00603400321 QUALITEST PHARMACEUTICALS, INC. yHYOSCYAMINE CAP 0.375 CR 00603400421 QUALITEST PHARMACEUTICALS, INC. yHYOSCYAMINE TAB 0.375 ER 00603400521 QUALITEST PHARMACEUTICALS, INC. yIBUPROFEN TAB 400MG 00603401821 QUALITEST PHARMACEUTICALS, INC. yIBUPROFEN TAB 400MG 00603401828 QUALITEST PHARMACEUTICALS, INC. yIBUPROFEN TAB 600MG 00603401921 QUALITEST PHARMACEUTICALS, INC. yIBUPROFEN TAB 600MG 00603401928 QUALITEST PHARMACEUTICALS, INC. yIBUPROFEN TAB 800MG 00603402021 QUALITEST PHARMACEUTICALS, INC. yIBUPROFEN TAB 800MG 00603402028 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN TAB 5MG 00603411621 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN TAB 5MG 00603411632 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN TAB 10MG 00603411721 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN TAB 10MG 00603411732 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN TAB 20MG 00603411821 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN TAB 20MG 00603411832 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN SUB 2.5MG 00603412221 QUALITEST PHARMACEUTICALS, INC. yISOSORB DIN SUB 5MG 00603412321 QUALITEST PHARMACEUTICALS, INC. yK-EFFERVESCE TAB 25MEQ EF 00603417016 QUALITEST PHARMACEUTICALS, INC. yK+ POTASSIUM POW 20MEQ 00603417316 QUALITEST PHARMACEUTICALS, INC. yMEPERITAB TAB 50MG 00603441521 QUALITEST PHARMACEUTICALS, INC. yMEPERITAB TAB 100MG 00603441621 QUALITEST PHARMACEUTICALS, INC. yMEPROZINE CAP 50-25MG 00603442421 QUALITEST PHARMACEUTICALS, INC. yMETHAZOLAMID TAB 25MG 00603447021 QUALITEST PHARMACEUTICALS, INC. yMETHAZOLAMID TAB 50MG 00603447121 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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METHOCARBAM TAB 500MG 00603448521 QUALITEST PHARMACEUTICALS, INC. yMETHOCARBAM TAB 500MG 00603448528 QUALITEST PHARMACEUTICALS, INC. yMETHOCARBAM TAB 750MG 00603448621 QUALITEST PHARMACEUTICALS, INC. yMETHOCARBAM TAB 750MG 00603448628 QUALITEST PHARMACEUTICALS, INC. yMETHYLPRED PAK 4MG 00603459315 QUALITEST PHARMACEUTICALS, INC. yMETHYLPRED TAB 4MG 00603459321 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM TAB 5MG 00603461421 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM TAB 5MG 00603461428 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM TAB 5MG 00603461432 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM TAB 10MG 00603461521 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM TAB 10MG 00603461528 QUALITEST PHARMACEUTICALS, INC. yMETOCLOPRAM TAB 10MG 00603461532 QUALITEST PHARMACEUTICALS, INC. yMETRONIDAZOL TAB 250MG 00603464021 QUALITEST PHARMACEUTICALS, INC. yMIGQUIN CAP 00603466421 QUALITEST PHARMACEUTICALS, INC. yMIGQUIN CAP 00603466424 QUALITEST PHARMACEUTICALS, INC. yMULTI VIT/FL CHW 0.25MG 00603471021 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FL CHW 0.5MG 00603471121 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FL CHW 0.5MG 00603471132 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FL CHW 1MG 00603471221 QUALITEST PHARMACEUTICALS, INC. yMULTI VIT/FL CHW 0.25MG 00603471321 QUALITEST PHARMACEUTICALS, INC. yMULT-VIT/FL CHW 0.5MG 00603471421 QUALITEST PHARMACEUTICALS, INC. yMULTI-VIT/FL CHW 1MG 00603471521 QUALITEST PHARMACEUTICALS, INC. yNIACIN CAP 125MG TD 00603473521 QUALITEST PHARMACEUTICALS, INC. yNIACIN CAP 250MG TD 00603473621 QUALITEST PHARMACEUTICALS, INC. yNIACIN CAP 250MG TD 00603473632 QUALITEST PHARMACEUTICALS, INC. yNITROGLYCER CAP 2.5MG CR 00603478221 QUALITEST PHARMACEUTICALS, INC. yNITROGLYCER CAP 6.5MG CR 00603478321 QUALITEST PHARMACEUTICALS, INC. yNITROGLYCER CAP 9MG CR 00603478420 QUALITEST PHARMACEUTICALS, INC. yORGAN-I NR TAB 200MG 00603488621 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497502 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497503 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497504 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497516 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497520 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497521 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497522 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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OXYBUTYNIN TAB 5MG 00603497528 QUALITEST PHARMACEUTICALS, INC. yOXYBUTYNIN TAB 5MG 00603497532 QUALITEST PHARMACEUTICALS, INC. yOXYCOD/APAP CAP 5-500MG 00603499721 QUALITEST PHARMACEUTICALS, INC. yOXYCOD/APAP TAB 5-325MG 00603499821 QUALITEST PHARMACEUTICALS, INC. yOXYCOD/APAP TAB 5-325MG 00603499828 QUALITEST PHARMACEUTICALS, INC. yPAPAVERINE CAP 150MG CR 00603504321 QUALITEST PHARMACEUTICALS, INC. yPAPAVERINE CAP 150MG CR 00603504332 QUALITEST PHARMACEUTICALS, INC. yPEMOLINE TAB 18.75MG 00603505521 QUALITEST PHARMACEUTICALS, INC. yPEMOLINE TAB 37.5MG 00603505621 QUALITEST PHARMACEUTICALS, INC. yPEMOLINE TAB 37.5MG 00603505628 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 2MG 00603509021 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 2MG 00603509028 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 4MG 00603509121 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 4MG 00603509128 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 8MG 00603509221 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 8MG 00603509228 QUALITEST PHARMACEUTICALS, INC. yPERPHENAZINE TAB 16MG 00603509321 QUALITEST PHARMACEUTICALS, INC. yPHENAZOPYRID TAB 100MG 00603514121 QUALITEST PHARMACEUTICALS, INC. yPHENAZOPYRID TAB 100MG 00603514132 QUALITEST PHARMACEUTICALS, INC. yPHENAZOPYRID TAB 200MG 00603514221 QUALITEST PHARMACEUTICALS, INC. yPHENAZOPYRID TAB 200MG 00603514232 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 16.2MG 00603516521 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 16.2MG 00603516532 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 32.4MG 00603516602 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 32.4MG 00603516616 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 32.4MG 00603516620 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 32.4MG 00603516621 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 32.4MG 00603516622 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 32.4MG 00603516632 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 64.8MG 00603516721 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 64.8MG 00603516732 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 97.2MG 00603516821 QUALITEST PHARMACEUTICALS, INC. yPHENOBARB TAB 97.2MG 00603516832 QUALITEST PHARMACEUTICALS, INC. yPHENTERMINE TAB 37.5MG 00603519221 QUALITEST PHARMACEUTICALS, INC. yPHENTERMINE TAB 37.5MG 00603519232 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 1MG 00603533521 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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PREDNISONE TAB 1MG 00603533532 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 2.5MG 00603533621 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE PAK 5MG 00603533715 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 5MG 00603533721 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE PAK 5MG 00603533731 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 5MG 00603533732 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE PAK 10MG 00603533815 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 10MG 00603533821 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 10MG 00603533828 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE PAK 10MG 00603533831 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 10MG 00603533832 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 20MG 00603533921 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 20MG 00603533928 QUALITEST PHARMACEUTICALS, INC. yPREDNISONE TAB 20MG 00603533932 QUALITEST PHARMACEUTICALS, INC. yPRENATAL TAB PLUS 00603536121 QUALITEST PHARMACEUTICALS, INC. yPRIMIDONE TAB 250MG 00603537021 QUALITEST PHARMACEUTICALS, INC. yPRIMIDONE TAB 50MG 00603537121 QUALITEST PHARMACEUTICALS, INC. yPRIMIDONE TAB 50MG 00603537128 QUALITEST PHARMACEUTICALS, INC. yPRIMIDONE TAB 250MG 00603537221 QUALITEST PHARMACEUTICALS, INC. yPRIMIDONE TAB 250MG 00603537228 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE TAB 12.5MG 00603543721 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE TAB 25MG 00603543821 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE TAB 25MG 00603543832 QUALITEST PHARMACEUTICALS, INC. yPROMETHAZINE TAB 50MG 00603543921 QUALITEST PHARMACEUTICALS, INC. yPROPAFENONE TAB 150MG 00603544821 QUALITEST PHARMACEUTICALS, INC. yPROPAFENONE TAB 150MG 00603544825 QUALITEST PHARMACEUTICALS, INC. yPROPAFENONE TAB 225MG 00603544921 QUALITEST PHARMACEUTICALS, INC. yPROPAFENONE TAB 300MG 00603545021 QUALITEST PHARMACEUTICALS, INC. yPROPOXY HCL CAP 65MG 00603545921 QUALITEST PHARMACEUTICALS, INC. yPROPOXY HCL CAP 65MG 00603545928 QUALITEST PHARMACEUTICALS, INC. yPROPOXY/APAP TAB 65-650MG 00603546221 QUALITEST PHARMACEUTICALS, INC. yPROPOXY/APAP TAB 65-650MG 00603546228 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 50/325 00603546521 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546621 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546628 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546632 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROPO-N/APAP TAB 100-650 00603546721 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546728 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546732 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546802 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546804 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546816 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546819 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546820 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546821 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546822 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546828 QUALITEST PHARMACEUTICALS, INC. yPROPO-N/APAP TAB 100-650 00603546832 QUALITEST PHARMACEUTICALS, INC. yQ-BID-LA TAB 600MG 00603554324 QUALITEST PHARMACEUTICALS, INC. yQUINDAL CR TAB 20-300MG 00603557121 QUALITEST PHARMACEUTICALS, INC. yQUININE SULF TAB 260MG 00603561821 QUALITEST PHARMACEUTICALS, INC. yQUININE SULF TAB 260MG 00603561828 QUALITEST PHARMACEUTICALS, INC. yQUININE SULF TAB 260MG 00603561832 QUALITEST PHARMACEUTICALS, INC. yQUININE SULF CAP 325MG 00603562221 QUALITEST PHARMACEUTICALS, INC. yQUININE SULF CAP 325MG 00603562228 QUALITEST PHARMACEUTICALS, INC. yQUININE SULF CAP 325MG 00603562232 QUALITEST PHARMACEUTICALS, INC. ySALSALATE TAB 500MG 00603575421 QUALITEST PHARMACEUTICALS, INC. ySALSALATE TAB 500MG 00603575428 QUALITEST PHARMACEUTICALS, INC. ySALSALATE TAB 750MG 00603575521 QUALITEST PHARMACEUTICALS, INC. ySALSALATE TAB 750MG 00603575528 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 25MG 00603576321 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 25MG 00603576328 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 25MG 00603576332 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 50MG 00603576421 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 50MG 00603576428 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 100MG 00603576521 QUALITEST PHARMACEUTICALS, INC. ySPIRONOLACT TAB 100MG 00603576528 QUALITEST PHARMACEUTICALS, INC. ySOTALOL HCL TAB 80MG 00603576921 QUALITEST PHARMACEUTICALS, INC. ySOTALOL HCL TAB 80MG 00603576928 QUALITEST PHARMACEUTICALS, INC. ySOTALOL HCL TAB 120MG 00603577021 QUALITEST PHARMACEUTICALS, INC. ySOTALOL HCL TAB 160MG 00603577121 QUALITEST PHARMACEUTICALS, INC. ySOTALOL HCL TAB 240MG 00603577221 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SULFAZINE TAB 500MG 00603580104 QUALITEST PHARMACEUTICALS, INC. ySULFAZINE TAB 500MG 00603580121 QUALITEST PHARMACEUTICALS, INC. ySULFAZINE TAB 500MG 00603580128 QUALITEST PHARMACEUTICALS, INC. ySULFAZINE TAB 500MG 00603580132 QUALITEST PHARMACEUTICALS, INC. ySULFAZINE EC TAB 500MG 00603580321 QUALITEST PHARMACEUTICALS, INC. ySULFAZINE EC TAB 500MG 00603580325 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 100MG CR 00603594421 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 100MG CR 00603594428 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 200MG CR 00603594521 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 200MG CR 00603594528 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 200MG CR 00603594532 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 300MG CR 00603594621 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 300MG CR 00603594628 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE TAB 300MG CR 00603594632 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE CAP 125MG ER 00603595021 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE CAP 200MG ER 00603595121 QUALITEST PHARMACEUTICALS, INC. yTHEOPHYLLINE CAP 300MG ER 00603595221 QUALITEST PHARMACEUTICALS, INC. yTHEROBEC TAB 00603596921 QUALITEST PHARMACEUTICALS, INC. yTHEROBEC TAB PLUS 00603597021 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 15MG 00603605021 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 30MG 00603605121 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 30MG 00603605132 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 60MG 00603605221 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 60MG 00603605232 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 90MG 00603605321 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 90MG 00603605332 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 120MG 00603605421 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 120MG 00603605432 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 180MG 00603605521 QUALITEST PHARMACEUTICALS, INC. yTHYROID TAB 180MG 00603605532 QUALITEST PHARMACEUTICALS, INC. yTRICOSAL TAB 500MG 00603621521 QUALITEST PHARMACEUTICALS, INC. yTRICOSAL TAB 750MG 00603621621 QUALITEST PHARMACEUTICALS, INC. yTRICOSAL TAB 1000MG 00603621721 QUALITEST PHARMACEUTICALS, INC. yTRIHEXYPHEN TAB 2MG 00603624021 QUALITEST PHARMACEUTICALS, INC. yTRIHEXYPHEN TAB 2MG 00603624032 QUALITEST PHARMACEUTICALS, INC. yTRIHEXYPHEN TAB 5MG 00603624121 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIHEXYPHEN TAB 5MG 00603624132 QUALITEST PHARMACEUTICALS, INC. yTRI-VIT/FL CHW 00603630021 QUALITEST PHARMACEUTICALS, INC. yVICA FORTE CAP 00603638121 QUALITEST PHARMACEUTICALS, INC. yYOHIMBINE TAB 5.4MG 00603643021 QUALITEST PHARMACEUTICALS, INC. yYOHIMBINE TAB 5.4MG 00603643032 QUALITEST PHARMACEUTICALS, INC. yA/B OTIC SOL 00603702073 QUALITEST PHARMACEUTICALS, INC. yACETIC ACID SOL 2% OTIC 00603703841 QUALITEST PHARMACEUTICALS, INC. yACETIC ACID SOL /HC OTIC 00603703939 QUALITEST PHARMACEUTICALS, INC. yOTICAINE SOL 20% OTIC 00603723873 QUALITEST PHARMACEUTICALS, INC. yEAR-GESIC DRO OTIC 00603724073 QUALITEST PHARMACEUTICALS, INC. yTOBRAMYCIN SOL 0.3% OP 00603734537 QUALITEST PHARMACEUTICALS, INC. yZOLENE HC DRO 00603749539 QUALITEST PHARMACEUTICALS, INC. yZOTANE HC DRO AQUEOUS 00603749639 QUALITEST PHARMACEUTICALS, INC. yACIDIC VAG GEL 00603770192 QUALITEST PHARMACEUTICALS, INC. yBENZOYL PER GEL 5% 00603770982 QUALITEST PHARMACEUTICALS, INC. yBENZOYL PER GEL 10% 00603771082 QUALITEST PHARMACEUTICALS, INC. yBENZOYL PER GEL 5% 00603771482 QUALITEST PHARMACEUTICALS, INC. yBENZOYL PER GEL 5% 00603771487 QUALITEST PHARMACEUTICALS, INC. yBENZOYL PER GEL 10% 00603771582 QUALITEST PHARMACEUTICALS, INC. yBENZOYL PER GEL 10% 00603771587 QUALITEST PHARMACEUTICALS, INC. yBETAMETH DIP CRE 0.05% 00603772883 QUALITEST PHARMACEUTICALS, INC. yCERVICAL CRE AMINO AC 00603772986 QUALITEST PHARMACEUTICALS, INC. yHYDROCORT CRE 2.5% 00603778178 QUALITEST PHARMACEUTICALS, INC. yHYDROCORT LOT 1% 00603778454 QUALITEST PHARMACEUTICALS, INC. yHYDROCORT LOT 2.5% 00603778552 QUALITEST PHARMACEUTICALS, INC. yHYDROQUINONE CRE 4% 00603778878 QUALITEST PHARMACEUTICALS, INC. yCLIOQUIN/HC CRE 3-1% 00603780176 QUALITEST PHARMACEUTICALS, INC. yMICONAZOLE CRE 2% 00603780550 QUALITEST PHARMACEUTICALS, INC. yMICONAZOLE CRE 2% 00603780573 QUALITEST PHARMACEUTICALS, INC. yNYSTATIN CRE 100000U 00603781874 QUALITEST PHARMACEUTICALS, INC. yNYSTATIN CRE 100000U 00603781878 QUALITEST PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.5% 00603785274 QUALITEST PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.025% 00603786174 QUALITEST PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.025% 00603786190 QUALITEST PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 00603786274 QUALITEST PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 00603786290 QUALITEST PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HEMORRHOIDAL SUP -HC 25MG 00603812711 QUALITEST PHARMACEUTICALS, INC. yHEMORRHOIDAL SUP -HC 25MG 00603812718 QUALITEST PHARMACEUTICALS, INC. yPROCTOSERT H SUP 30 MG 00603813611 QUALITEST PHARMACEUTICALS, INC. yPROCTOSERT H SUP 30 MG 00603813618 QUALITEST PHARMACEUTICALS, INC. yACTHAR HP INJ 80UNIT 63004773101 QUESTCOR PHARMACEUTICALS, INC. yNASCOBAL GEL 63004773204 QUESTCOR PHARMACEUTICALS, INC. yDORAL TAB 15MG 63004773401 QUESTCOR PHARMACEUTICALS, INC. yDISPERMOX TAB 600MG 10631017620 RANBAXY LABORATORIES INCORPORATED yRIOMET SOL 10631020601 RANBAXY LABORATORIES INCORPORATED yRIOMET SOL 10631020602 RANBAXY LABORATORIES INCORPORATED yPROCTO-KIT CRE 1% 10631040501 RANBAXY LABORATORIES INCORPORATED yPROCTO-KIT CRE 2.5% 10631040601 RANBAXY LABORATORIES INCORPORATED yPROCTOSOL HC CRE 2.5% 10631040701 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 30MG 10631044731 RANBAXY LABORATORIES INCORPORATED yDISPERMOX TAB 200MG 10631056520 RANBAXY LABORATORIES INCORPORATED yDISPERMOX TAB 400MG 10631056720 RANBAXY LABORATORIES INCORPORATED yPANIXINE TAB 125MG 10631057301 RANBAXY LABORATORIES INCORPORATED yPANIXINE TAB 125MG 10631057340 RANBAXY LABORATORIES INCORPORATED yPANIXINE TAB 250MG 10631057401 RANBAXY LABORATORIES INCORPORATED yPANIXINE TAB 250MG 10631057440 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 10MG 10631058431 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 10MG 10631058477 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 20MG 10631058531 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 20MG 10631058577 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 40MG 10631058631 RANBAXY LABORATORIES INCORPORATED ySOTRET CAP 40MG 10631058677 RANBAXY LABORATORIES INCORPORATED yDOXYCYC MONO TAB 75MG 63304013101 RANBAXY PHARMACEUTICALS, INC. yDOXYCYC MONO TAB 100MG 63304013204 RANBAXY PHARMACEUTICALS, INC. yDOXYCYC MONO TAB 100MG 63304013250 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL TAB 250MG 63304014801 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL TAB 500MG 63304014901 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL TAB 500MG 63304014950 RANBAXY PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 10-12.5 63304015501 RANBAXY PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-12.5 63304015601 RANBAXY PHARMACEUTICALS, INC. yBENAZEP/HCTZ TAB 20-25MG 63304015701 RANBAXY PHARMACEUTICALS, INC. yNORTRIPTYLIN SOL 10MG/5ML 63304020201 RANBAXY PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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OPIUM TIN 10% 63304020301 RANBAXY PHARMACEUTICALS, INC. yOPIUM TIN 10% 63304020302 RANBAXY PHARMACEUTICALS, INC. yMIDAZOLAM SYP 2MG/ML 63304020518 RANBAXY PHARMACEUTICALS, INC. yRIOMET SOL 63304020601 RANBAXY PHARMACEUTICALS, INC. yRIOMET SOL 63304020602 RANBAXY PHARMACEUTICALS, INC. yAMYTAL SOD INJ 500MG 63304030310 RANBAXY PHARMACEUTICALS, INC. yFOSINOP/HCTZ TAB 10/12.5 63304040301 RANBAXY PHARMACEUTICALS, INC. yFOSINOP/HCTZ TAB 20/12.5 63304040401 RANBAXY PHARMACEUTICALS, INC. yPROCTO-KIT CRE 1% 63304040501 RANBAXY PHARMACEUTICALS, INC. yPROCTO-KIT CRE 2.5% 63304040601 RANBAXY PHARMACEUTICALS, INC. yPROCTOSOL HC CRE 2.5% 63304040701 RANBAXY PHARMACEUTICALS, INC. yPROCTOSOL SUP 25MG 63304040812 RANBAXY PHARMACEUTICALS, INC. yPROCTOSOL SUP 25MG 63304040824 RANBAXY PHARMACEUTICALS, INC. yGLIMEPIRIDE TAB 1MG 63304042501 RANBAXY PHARMACEUTICALS, INC. yGLIMEPIRIDE TAB 2MG 63304042601 RANBAXY PHARMACEUTICALS, INC. yGLIMEPIRIDE TAB 4MG 63304042701 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 30MG 63304044731 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 63304050001 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 5MG 63304050005 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 63304050101 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 10MG 63304050105 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 63304050205 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 63304050228 RANBAXY PHARMACEUTICALS, INC. yBUSPIRONE TAB 15MG 63304050260 RANBAXY PHARMACEUTICALS, INC. yACYCLOVIR TAB 400MG 63304050401 RANBAXY PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 63304050501 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 875MG 63304050901 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV TAB 875MG 63304050920 RANBAXY PHARMACEUTICALS, INC. yCEFADROXIL TAB 1GM 63304051250 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CHW 250MG 63304051501 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CHW 250MG 63304051504 RANBAXY PHARMACEUTICALS, INC. yNITROFURANTN CAP 100MG 63304051801 RANBAXY PHARMACEUTICALS, INC. yCEFPODOXIME TAB 100MG 63304052020 RANBAXY PHARMACEUTICALS, INC. yCEFPODOXIME TAB 200MG 63304052101 RANBAXY PHARMACEUTICALS, INC. yCEFPODOXIME TAB 200MG 63304052120 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 2.5MG 63304053101 RANBAXY PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOPRIL TAB 5MG 63304053201 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 5MG 63304053210 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 63304053301 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 10MG 63304053310 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 63304053401 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 20MG 63304053410 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 63304053501 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 40MG 63304053510 RANBAXY PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 10-12.5 63304053601 RANBAXY PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-12.5 63304053701 RANBAXY PHARMACEUTICALS, INC. yLISINOP/HCTZ TAB 20-25MG 63304053801 RANBAXY PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 3.75MG 63304055201 RANBAXY PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 3.75MG 63304055205 RANBAXY PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 7.5MG 63304055301 RANBAXY PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 7.5MG 63304055305 RANBAXY PHARMACEUTICALS, INC. yCLORAZ DIPOT TAB 15MG 63304055401 RANBAXY PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-60MG 63304056101 RANBAXY PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-60MG 63304056105 RANBAXY PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 63304056201 RANBAXY PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 63304056205 RANBAXY PHARMACEUTICALS, INC. yAPAP/CODEINE TAB 300-30MG 63304056210 RANBAXY PHARMACEUTICALS, INC. yCEFADROXIL CAP 500MG 63304058201 RANBAXY PHARMACEUTICALS, INC. yCEFADROXIL CAP 500MG 63304058250 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 10MG 63304058431 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 10MG 63304058477 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 20MG 63304058531 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 20MG 63304058577 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 40MG 63304058631 RANBAXY PHARMACEUTICALS, INC. ySOTRET CAP 40MG 63304058677 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN TAB 600MG 63304059201 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN TAB 600MG 63304059205 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN TAB 800MG 63304059301 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN TAB 800MG 63304059305 RANBAXY PHARMACEUTICALS, INC. yLISINOPRIL TAB 30MG 63304059901 RANBAXY PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 63304060028 RANBAXY PHARMACEUTICALS, INC. yTAMOXIFEN TAB 10MG 63304060060 RANBAXY PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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TAMOXIFEN TAB 20MG 63304060130 RANBAXY PHARMACEUTICALS, INC. yTAMOXIFEN TAB 20MG 63304060190 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN CAP 100MG 63304062701 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN CAP 100MG 63304062705 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN CAP 300MG 63304062801 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN CAP 300MG 63304062805 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN CAP 400MG 63304062901 RANBAXY PHARMACEUTICALS, INC. yGABAPENTIN CAP 400MG 63304062905 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 63304063201 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 63304063230 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 40MG 63304063290 RANBAXY PHARMACEUTICALS, INC. yGANCICLOVIR CAP 250MG 63304063628 RANBAXY PHARMACEUTICALS, INC. yGANCICLOVIR CAP 500MG 63304063728 RANBAXY PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 63304065201 RANBAXY PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 63304065205 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CAP 250MG 63304065401 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CAP 250MG 63304065405 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CAP 500MG 63304065501 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CAP 500MG 63304065505 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 63304065601 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 63304065605 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 63304065701 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 63304065705 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR CAP 250MG 63304065801 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR CAP 500MG 63304065901 RANBAXY PHARMACEUTICALS, INC. yTERAZOSIN CAP 1MG 63304066205 RANBAXY PHARMACEUTICALS, INC. yTERAZOSIN CAP 2MG 63304066305 RANBAXY PHARMACEUTICALS, INC. yTERAZOSIN CAP 5MG 63304066405 RANBAXY PHARMACEUTICALS, INC. yTERAZOSIN CAP 10MG 63304066505 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 63304068630 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 10MG 63304068690 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 63304068730 RANBAXY PHARMACEUTICALS, INC. yFLUOXETINE CAP 20MG 63304068790 RANBAXY PHARMACEUTICALS, INC. yPIROXICAM CAP 10MG 63304069001 RANBAXY PHARMACEUTICALS, INC. yCLINDAMYCIN CAP 150MG 63304069201 RANBAXY PHARMACEUTICALS, INC. yCLINDAMYCIN CAP 150MG 63304069205 RANBAXY PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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CLINDAMYCIN CAP 300MG 63304069301 RANBAXY PHARMACEUTICALS, INC. yCLINDAMYCIN CAP 300MG 63304069316 RANBAXY PHARMACEUTICALS, INC. yMINOCYCLINE CAP 50MG 63304069401 RANBAXY PHARMACEUTICALS, INC. yMINOCYCLINE CAP 75MG 63304069501 RANBAXY PHARMACEUTICALS, INC. yMINOCYCLINE CAP 100MG 63304069605 RANBAXY PHARMACEUTICALS, INC. yMINOCYCLINE CAP 100MG 63304069650 RANBAXY PHARMACEUTICALS, INC. yMORPHINE SUL TAB 10MG 63304070601 RANBAXY PHARMACEUTICALS, INC. yMORPHINE SUL TAB 15MG 63304070701 RANBAXY PHARMACEUTICALS, INC. yMORPHINE SUL TAB 30MG 63304070801 RANBAXY PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 250MG 63304070901 RANBAXY PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 500MG 63304071001 RANBAXY PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 750MG 63304071101 RANBAXY PHARMACEUTICALS, INC. yCIPROFLOXACN TAB 750MG 63304071150 RANBAXY PHARMACEUTICALS, INC. yOFLOXACIN TAB 300MG 63304071550 RANBAXY PHARMACEUTICALS, INC. yOFLOXACIN TAB 200MG 63304071650 RANBAXY PHARMACEUTICALS, INC. yOFLOXACIN TAB 400MG 63304071701 RANBAXY PHARMACEUTICALS, INC. yCLARITHROMYC TAB 250MG 63304072501 RANBAXY PHARMACEUTICALS, INC. yCLARITHROMYC TAB 250MG 63304072560 RANBAXY PHARMACEUTICALS, INC. yCLARITHROMYC TAB 500MG 63304072601 RANBAXY PHARMACEUTICALS, INC. yCLARITHROMYC TAB 500MG 63304072660 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 5MG 63304073601 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 5MG 63304073605 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 63304073701 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 10MG 63304073705 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 63304073801 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 20MG 63304073805 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 63304073901 RANBAXY PHARMACEUTICALS, INC. yBENAZEPRIL TAB 40MG 63304073905 RANBAXY PHARMACEUTICALS, INC. yCODEINE PHOS TAB SOL 30MG 63304074801 RANBAXY PHARMACEUTICALS, INC. yCODEINE PHOS TAB SOL 60MG 63304074901 RANBAXY PHARMACEUTICALS, INC. yCEFUROXIME TAB 250MG 63304075120 RANBAXY PHARMACEUTICALS, INC. yCEFUROXIME TAB 250MG 63304075160 RANBAXY PHARMACEUTICALS, INC. yCEFUROXIME TAB 500MG 63304075220 RANBAXY PHARMACEUTICALS, INC. yCEFUROXIME TAB 500MG 63304075260 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV CHW 200MG 63304075320 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV CHW 400MG 63304075420 RANBAXY PHARMACEUTICALS, INC. y

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Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMOXICILLIN CHW 200MG 63304076020 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CHW 400MG 63304076101 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN CHW 400MG 63304076120 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN TAB 500MG 63304076220 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN TAB 875MG 63304076301 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN TAB 875MG 63304076305 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN TAB 875MG 63304076320 RANBAXY PHARMACEUTICALS, INC. yMETFORMIN TAB 750MG ER 63304076701 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 0.5MG 63304077201 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 0.5MG 63304077205 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 1MG 63304077301 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 1MG 63304077305 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 1MG 63304077310 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 2MG 63304077401 RANBAXY PHARMACEUTICALS, INC. yLORAZEPAM TAB 2MG 63304077405 RANBAXY PHARMACEUTICALS, INC. yFOSINOPRIL TAB 10MG 63304077510 RANBAXY PHARMACEUTICALS, INC. yFOSINOPRIL TAB 10MG 63304077590 RANBAXY PHARMACEUTICALS, INC. yFOSINOPRIL TAB 20MG 63304077610 RANBAXY PHARMACEUTICALS, INC. yFOSINOPRIL TAB 20MG 63304077690 RANBAXY PHARMACEUTICALS, INC. yFOSINOPRIL TAB 40MG 63304077710 RANBAXY PHARMACEUTICALS, INC. yFOSINOPRIL TAB 40MG 63304077790 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 5MG 63304078910 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 5MG 63304078930 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 5MG 63304078990 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 10MG 63304079010 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 10MG 63304079030 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 10MG 63304079090 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 20MG 63304079110 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 20MG 63304079130 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 20MG 63304079190 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 40MG 63304079210 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 40MG 63304079230 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 40MG 63304079290 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 80MG 63304079310 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 80MG 63304079330 RANBAXY PHARMACEUTICALS, INC. ySIMVASTATIN TAB 80MG 63304079350 RANBAXY PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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SIMVASTATIN TAB 80MG 63304079390 RANBAXY PHARMACEUTICALS, INC. yFLECAINIDE TAB 50MG 63304079401 RANBAXY PHARMACEUTICALS, INC. yFLECAINIDE TAB 100MG 63304079501 RANBAXY PHARMACEUTICALS, INC. yFLECAINIDE TAB 150MG 63304079601 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 50MG 63304080330 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 100MG 63304080401 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 100MG 63304080430 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 150MG 63304080512 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 200MG 63304080601 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE TAB 200MG 63304080630 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 63304083401 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 63304083410 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 63304083501 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 5MG 63304083510 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 63304083601 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 10MG 63304083610 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 63304083701 RANBAXY PHARMACEUTICALS, INC. yENALAPRIL TAB 20MG 63304083710 RANBAXY PHARMACEUTICALS, INC. yRANITIDINE TAB 150MG 63304083801 RANBAXY PHARMACEUTICALS, INC. yRANITIDINE TAB 150MG 63304083805 RANBAXY PHARMACEUTICALS, INC. yRANITIDINE TAB 150MG 63304083860 RANBAXY PHARMACEUTICALS, INC. yRANITIDINE TAB 300MG 63304083901 RANBAXY PHARMACEUTICALS, INC. yRANITIDINE TAB 300MG 63304083904 RANBAXY PHARMACEUTICALS, INC. yRANITIDINE TAB 300MG 63304083930 RANBAXY PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 63304086001 RANBAXY PHARMACEUTICALS, INC. yMETFORMIN TAB 500MG ER 63304086005 RANBAXY PHARMACEUTICALS, INC. yFENOFIBRATE TAB 54MG 63304090090 RANBAXY PHARMACEUTICALS, INC. yFENOFIBRATE TAB 160MG 63304090105 RANBAXY PHARMACEUTICALS, INC. yFENOFIBRATE TAB 160MG 63304090190 RANBAXY PHARMACEUTICALS, INC. yAMPHETAMINE TAB 5MG 63304090801 RANBAXY PHARMACEUTICALS, INC. yAMPHETAMINE TAB 10MG 63304090901 RANBAXY PHARMACEUTICALS, INC. yAMPHETAMINE TAB 20MG 63304091001 RANBAXY PHARMACEUTICALS, INC. yAMPHETAMINE TAB 30MG 63304091101 RANBAXY PHARMACEUTICALS, INC. yZIDOVUDINE TAB 300MG 63304092060 RANBAXY PHARMACEUTICALS, INC. yCEFAZOLIN INJ 1GM 63304094025 RANBAXY PHARMACEUTICALS, INC. yCEFAZOLIN INJ 10GM 63304094110 RANBAXY PHARMACEUTICALS, INC. y

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CEFUROXIME INJ 750MG 63304094625 RANBAXY PHARMACEUTICALS, INC. yCEFUROXIME INJ 1.5GM 63304094725 RANBAXY PHARMACEUTICALS, INC. yCEFUROXIME INJ 7.5GM 63304094810 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 125/5ML 63304095401 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 125/5ML 63304095402 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 187/5ML 63304095503 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 187/5ML 63304095504 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 250/5ML 63304095601 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 250/5ML 63304095602 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 375/5ML 63304095703 RANBAXY PHARMACEUTICALS, INC. yCEFACLOR SUS 375/5ML 63304095704 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN SUS 125/5ML 63304095801 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN SUS 125/5ML 63304095802 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN SUS 250/5ML 63304095901 RANBAXY PHARMACEUTICALS, INC. yCEPHALEXIN SUS 250/5ML 63304095902 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL SUS 125/5ML 63304096001 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL SUS 125/5ML 63304096003 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL SUS 125/5ML 63304096004 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL SUS 250/5ML 63304096101 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL SUS 250/5ML 63304096103 RANBAXY PHARMACEUTICALS, INC. yCEFPROZIL SUS 250/5ML 63304096104 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN SUS 200/5ML 63304096901 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN SUS 200/5ML 63304096903 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN SUS 200/5ML 63304096904 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN SUS 400/5ML 63304097001 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN SUS 400/5ML 63304097003 RANBAXY PHARMACEUTICALS, INC. yAMOXICILLIN SUS 400/5ML 63304097004 RANBAXY PHARMACEUTICALS, INC. yCEFADROXIL SUS 250/5ML 63304097304 RANBAXY PHARMACEUTICALS, INC. yCEFADROXIL SUS 500/5ML 63304097401 RANBAXY PHARMACEUTICALS, INC. yCEFADROXIL SUS 500/5ML 63304097404 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE SUS 10MG/ML 63304097505 RANBAXY PHARMACEUTICALS, INC. yFLUCONAZOLE SUS 40MG/ML 63304097605 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 63304097701 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 63304097703 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 200/5ML 63304097704 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 63304097901 RANBAXY PHARMACEUTICALS, INC. y

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AMOX/K CLAV SUS 400/5ML 63304097903 RANBAXY PHARMACEUTICALS, INC. yAMOX/K CLAV SUS 400/5ML 63304097904 RANBAXY PHARMACEUTICALS, INC. yZONISAMIDE CAP 100MG 63304099201 RANBAXY PHARMACEUTICALS, INC. yBETHANECHOL TAB 5MG 63304099301 RANBAXY PHARMACEUTICALS, INC. yBETHANECHOL TAB 10MG 63304099401 RANBAXY PHARMACEUTICALS, INC. yBETHANECHOL TAB 25MG 63304099501 RANBAXY PHARMACEUTICALS, INC. yBETHANECHOL TAB 50MG 63304099601 RANBAXY PHARMACEUTICALS, INC. yORFADIN CAP 2MG 66607100206 RARE DISEASE THERAPEUTICS, INC. yORFADIN CAP 5MG 66607100506 RARE DISEASE THERAPEUTICS, INC. yORFADIN CAP 10MG 66607101006 RARE DISEASE THERAPEUTICS, INC. yBUPRENEX INJ 0.324/ML 12496075701 RECKITT BENCKISER PHARMACEUTICALS, INC. ySUBUTEX SUB 2MG 12496127802 RECKITT BENCKISER PHARMACEUTICALS, INC. ySUBOXONE SUB 2-0.5MG 12496128302 RECKITT BENCKISER PHARMACEUTICALS, INC. ySUBOXONE SUB 8-2MG 12496130602 RECKITT BENCKISER PHARMACEUTICALS, INC. ySUBUTEX SUB 8MG 12496131002 RECKITT BENCKISER PHARMACEUTICALS, INC. yFOLBALIN TAB PLUS 12593004790 RED RIVER PHARMA MANUFACTURING, LLC yAXID CAP 150MG 65726014415 RELIANT PHARMACEUTICALS, INC. yAXID CAP 300MG 65726014510 RELIANT PHARMACEUTICALS, INC. yDYNACIRC CR TAB 5MG 65726023510 RELIANT PHARMACEUTICALS, INC. yDYNACIRC CR TAB 10MG 65726023610 RELIANT PHARMACEUTICALS, INC. yINNOPRAN XL CAP 80MG 65726025010 RELIANT PHARMACEUTICALS, INC. yINNOPRAN XL CAP 80MG 65726025025 RELIANT PHARMACEUTICALS, INC. yINNOPRAN XL CAP 120MG 65726025110 RELIANT PHARMACEUTICALS, INC. yINNOPRAN XL CAP 120MG 65726025125 RELIANT PHARMACEUTICALS, INC. yRYTHMOL SR CAP 225MG 65726026115 RELIANT PHARMACEUTICALS, INC. yRYTHMOL SR CAP 225MG 65726026125 RELIANT PHARMACEUTICALS, INC. yRYTHMOL SR CAP 325MG 65726026215 RELIANT PHARMACEUTICALS, INC. yRYTHMOL SR CAP 425MG 65726026315 RELIANT PHARMACEUTICALS, INC. yRYTHMOL TAB 150MG 65726026525 RELIANT PHARMACEUTICALS, INC. yRYTHMOL TAB 225MG 65726026625 RELIANT PHARMACEUTICALS, INC. yRYTHMOL TAB 300MG 65726026725 RELIANT PHARMACEUTICALS, INC. yANTARA CAP 43MG 65726040110 RELIANT PHARMACEUTICALS, INC. yANTARA CAP 130MG 65726040310 RELIANT PHARMACEUTICALS, INC. yOMACOR CAP 1GM 65726042415 RELIANT PHARMACEUTICALS, INC. yOMACOR CAP 1GM 65726042427 RELIANT PHARMACEUTICALS, INC. yFOLIC ACID TAB 1MG 54738009003 RICHMOND PHARMACEUTICALS, INC. y

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DOCUSATE SOD CAP 250MG 54738009901 RICHMOND PHARMACEUTICALS, INC. yDOCUSATE SOD CAP 250MG 54738009903 RICHMOND PHARMACEUTICALS, INC. yDOCUSATE SOD CAP 250MG 54738009913 RICHMOND PHARMACEUTICALS, INC. yBISMUTH CHW 262MG 54738010230 RICHMOND PHARMACEUTICALS, INC. yCHLORPHENIR TAB 4MG 54738010301 RICHMOND PHARMACEUTICALS, INC. yCHLORPHENIR TAB 4MG 54738010303 RICHMOND PHARMACEUTICALS, INC. yCHLORPHENIR TAB 4MG 54738010313 RICHMOND PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 25MG 54738011501 RICHMOND PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 25MG 54738011503 RICHMOND PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 25MG 54738011513 RICHMOND PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 50MG 54738011601 RICHMOND PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 50MG 54738011603 RICHMOND PHARMACEUTICALS, INC. yDIPHENHYDRAM CAP 50MG 54738011613 RICHMOND PHARMACEUTICALS, INC. yIBUPROFEN TAB 600MG 54738012001 RICHMOND PHARMACEUTICALS, INC. yIBUPROFEN TAB 600MG 54738012002 RICHMOND PHARMACEUTICALS, INC. yIBUPROFEN TAB 600MG 54738012013 RICHMOND PHARMACEUTICALS, INC. yIBUPROFEN TAB 800MG 54738012101 RICHMOND PHARMACEUTICALS, INC. yIBUPROFEN TAB 800MG 54738012102 RICHMOND PHARMACEUTICALS, INC. yIBUPROFEN TAB 800MG 54738012113 RICHMOND PHARMACEUTICALS, INC. yPSEUDOEPHEDR TAB 60MG 54738012401 RICHMOND PHARMACEUTICALS, INC. ySPIRONOLACT TAB 25MG 54738013001 RICHMOND PHARMACEUTICALS, INC. ySPIRONOLACT TAB 50MG 54738013101 RICHMOND PHARMACEUTICALS, INC. ySPIRONOLACT TAB 50MG 54738013102 RICHMOND PHARMACEUTICALS, INC. ySPIRONOLACT TAB 100MG 54738013201 RICHMOND PHARMACEUTICALS, INC. ySPIRONOLACT TAB 100MG 54738013202 RICHMOND PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 54738021001 RICHMOND PHARMACEUTICALS, INC. yTRAMADOL HCL TAB 50MG 54738021002 RICHMOND PHARMACEUTICALS, INC. yHYDROXYUREA CAP 500MG 54738054701 RICHMOND PHARMACEUTICALS, INC. yPERPHENAZINE TAB 2MG 54738055001 RICHMOND PHARMACEUTICALS, INC. yPERPHENAZINE TAB 4MG 54738055102 RICHMOND PHARMACEUTICALS, INC. yPERPHENAZINE TAB 8MG 54738055201 RICHMOND PHARMACEUTICALS, INC. yPERPHENAZINE TAB 8MG 54738055202 RICHMOND PHARMACEUTICALS, INC. yPERPHENAZINE TAB 16MG 54738055301 RICHMOND PHARMACEUTICALS, INC. yTRIHEXYPHEN TAB 2MG 54738055401 RICHMOND PHARMACEUTICALS, INC. yTRIHEXYPHEN TAB 2MG 54738055403 RICHMOND PHARMACEUTICALS, INC. yTRIHEXYPHEN TAB 5MG 54738055501 RICHMOND PHARMACEUTICALS, INC. y

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TRIHEXYPHEN TAB 5MG 54738055503 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 54738057001 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 54738057002 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 54738057003 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 54738057101 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 54738057102 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 54738057103 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 54738057201 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 54738057202 RICHMOND PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 54738057203 RICHMOND PHARMACEUTICALS, INC. yCYPROHEPTAD TAB 4MG 54738058001 RICHMOND PHARMACEUTICALS, INC. yCYPROHEPTAD TAB 4MG 54738058003 RICHMOND PHARMACEUTICALS, INC. yISOSORB DIN TAB 30MG 54738059001 RICHMOND PHARMACEUTICALS, INC. yISOSORB DIN TAB 30MG 54738059003 RICHMOND PHARMACEUTICALS, INC. yMAG-PHEN TAB 25-600MG 64980010101 RISING PHARMACEUTICALS, INC. yVITA S FORTE TAB 64980010201 RISING PHARMACEUTICALS, INC. yPHOSPHA 250 TAB NEUTRAL 64980010401 RISING PHARMACEUTICALS, INC. yFOLITAB TAB 64980010503 RISING PHARMACEUTICALS, INC. yNATAFOLIC-PN TAB 64980010701 RISING PHARMACEUTICALS, INC. yENTAB-DM TAB 12 HRS 64980010801 RISING PHARMACEUTICALS, INC. yFEOGEN FORTE CAP 64980010901 RISING PHARMACEUTICALS, INC. yBENZTROPINE TAB 0.5MG 64980011101 RISING PHARMACEUTICALS, INC. yBENZTROPINE TAB 1MG 64980011201 RISING PHARMACEUTICALS, INC. yBENZTROPINE TAB 1MG 64980011210 RISING PHARMACEUTICALS, INC. yBENZTROPINE TAB 2MG 64980011301 RISING PHARMACEUTICALS, INC. yBENZTROPINE TAB 2MG 64980011310 RISING PHARMACEUTICALS, INC. yRENAPHRO CAP 64980011401 RISING PHARMACEUTICALS, INC. yFEOGEN CAP 64980011501 RISING PHARMACEUTICALS, INC. yFEOGEN FA CAP 64980011601 RISING PHARMACEUTICALS, INC. yNUTRIFAC ZX TAB 64980011806 RISING PHARMACEUTICALS, INC. yMETHENAM HIP TAB 1GM 64980011901 RISING PHARMACEUTICALS, INC. yNATAFOLIC-OB TAB 64980012001 RISING PHARMACEUTICALS, INC. yCYPROHEPTAD TAB 4MG 64980012301 RISING PHARMACEUTICALS, INC. yCYPROHEPTAD TAB 4MG 64980012310 RISING PHARMACEUTICALS, INC. yNU-NATAL TAB ADVANCED 64980012509 RISING PHARMACEUTICALS, INC. yNUFOL TAB 64980012709 RISING PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXFOL TAB 64980012809 RISING PHARMACEUTICALS, INC. yLEVOCARNITIN TAB 330MG 64980013009 RISING PHARMACEUTICALS, INC. yGLYCOPYRROL TAB 1MG 64980013101 RISING PHARMACEUTICALS, INC. yGLYCOPYRROL TAB 2MG 64980013201 RISING PHARMACEUTICALS, INC. yPOT CITRATE TAB 540MG 64980013701 RISING PHARMACEUTICALS, INC. yPOT CITRATE TAB 1080MG 64980013801 RISING PHARMACEUTICALS, INC. yURSODIOL CAP 300MG 64980013901 RISING PHARMACEUTICALS, INC. yPROCTOZONE CRE -HC 2.5% 64980030130 RISING PHARMACEUTICALS, INC. yPROCTO-PAK CRE 1% 64980030230 RISING PHARMACEUTICALS, INC. yDENTA 5000 CRE PLUS 64980030550 RISING PHARMACEUTICALS, INC. yDENTA 5000 CRE PLUS 2PK 64980030650 RISING PHARMACEUTICALS, INC. yDENTAGEL GEL 1.1% 64980030760 RISING PHARMACEUTICALS, INC. yLACTIC ACID CRE E 64980030912 RISING PHARMACEUTICALS, INC. yLACTIC ACID CRE E 64980030924 RISING PHARMACEUTICALS, INC. yLACTIC ACID LOT 10% 64980031036 RISING PHARMACEUTICALS, INC. yANTHRALIN CRE 1% 64980031250 RISING PHARMACEUTICALS, INC. yMEDI-PASTE OIN 64980031345 RISING PHARMACEUTICALS, INC. yMEDI-PASTE OIN 64980031360 RISING PHARMACEUTICALS, INC. yLIDAZONE CRE 64980031914 RISING PHARMACEUTICALS, INC. yLIDAZONE HC KIT 64980031920 RISING PHARMACEUTICALS, INC. yLEVOCARNITIN SOL 1GM/10ML 64980050312 RISING PHARMACEUTICALS, INC. yCYPROHEPTAD SYP 2MG/5ML 64980050448 RISING PHARMACEUTICALS, INC. yFLUNISOLIDE SPR 0.025% 64980050625 RISING PHARMACEUTICALS, INC. yRE 10 WASH LIQ 68032010006 RIVER'S EDGE PHARMACEUTICALS yRE 10 WASH LIQ 68032010012 RIVER'S EDGE PHARMACEUTICALS yRE 40 LOT 40% 68032010108 RIVER'S EDGE PHARMACEUTICALS yRE 40 GEL 40% 68032010115 RIVER'S EDGE PHARMACEUTICALS yROSADERM EMU CLEANSER 68032010406 RIVER'S EDGE PHARMACEUTICALS yROSADERM EMU CLEANSER 68032010412 RIVER'S EDGE PHARMACEUTICALS yLIDOCAINE CRE 3% 68032010503 RIVER'S EDGE PHARMACEUTICALS yLIDOCAINE LOT 3% 68032010517 RIVER'S EDGE PHARMACEUTICALS yLIDOCAINE/HC CRE 3%-0.5% 68032010603 RIVER'S EDGE PHARMACEUTICALS yLIDOCAINE/HC LOT 3%-0.5% 68032010617 RIVER'S EDGE PHARMACEUTICALS yRE2+30 SYP 68032010704 RIVER'S EDGE PHARMACEUTICALS yHYDROQUINONE CRE 4%/SUNS 68032010801 RIVER'S EDGE PHARMACEUTICALS yLIDOCAINE/HC CRE 3%-0.5% 68032011101 RIVER'S EDGE PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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UREA LOT 35% 68032012207 RIVER'S EDGE PHARMACEUTICALS yUREA LOT 35% 68032012211 RIVER'S EDGE PHARMACEUTICALS yLIDOCAINE/HC KIT 3%-0.5% 68032012420 RIVER'S EDGE PHARMACEUTICALS yLACTIC ACID LOT 10% 68032012512 RIVER'S EDGE PHARMACEUTICALS yLACTIC ACID LOT 10% 68032012516 RIVER'S EDGE PHARMACEUTICALS yLACTIC ACID CRE 10% 68032012604 RIVER'S EDGE PHARMACEUTICALS yLACTIC ACID CRE 10% 68032012608 RIVER'S EDGE PHARMACEUTICALS ySELENIUM SUL SHA 2.25% 68032012718 RIVER'S EDGE PHARMACEUTICALS yGUAPHEN TAB FORTE 68032013310 RIVER'S EDGE PHARMACEUTICALS yGUAPHEN II TAB DM 68032013410 RIVER'S EDGE PHARMACEUTICALS yALINIA TAB 500MG 67546011111 ROMARK LABORATORIES, L.C. yALINIA TAB 500MG 67546011132 ROMARK LABORATORIES, L.C. yALINIA SUS 100MG/5M 67546021221 ROMARK LABORATORIES, L.C. yFLUCONAZOLE SUS 10MG/ML 00054000285 ROXANE LABORATORIES, INC. yCALCITRIOL CAP 0.25MCG 00054000713 ROXANE LABORATORIES, INC. yCALCITRIOL CAP 0.25MCG 00054000725 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 50MG 00054001020 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 50MG 00054001021 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 50MG 00054001025 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 100MG 00054001120 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 100MG 00054001121 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 100MG 00054001125 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 150MG 00054001221 ROXANE LABORATORIES, INC. yFLECAINIDE TAB 150MG 00054001225 ROXANE LABORATORIES, INC. yPREDNISONE TAB 10MG 00054001720 ROXANE LABORATORIES, INC. yPREDNISONE TAB 10MG 00054001725 ROXANE LABORATORIES, INC. yPREDNISONE TAB 10MG 00054001729 ROXANE LABORATORIES, INC. yPREDNISONE TAB 20MG 00054001820 ROXANE LABORATORIES, INC. yPREDNISONE TAB 20MG 00054001825 ROXANE LABORATORIES, INC. yPREDNISONE TAB 20MG 00054001829 ROXANE LABORATORIES, INC. yPREDNISONE TAB 50MG 00054001920 ROXANE LABORATORIES, INC. yPREDNISONE TAB 50MG 00054001925 ROXANE LABORATORIES, INC. yLITHIUM CARB TAB 450MG ER 00054002025 ROXANE LABORATORIES, INC. yLITHIUM CARB TAB 300MG ER 00054002125 ROXANE LABORATORIES, INC. yLITHIUM CARB TAB 300MG ER 00054002129 ROXANE LABORATORIES, INC. yMEFLOQUINE TAB 250MG 00054002511 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CILOSTAZOL TAB 50MG 00054002821 ROXANE LABORATORIES, INC. yCLARITHROMYC TAB 250MG 00054003621 ROXANE LABORATORIES, INC. yCLARITHROMYC TAB 500MG 00054003721 ROXANE LABORATORIES, INC. yCILOSTAZOL TAB 100MG 00054004421 ROXANE LABORATORIES, INC. yIPRATROPIUM SPR 0.03% 00054004544 ROXANE LABORATORIES, INC. yIPRATROPIUM SPR 0.06% 00054004641 ROXANE LABORATORIES, INC. yZIDOVUDINE TAB 300MG 00054005221 ROXANE LABORATORIES, INC. yPILOCARPINE TAB 5MG 00054005625 ROXANE LABORATORIES, INC. yPILOCARPINE TAB 5MG 00054005629 ROXANE LABORATORIES, INC. yDIGOXIN SOL 0.05/ML 00054005716 ROXANE LABORATORIES, INC. yDIGOXIN SOL 0.05/ML 00054005746 ROXANE LABORATORIES, INC. yDIGOXIN SOL 0.05/ML 00054005755 ROXANE LABORATORIES, INC. yCITALOPRAM SOL 10MG/5ML 00054006258 ROXANE LABORATORIES, INC. yONDANSETRON SOL HCL 00054006447 ROXANE LABORATORIES, INC. yTORSEMIDE TAB 5MG 00054007525 ROXANE LABORATORIES, INC. yTORSEMIDE TAB 20MG 00054007725 ROXANE LABORATORIES, INC. yTORSEMIDE TAB 20MG 00054007729 ROXANE LABORATORIES, INC. ySERTRALINE CON 20MG/ML 00054008246 ROXANE LABORATORIES, INC. yZONISAMIDE CAP 100MG 00054010525 ROXANE LABORATORIES, INC. ySOD POLY SUL SUS 30/120ML 00054016550 ROXANE LABORATORIES, INC. ySOD POLY SUL SUS 15/60ML 00054016551 ROXANE LABORATORIES, INC. ySOD POLY SUL SUS 50/200ML 00054016555 ROXANE LABORATORIES, INC. ySOD POLY SUL SUS 15/60ML 00054016563 ROXANE LABORATORIES, INC. yMELOXICAM TAB 7.5MG 00054022613 ROXANE LABORATORIES, INC. yMELOXICAM TAB 7.5MG 00054022625 ROXANE LABORATORIES, INC. yMELOXICAM TAB 15MG 00054022713 ROXANE LABORATORIES, INC. yMELOXICAM TAB 15MG 00054022725 ROXANE LABORATORIES, INC. yMELOXICAM SUS 7.5/5ML 00054022849 ROXANE LABORATORIES, INC. yANAGRELIDE CAP 1MG 00054209725 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 150MG 00054252625 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 300MG 00054252725 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 300MG 00054252731 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 600MG 00054253125 ROXANE LABORATORIES, INC. yOXYCOD/APAP CAP 5-500MG 00054279525 ROXANE LABORATORIES, INC. yACETYLCYST SOL 10% 00054302502 ROXANE LABORATORIES, INC. yACETYLCYST SOL 20% 00054302602 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ACETYLCYST SOL 10% 00054302702 ROXANE LABORATORIES, INC. yACETYLCYST SOL 20% 00054302802 ROXANE LABORATORIES, INC. yALPRAZOLAM CON 1 MG/ML 00054306844 ROXANE LABORATORIES, INC. yBUTORPHANOL SOL 10MG/ML 00054309036 ROXANE LABORATORIES, INC. yCALCIUM CARB SUS 1250/5ML 00054311763 ROXANE LABORATORIES, INC. yCALCITRIOL SOL 1MCG/ML 00054312041 ROXANE LABORATORIES, INC. yCOCAINE HCL SOL 4% 00054315440 ROXANE LABORATORIES, INC. yCOCAINE HCL SOL 10% 00054315540 ROXANE LABORATORIES, INC. yDEXAMETHASON CON 1MG/ML 00054317644 ROXANE LABORATORIES, INC. yDEXAMETHASON SOL 0.5/5ML 00054317763 ROXANE LABORATORIES, INC. yDIAZEPAM CON 5MG/ML 00054318544 ROXANE LABORATORIES, INC. yDIAZEPAM SOL 1MG/ML 00054318863 ROXANE LABORATORIES, INC. yDIPHEN/ATROP LIQ 2.5/5 00054319446 ROXANE LABORATORIES, INC. yFLUTICASONE SPR 50MCG 00054327099 ROXANE LABORATORIES, INC. yFUROSEMIDE SOL 10MG/ML 00054329446 ROXANE LABORATORIES, INC. yFUROSEMIDE SOL 10MG/ML 00054329450 ROXANE LABORATORIES, INC. yFUROSEMIDE SOL 8MG/ML 00054329863 ROXANE LABORATORIES, INC. yLACTULOSE SOL 10GM/15 00054348663 ROXANE LABORATORIES, INC. yLIDOCAINE SOL 2% VISC 00054350049 ROXANE LABORATORIES, INC. yLIDOCAINE SOL 4% 00054350547 ROXANE LABORATORIES, INC. yLITHIUM CITR SYP 8MEQ/5ML 00054352763 ROXANE LABORATORIES, INC. yLORAZEPAM CON 2MG/ML 00054353244 ROXANE LABORATORIES, INC. yMEGESTROL AC SUS 40MG/ML 00054354258 ROXANE LABORATORIES, INC. yMEPERIDINE SOL 50MG/5ML 00054354563 ROXANE LABORATORIES, INC. yMETHADONE CON 10MG/ML 00054355344 ROXANE LABORATORIES, INC. yMETHADONE SOL 5MG/5ML 00054355563 ROXANE LABORATORIES, INC. yMETHADONE SOL 10MG/5ML 00054355663 ROXANE LABORATORIES, INC. yMIDAZOLAM SYP 2MG/ML 00054356699 ROXANE LABORATORIES, INC. yMILK OF MAGN SUS 00054356749 ROXANE LABORATORIES, INC. yMILK OF MAGN SUS 00054356761 ROXANE LABORATORIES, INC. yNAPROXEN SUS 125/5ML 00054363063 ROXANE LABORATORIES, INC. yROXICODONE CON 20MG/ML 00054368344 ROXANE LABORATORIES, INC. yROXICET SOL 5-325/5 00054368663 ROXANE LABORATORIES, INC. yPREDNISONE CON 5MG/ML 00054372144 ROXANE LABORATORIES, INC. yPREDNISONE SOL 5MG/5ML 00054372250 ROXANE LABORATORIES, INC. yPREDNISONE SOL 5MG/5ML 00054372263 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROPRANOLOL SOL 20MG/5ML 00054372763 ROXANE LABORATORIES, INC. yPROPRANOLOL SOL 40MG/5ML 00054373063 ROXANE LABORATORIES, INC. yROXANOL SOL 20MG/ML 00054375144 ROXANE LABORATORIES, INC. yROXANOL SOL 20MG/ML 00054375150 ROXANE LABORATORIES, INC. yROXANOL SOL 20MG/ML 00054375158 ROXANE LABORATORIES, INC. ySALIVA SUBST SOL 00054376950 ROXANE LABORATORIES, INC. yROXANOL-T SOL 20MG/ML 00054377444 ROXANE LABORATORIES, INC. yROXANOL-T SOL 20MG/ML 00054377450 ROXANE LABORATORIES, INC. yMORPHINE SUL SOL 10MG/5ML 00054378549 ROXANE LABORATORIES, INC. yMORPHINE SUL SOL 10MG/5ML 00054378563 ROXANE LABORATORIES, INC. yMORPHINE SUL SOL 20MG/5ML 00054378649 ROXANE LABORATORIES, INC. yMORPHINE SUL SOL 20MG/5ML 00054378663 ROXANE LABORATORIES, INC. ySOD POLY SUL SUS 15GM/60 00054380563 ROXANE LABORATORIES, INC. yAZATHIOPRINE TAB 50MG 00054408425 ROXANE LABORATORIES, INC. yCALCIUM CARB TAB 1250MG 00054412025 ROXANE LABORATORIES, INC. yCALCIUM GLUC TAB 500MG 00054412125 ROXANE LABORATORIES, INC. yCYCLOPHOSPH TAB 25MG 00054412925 ROXANE LABORATORIES, INC. yCYCLOPHOSPH TAB 50MG 00054413025 ROXANE LABORATORIES, INC. yCLOTRIMAZOLE TRO 10MG 00054414622 ROXANE LABORATORIES, INC. yCLOTRIMAZOLE TRO 10MG 00054414623 ROXANE LABORATORIES, INC. yCODEINE SULF TAB 30MG 00054415625 ROXANE LABORATORIES, INC. yCODEINE SULF TAB 60MG 00054415725 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 0.5MG 00054417925 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 0.75MG 00054418025 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 1MG 00054418125 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 1.5MG 00054418225 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 2MG 00054418325 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 4MG 00054418425 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 6MG 00054418625 ROXANE LABORATORIES, INC. yDOLOPHINE TAB 5MG 00054421825 ROXANE LABORATORIES, INC. yDOLOPHINE TAB 10MG 00054421925 ROXANE LABORATORIES, INC. yDICLOFENAC TAB 50MG EC 00054422125 ROXANE LABORATORIES, INC. yDICLOFENAC TAB 50MG EC 00054422131 ROXANE LABORATORIES, INC. yDICLOFENAC TAB 75MG EC 00054422225 ROXANE LABORATORIES, INC. yDICLOFENAC TAB 75MG EC 00054422231 ROXANE LABORATORIES, INC. yFLUCONAZOLE TAB 100MG 00054428813 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FUROSEMIDE TAB 20MG 00054429725 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 20MG 00054429731 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 40MG 00054429925 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 40MG 00054429931 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 80MG 00054430125 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 80MG 00054430129 ROXANE LABORATORIES, INC. yHYDROMORPHON TAB 8MG 00054437025 ROXANE LABORATORIES, INC. yHYDROMORPHON TAB 2MG 00054439225 ROXANE LABORATORIES, INC. yHYDROMORPHON TAB 4MG 00054439425 ROXANE LABORATORIES, INC. yLEVORPHANOL TAB 2MG 00054449425 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 5MG 00054449613 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 5MG 00054449625 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 10MG 00054449705 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 10MG 00054449710 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 15MG 00054449810 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 25MG 00054449911 ROXANE LABORATORIES, INC. yLITHIUM CARB TAB 300MG 00054452725 ROXANE LABORATORIES, INC. yLITHIUM CARB TAB 300MG 00054452731 ROXANE LABORATORIES, INC. yMETHOTREXATE TAB 2.5MG 00054455015 ROXANE LABORATORIES, INC. yMETHOTREXATE TAB 2.5MG 00054455025 ROXANE LABORATORIES, INC. yMETHADONE TAB 5MG 00054457025 ROXANE LABORATORIES, INC. yMETHADONE TAB 10MG 00054457125 ROXANE LABORATORIES, INC. yMERCAPTOPUR TAB 50MG 00054458111 ROXANE LABORATORIES, INC. yMERCAPTOPUR TAB 50MG 00054458127 ROXANE LABORATORIES, INC. yMORPHINE SUL TAB 15MG 00054458225 ROXANE LABORATORIES, INC. yMORPHINE SUL TAB 30MG 00054458325 ROXANE LABORATORIES, INC. yMEPERIDINE TAB 50MG 00054459525 ROXANE LABORATORIES, INC. yMEPERIDINE TAB 100MG 00054459625 ROXANE LABORATORIES, INC. yMEGESTROL AC TAB 20MG 00054460325 ROXANE LABORATORIES, INC. yMEGESTROL AC TAB 40MG 00054460425 ROXANE LABORATORIES, INC. yROXICET TAB 5-325MG 00054465025 ROXANE LABORATORIES, INC. yROXICET TAB 5-325MG 00054465029 ROXANE LABORATORIES, INC. yROXICODONE TAB 5MG 00054465725 ROXANE LABORATORIES, INC. yROXICODONE TAB 15MG 00054465825 ROXANE LABORATORIES, INC. yROXICODONE TAB 30MG 00054466525 ROXANE LABORATORIES, INC. yMIRTAZAPINE TAB 15MG 00054467613 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MIRTAZAPINE TAB 30MG 00054467713 ROXANE LABORATORIES, INC. yMIRTAZAPINE TAB 45MG 00054467813 ROXANE LABORATORIES, INC. yPROPANTHELIN TAB 15MG 00054472125 ROXANE LABORATORIES, INC. yPREDNISONE TAB 5MG 00054472825 ROXANE LABORATORIES, INC. yPREDNISONE TAB 5MG 00054472831 ROXANE LABORATORIES, INC. yPREDNISONE TAB 20MG 00054472925 ROXANE LABORATORIES, INC. yPREDNISONE TAB 20MG 00054472929 ROXANE LABORATORIES, INC. yPREDNISONE TAB 1MG 00054474125 ROXANE LABORATORIES, INC. yPREDNISONE TAB 1MG 00054474131 ROXANE LABORATORIES, INC. yPREDNISONE TAB 2.5MG 00054474225 ROXANE LABORATORIES, INC. yPSEUDOEPHEDR TAB 30MG 00054474325 ROXANE LABORATORIES, INC. yPSEUDOEPHEDR TAB 60MG 00054474425 ROXANE LABORATORIES, INC. yTORECAN TAB 10MG 00054474825 ROXANE LABORATORIES, INC. yROXICET TAB 5-500MG 00054478425 ROXANE LABORATORIES, INC. yORAMORPH SR TAB 60MG 00054479225 ROXANE LABORATORIES, INC. yORAMORPH SR TAB 30MG 00054480525 ROXANE LABORATORIES, INC. yTAMOXIFEN TAB 10MG 00054483121 ROXANE LABORATORIES, INC. yTAMOXIFEN TAB 10MG 00054483126 ROXANE LABORATORIES, INC. yTRIAZOLAM TAB 0.125MG 00054485806 ROXANE LABORATORIES, INC. yTRIAZOLAM TAB 0.25MG 00054485906 ROXANE LABORATORIES, INC. yTRIAZOLAM TAB 0.25MG 00054485929 ROXANE LABORATORIES, INC. yAZATHIOPRINE TAB 50MG 00054808425 ROXANE LABORATORIES, INC. yCALCIUM CARB SUS 1250/5ML 00054811616 ROXANE LABORATORIES, INC. yCALCIUM CARB TAB 1250MG 00054812025 ROXANE LABORATORIES, INC. yCALCIUM GLUC TAB 500MG 00054812125 ROXANE LABORATORIES, INC. yCLOTRIMAZOLE TRO 10MG 00054814622 ROXANE LABORATORIES, INC. yCODEINE SULF TAB 15MG 00054815524 ROXANE LABORATORIES, INC. yCODEINE SULF TAB 30MG 00054815624 ROXANE LABORATORIES, INC. yCOCAINE HCL SOL 4% 00054816302 ROXANE LABORATORIES, INC. yCOCAINE HCL SOL 10% 00054816402 ROXANE LABORATORIES, INC. yDIPHEN/ATROP LIQ 2.5/5 00054817116 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 1MG 00054817425 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 4MG 00054817525 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 2MG 00054817625 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 0.5MG 00054817925 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 0.75MG 00054818025 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEXAMETHASON TAB 1.5MG 00054818125 ROXANE LABORATORIES, INC. yDEXAMETHASON TAB 6MG 00054818325 ROXANE LABORATORIES, INC. yDIPHEN/ATROP LIQ 2.5/5 00054819116 ROXANE LABORATORIES, INC. yDIAZEPAM SOL 1MG/ML 00054820716 ROXANE LABORATORIES, INC. yDICLOFENAC TAB 50MG EC 00054822125 ROXANE LABORATORIES, INC. yDICLOFENAC TAB 75MG EC 00054822225 ROXANE LABORATORIES, INC. yFLUCONAZOLE TAB 100MG 00054828825 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 20MG 00054829725 ROXANE LABORATORIES, INC. yFUROSEMIDE SOL 8MG/ML 00054829816 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 40MG 00054829925 ROXANE LABORATORIES, INC. yFUROSEMIDE TAB 80MG 00054830125 ROXANE LABORATORIES, INC. yHYDROMORPHON TAB 2MG 00054839224 ROXANE LABORATORIES, INC. yHYDROMORPHON TAB 4MG 00054839424 ROXANE LABORATORIES, INC. yLACTULOSE SOL 10GM/15 00054848616 ROXANE LABORATORIES, INC. yLEUCOVOR CA TAB 5MG 00054849619 ROXANE LABORATORIES, INC. yLIDOCAINE SOL 2% VISC 00054850016 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 150MG 00054852625 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 300MG 00054852725 ROXANE LABORATORIES, INC. yLITHIUM CARB TAB 300MG 00054852825 ROXANE LABORATORIES, INC. yLITHIUM CITR SOL 8MEQ/5ML 00054852904 ROXANE LABORATORIES, INC. yLITHIUM CARB CAP 600MG 00054853125 ROXANE LABORATORIES, INC. yLOPERAMIDE LIQ 1MG/5ML 00054853416 ROXANE LABORATORIES, INC. yLOPERAMIDE LIQ 1MG/5ML 00054853516 ROXANE LABORATORIES, INC. yMETHOTREXATE TAB 2.5MG 00054855025 ROXANE LABORATORIES, INC. yMETHADONE TAB 5MG 00054855324 ROXANE LABORATORIES, INC. yMETHADONE TAB 10MG 00054855424 ROXANE LABORATORIES, INC. yMORPHINE SUL TAB 15MG 00054858224 ROXANE LABORATORIES, INC. yMORPHINE SUL TAB 30MG 00054858324 ROXANE LABORATORIES, INC. yMORPHINE SUL SOL 10MG/5ML 00054858516 ROXANE LABORATORIES, INC. yMORPHINE SUL SOL 20MG/10 00054858616 ROXANE LABORATORIES, INC. yMEPERIDINE TAB 50MG 00054859511 ROXANE LABORATORIES, INC. yMEPERIDINE TAB 100MG 00054859611 ROXANE LABORATORIES, INC. yMEGESTROL AC TAB 20MG 00054860325 ROXANE LABORATORIES, INC. yMEGESTROL AC TAB 40MG 00054860425 ROXANE LABORATORIES, INC. yROXICET SOL 5-325/5 00054864816 ROXANE LABORATORIES, INC. yROXICET TAB 5-325MG 00054865024 ROXANE LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ROXICODONE TAB 5MG 00054865724 ROXANE LABORATORIES, INC. yMIRTAZAPINE TAB 15MG 00054867625 ROXANE LABORATORIES, INC. yMIRTAZAPINE TAB 30MG 00054867725 ROXANE LABORATORIES, INC. yPREDNISONE SOL 5MG/5ML 00054872216 ROXANE LABORATORIES, INC. yPREDNISONE TAB 5MG 00054872425 ROXANE LABORATORIES, INC. yPREDNISONE TAB 10MG 00054872525 ROXANE LABORATORIES, INC. yPREDNISONE TAB 20MG 00054872625 ROXANE LABORATORIES, INC. yPREDNISONE TAB 1MG 00054873925 ROXANE LABORATORIES, INC. yPREDNISONE TAB 2.5MG 00054874025 ROXANE LABORATORIES, INC. yROXICODONE SOL 5MG/5ML 00054878216 ROXANE LABORATORIES, INC. yORAMORPH SR TAB 15MG 00054879024 ROXANE LABORATORIES, INC. yORAMORPH SR TAB 30MG 00054880524 ROXANE LABORATORIES, INC. ySPS SUS 30GM/120 00054881501 ROXANE LABORATORIES, INC. ySOD POLY SUL SUS 15GM/60 00054881611 ROXANE LABORATORIES, INC. ySPS SUS 50GM/200 00054881755 ROXANE LABORATORIES, INC. yTAMOXIFEN TAB 10MG 00054883125 ROXANE LABORATORIES, INC. yTAMOXIFEN TAB 20MG 00054883425 ROXANE LABORATORIES, INC. yTRIAZOLAM TAB 0.125MG 00054885825 ROXANE LABORATORIES, INC. yTRIAZOLAM TAB 0.25MG 00054885925 ROXANE LABORATORIES, INC. yALBUTEROL NEB 0.083% 66794000125 RXELITE HOLDINGS, INC. D.B.A. RXELITE yALBUTEROL NEB 0.083% 66794000130 RXELITE HOLDINGS, INC. D.B.A. RXELITE yALBUTEROL NEB 0.083% 66794000160 RXELITE HOLDINGS, INC. D.B.A. RXELITE yIPRATROPIUM SOL INHAL 66794000225 RXELITE HOLDINGS, INC. D.B.A. RXELITE yIPRATROPIUM SOL INHAL 66794000230 RXELITE HOLDINGS, INC. D.B.A. RXELITE yIPRATROPIUM SOL INHAL 66794000260 RXELITE HOLDINGS, INC. D.B.A. RXELITE yCOLAZAL CAP 750MG 65649010102 SALIX PHARMACEUTICALS, INC. yCOLAZAL CAP 750MG 65649010150 SALIX PHARMACEUTICALS, INC. yMOVIPREP SOL 65649020175 SALIX PHARMACEUTICALS, INC. yAZASAN TAB 75 MG 65649023141 SALIX PHARMACEUTICALS, INC. yAZASAN TAB 100MG 65649024141 SALIX PHARMACEUTICALS, INC. yXIFAXAN TAB 200MG 65649030103 SALIX PHARMACEUTICALS, INC. yXIFAXAN TAB 200MG 65649030105 SALIX PHARMACEUTICALS, INC. yXIFAXAN TAB 200MG 65649030141 SALIX PHARMACEUTICALS, INC. yANUSOL-HC CRE 2.5% 65649040130 SALIX PHARMACEUTICALS, INC. yANUSOL-HC SUP 25MG 65649041112 SALIX PHARMACEUTICALS, INC. yANUSOL-HC SUP 25MG 65649041124 SALIX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROCTOCORT CRE 1% 65649050130 SALIX PHARMACEUTICALS, INC. yPROCTOCORT SUP 30MG 65649051112 SALIX PHARMACEUTICALS, INC. yPROCTOCORT SUP 30MG 65649051124 SALIX PHARMACEUTICALS, INC. yOSMOPREP TAB 1.5GM 65649070141 SALIX PHARMACEUTICALS, INC. yVISICOL TAB 1.5GM 66934010001 SALIX PHARMACEUTICALS, INC. yVISICOL TAB 1.5GM 66934010040 SALIX PHARMACEUTICALS, INC. yIB-STAT SPR 0.125/ML 66934020030 SALIX PHARMACEUTICALS, INC. yTRIAMT/HCTZ TAB 75-50MG 00781100801 SANDOZ yTRIAMT/HCTZ TAB 75-50MG 00781100805 SANDOZ yTRIFLUOPERAZ TAB 1MG 00781103001 SANDOZ yTRIFLUOPERAZ TAB 2MG 00781103201 SANDOZ yTRIFLUOPERAZ TAB 5MG 00781103401 SANDOZ yTRIFLUOPERAZ TAB 10MG 00781103601 SANDOZ yPERPHENAZINE TAB 2MG 00781104601 SANDOZ yPERPHENAZINE TAB 2MG 00781104613 SANDOZ yPERPHENAZINE TAB 4MG 00781104701 SANDOZ yPERPHENAZINE TAB 4MG 00781104713 SANDOZ yPERPHENAZINE TAB 16MG 00781104901 SANDOZ yBUPROPION TAB 75MG 00781105301 SANDOZ yBUPROPION TAB 75MG 00781105310 SANDOZ yALPRAZOLAM TAB 0.25MG 00781106101 SANDOZ yALPRAZOLAM TAB 0.25MG 00781106105 SANDOZ yALPRAZOLAM TAB 0.25MG 00781106110 SANDOZ yBUPROPION TAB 100MG 00781106401 SANDOZ yBUPROPION TAB 100MG 00781106410 SANDOZ yMETHAZOLAMID TAB 50MG 00781107101 SANDOZ yMETHAZOLAMID TAB 25MG 00781107201 SANDOZ yATENOLOL TAB 25MG 00781107801 SANDOZ yATENOLOL TAB 25MG 00781107810 SANDOZ yALPRAZOLAM TAB 1MG 00781107901 SANDOZ yALPRAZOLAM TAB 1MG 00781107905 SANDOZ yALPRAZOLAM TAB 1MG 00781107910 SANDOZ yALPRAZOLAM TAB 2MG 00781108901 SANDOZ yALPRAZOLAM TAB 2MG 00781108905 SANDOZ yTRIAMT/HCTZ TAB 37.5-25 00781112301 SANDOZ yTRIAMT/HCTZ TAB 37.5-25 00781112305 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GLYBURIDE TAB 1.25MG 00781113801 SANDOZ yGLYBURIDE TAB 2.5MG 00781114601 SANDOZ yNAPROXEN TAB 250MG 00781116301 SANDOZ yNAPROXEN TAB 250MG 00781116305 SANDOZ yNAPROXEN TAB 375MG 00781116401 SANDOZ yNAPROXEN TAB 375MG 00781116405 SANDOZ yNAPROXEN TAB 500MG 00781116501 SANDOZ yNAPROXEN TAB 500MG 00781116505 SANDOZ yLISINOP/HCTZ TAB 20-12.5 00781117601 SANDOZ yLISINOP/HCTZ TAB 20-25MG 00781117801 SANDOZ yNAPROXEN SOD TAB 550MG 00781118801 SANDOZ yGLYBURIDE TAB 5MG 00781119101 SANDOZ yGLYBURIDE TAB 5MG 00781119110 SANDOZ yAMIODARONE TAB 200MG 00781120305 SANDOZ yAMIODARONE TAB 200MG 00781120360 SANDOZ yAMIODARONE TAB 200MG 00781120392 SANDOZ yPENICILLN VK TAB 250MG 00781120501 SANDOZ yPENICILLN VK TAB 250MG 00781120510 SANDOZ yLOVASTATIN TAB 20MG 00781121010 SANDOZ yLOVASTATIN TAB 20MG 00781121060 SANDOZ yLOVASTATIN TAB 40MG 00781121310 SANDOZ yLOVASTATIN TAB 40MG 00781121360 SANDOZ yMETOPROLOL TAB 50MG 00781122301 SANDOZ yMETOPROLOL TAB 50MG 00781122310 SANDOZ yMETOPROLOL TAB 100MG 00781122801 SANDOZ yMETOPROLOL TAB 100MG 00781122810 SANDOZ yLONOX TAB 2.5MG 00781126201 SANDOZ yLONOX TAB 2.5MG 00781126205 SANDOZ yLONOX TAB 2.5MG 00781126210 SANDOZ yLONOX TAB 2.5MG 00781126213 SANDOZ yLOVASTATIN TAB 10MG 00781132305 SANDOZ yCYCLOBENZAPR TAB 10MG 00781132410 SANDOZ yMECLIZINE TAB 12.5MG 00781134501 SANDOZ yCLEMASTINE TAB 1.34MG 00781135801 SANDOZ yCLEMASTINE TAB 2.68MG 00781135901 SANDOZ yMECLIZINE TAB 25MG 00781137501 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DICLOFENAC TAB 100MG XR 00781138101 SANDOZ yHALOPERIDOL TAB 0.5MG 00781139101 SANDOZ yHALOPERIDOL TAB 0.5MG 00781139113 SANDOZ yHALOPERIDOL TAB 1MG 00781139201 SANDOZ yHALOPERIDOL TAB 1MG 00781139213 SANDOZ yHALOPERIDOL TAB 2MG 00781139301 SANDOZ yHALOPERIDOL TAB 2MG 00781139313 SANDOZ yHALOPERIDOL TAB 5MG 00781139601 SANDOZ yHALOPERIDOL TAB 5MG 00781139610 SANDOZ yHALOPERIDOL TAB 5MG 00781139613 SANDOZ yHALOPERIDOL TAB 10MG 00781139701 SANDOZ yHALOPERIDOL TAB 10MG 00781139713 SANDOZ yHALOPERIDOL TAB 20MG 00781139801 SANDOZ yLORAZEPAM TAB 0.5MG 00781140301 SANDOZ yLORAZEPAM TAB 0.5MG 00781140305 SANDOZ yLORAZEPAM TAB 1MG 00781140401 SANDOZ yLORAZEPAM TAB 1MG 00781140405 SANDOZ yLORAZEPAM TAB 2MG 00781140501 SANDOZ yLORAZEPAM TAB 2MG 00781140505 SANDOZ yHYDROXYCHLOR TAB 200MG 00781140701 SANDOZ yHYDROXYCHLOR TAB 200MG 00781140705 SANDOZ yFLUPHENAZINE TAB 1MG 00781143601 SANDOZ yFLUPHENAZINE TAB 1MG 00781143613 SANDOZ yFLUPHENAZINE TAB 2.5MG 00781143701 SANDOZ yFLUPHENAZINE TAB 5MG 00781143801 SANDOZ yFLUPHENAZINE TAB 10MG 00781143901 SANDOZ yFUROSEMIDE TAB 80MG 00781144601 SANDOZ yFUROSEMIDE TAB 80MG 00781144605 SANDOZ yGLIPIZIDE TAB 5MG 00781145201 SANDOZ yGLIPIZIDE TAB 5MG 00781145210 SANDOZ yGLIPIZIDE TAB 10MG 00781145301 SANDOZ yGLIPIZIDE TAB 10MG 00781145310 SANDOZ yAMITRIPTYLIN TAB 10MG 00781148601 SANDOZ yAMITRIPTYLIN TAB 10MG 00781148610 SANDOZ yAMITRIPTYLIN TAB 25MG 00781148701 SANDOZ yAMITRIPTYLIN TAB 25MG 00781148710 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMITRIPTYLIN TAB 50MG 00781148801 SANDOZ yAMITRIPTYLIN TAB 50MG 00781148810 SANDOZ yAMITRIPTYLIN TAB 75MG 00781148901 SANDOZ yAMITRIPTYLIN TAB 100MG 00781149001 SANDOZ yAMITRIPTYLIN TAB 150MG 00781149101 SANDOZ yAZITHROMYCIN TAB 250MG 00781149631 SANDOZ yAZITHROMYCIN TAB 250MG 00781149668 SANDOZ yAZITHROMYCIN TAB 250MG 00781149669 SANDOZ yAZITHROMYCIN TAB 600MG 00781149731 SANDOZ yATENOLOL TAB 50MG 00781150601 SANDOZ yATENOLOL TAB 50MG 00781150610 SANDOZ yATENOLOL TAB 100MG 00781150701 SANDOZ yATENOLOL TAB 100MG 00781150710 SANDOZ yPOT CHLORIDE TAB 8MEQ SR 00781151601 SANDOZ yPOT CHLORIDE TAB 8MEQ SR 00781151610 SANDOZ yPOT CHLORIDE TAB 10MEQ CR 00781152601 SANDOZ yPOT CHLORIDE TAB 10MEQ CR 00781152610 SANDOZ yBUPROPION TAB 150MG 00781152960 SANDOZ yPSEUDOEPHEDR TAB 30MG 00781153301 SANDOZ yPSEUDOEPHEDR TAB 60MG 00781153501 SANDOZ yMECLIZINE TAB 12.5MG 00781154201 SANDOZ yMECLIZINE TAB 25MG 00781154401 SANDOZ yMECLIZINE TAB 25MG 00781154410 SANDOZ yISOSORB DIN TAB 10MG 00781155601 SANDOZ yISOSORB DIN TAB 10MG 00781155610 SANDOZ yISOSORB DIN TAB 10MG 00781155613 SANDOZ ySPIRONOLACT TAB 25MG 00781159901 SANDOZ ySPIRONOLACT TAB 25MG 00781159905 SANDOZ ySPIRONOLACT TAB 25MG 00781159910 SANDOZ yTHIORIDAZINE TAB 10MG 00781160401 SANDOZ yTHIORIDAZINE TAB 15MG 00781161401 SANDOZ yAMOX/K CLAV CHW 200MG 00781161966 SANDOZ yTHIORIDAZINE TAB 25MG 00781162401 SANDOZ yISOSORB DIN TAB 5MG 00781163501 SANDOZ yAMOX/K CLAV CHW 400MG 00781164366 SANDOZ yTHIORIDAZINE TAB 100MG 00781164401 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NAPROXEN DR TAB 375MG 00781164601 SANDOZ yNAPROXEN DR TAB 500MG 00781165301 SANDOZ yPENICILLN VK TAB 500MG 00781165501 SANDOZ yPENICILLN VK TAB 500MG 00781165510 SANDOZ yTHIORIDAZINE TAB 150MG 00781166401 SANDOZ yLISINOPRIL TAB 5MG 00781166501 SANDOZ yLISINOPRIL TAB 10MG 00781166601 SANDOZ yLISINOPRIL TAB 20MG 00781166701 SANDOZ yLISINOPRIL TAB 40MG 00781166801 SANDOZ yLISINOPRIL TAB 2.5MG 00781166901 SANDOZ yLISINOPRIL TAB 30MG 00781167301 SANDOZ yTHIORIDAZINE TAB 200MG 00781167401 SANDOZ yISOSORB DIN TAB 20MG 00781169501 SANDOZ yISOSORB DIN TAB 20MG 00781169510 SANDOZ yISOSORB DIN TAB 20MG 00781169513 SANDOZ yCHLORPROMAZ TAB 10MG 00781171501 SANDOZ yCHLORPROMAZ TAB 25MG 00781171601 SANDOZ yCHLORPROMAZ TAB 50MG 00781171701 SANDOZ yCHLORPROMAZ TAB 100MG 00781171801 SANDOZ yCHLORPROMAZ TAB 200MG 00781171901 SANDOZ yPEMOLINE TAB 37.5MG 00781174101 SANDOZ yMETHOCARBAM TAB 750MG 00781175001 SANDOZ yPEMOLINE TAB 75MG 00781175101 SANDOZ yMETHOCARBAM TAB 500MG 00781176001 SANDOZ yIMIPRAM HCL TAB 10MG 00781176201 SANDOZ yIMIPRAM HCL TAB 25MG 00781176401 SANDOZ yIMIPRAM HCL TAB 25MG 00781176410 SANDOZ yIMIPRAM HCL TAB 25MG 00781176413 SANDOZ yIMIPRAM HCL TAB 50MG 00781176601 SANDOZ yIMIPRAM HCL TAB 50MG 00781176610 SANDOZ yIMIPRAM HCL TAB 50MG 00781176613 SANDOZ yDICLOFENAC TAB 25MG EC 00781178501 SANDOZ yDICLOFENAC TAB 50MG EC 00781178701 SANDOZ yDICLOFENAC TAB 75MG DR 00781178901 SANDOZ yFUROSEMIDE TAB 20MG 00781181801 SANDOZ yFUROSEMIDE TAB 20MG 00781181810 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CAPTOPRIL TAB 12.5MG 00781182801 SANDOZ yCAPTOPRIL TAB 12.5MG 00781182810 SANDOZ yCAPTOPRIL TAB 25MG 00781182901 SANDOZ yCAPTOPRIL TAB 25MG 00781182910 SANDOZ yPROMETHAZINE TAB 25MG 00781183001 SANDOZ yPROMETHAZINE TAB 25MG 00781183010 SANDOZ yPROMETHAZINE TAB 50MG 00781183201 SANDOZ yCAPTOPRIL TAB 50MG 00781183801 SANDOZ yCAPTOPRIL TAB 50MG 00781183810 SANDOZ yCAPTOPRIL TAB 100MG 00781183901 SANDOZ yISOXSUPRINE TAB 10MG 00781184001 SANDOZ yISOXSUPRINE TAB 10MG 00781184013 SANDOZ yISOXSUPRINE TAB 20MG 00781184201 SANDOZ yISOXSUPRINE TAB 20MG 00781184213 SANDOZ yLISINOP/HCTZ TAB 10-12.5 00781184801 SANDOZ yAMOX/K CLAV TAB 875MG 00781185220 SANDOZ yAMOX/K CLAV TAB 250MG 00781187431 SANDOZ yRANITIDINE TAB 150MG 00781188310 SANDOZ yRANITIDINE TAB 150MG 00781188313 SANDOZ yRANITIDINE TAB 150MG 00781188360 SANDOZ yRANITIDINE TAB 300MG 00781188425 SANDOZ yRANITIDINE TAB 300MG 00781188431 SANDOZ yBENAZEPRIL TAB 5MG 00781189101 SANDOZ yBENAZEPRIL TAB 10MG 00781189201 SANDOZ yBENAZEPRIL TAB 20MG 00781189301 SANDOZ yBENAZEPRIL TAB 40MG 00781189401 SANDOZ yFLUCONAZOLE TAB 150MG 00781192106 SANDOZ yFLUCONAZOLE TAB 100MG 00781192931 SANDOZ yAZITHROMYCIN TAB 500MG 00781194131 SANDOZ yAZITHROMYCIN TAB 500MG 00781194133 SANDOZ yCLARITHROMYC TAB 250MG 00781196160 SANDOZ yCLARITHROMYC TAB 500MG 00781196260 SANDOZ yFUROSEMIDE TAB 40MG 00781196601 SANDOZ yFUROSEMIDE TAB 40MG 00781196610 SANDOZ yDESIPRAMINE TAB 10MG 00781197101 SANDOZ yDESIPRAMINE TAB 25MG 00781197201 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DESIPRAMINE TAB 50MG 00781197301 SANDOZ yDESIPRAMINE TAB 50MG 00781197310 SANDOZ yDESIPRAMINE TAB 75MG 00781197401 SANDOZ yDESIPRAMINE TAB 100MG 00781197501 SANDOZ yDESIPRAMINE TAB 150MG 00781197650 SANDOZ yAMOXICILLIN CAP 250MG 00781202001 SANDOZ yAMOXICILLIN CAP 250MG 00781202005 SANDOZ yAMOXICILLIN CAP 250MG 00781202031 SANDOZ yAMOXICILLIN CAP 250MG 00781202076 SANDOZ yCLOMIPRAMINE CAP 25MG 00781202701 SANDOZ yCLOMIPRAMINE CAP 50MG 00781203701 SANDOZ yRIBAVIRIN CAP 200MG 00781204304 SANDOZ yRIBAVIRIN CAP 200MG 00781204316 SANDOZ yRIBAVIRIN CAP 200MG 00781204342 SANDOZ yRIBAVIRIN CAP 200MG 00781204367 SANDOZ yCLOMIPRAMINE CAP 75MG 00781204701 SANDOZ yAMANTADINE CAP 100MG 00781204801 SANDOZ yAMANTADINE CAP 100MG 00781204805 SANDOZ yTERAZOSIN CAP 1MG 00781205101 SANDOZ yTERAZOSIN CAP 1MG 00781205105 SANDOZ yTERAZOSIN CAP 2MG 00781205201 SANDOZ yTERAZOSIN CAP 2MG 00781205205 SANDOZ yTERAZOSIN CAP 5MG 00781205301 SANDOZ yTERAZOSIN CAP 5MG 00781205305 SANDOZ yTERAZOSIN CAP 10MG 00781205401 SANDOZ yTERAZOSIN CAP 10MG 00781205405 SANDOZ yTRIAM/HCTZ CAP 37.5-25 00781207401 SANDOZ yTRIAM/HCTZ CAP 37.5-25 00781207410 SANDOZ yCLINDAMYCIN CAP 150MG 00781211201 SANDOZ yCLINDAMYCIN CAP 300MG 00781211301 SANDOZ yCLINDAMYCIN CAP 300MG 00781211317 SANDOZ yBROMOCRIPTIN CAP 5MG 00781211901 SANDOZ yBROMOCRIPTIN CAP 5MG 00781211931 SANDOZ yAMPICILLIN CAP 250MG 00781214401 SANDOZ yAMPICILLIN CAP 500MG 00781214501 SANDOZ yTEMAZEPAM CAP 15MG 00781220101 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TEMAZEPAM CAP 15MG 00781220105 SANDOZ yTEMAZEPAM CAP 30MG 00781220201 SANDOZ yTEMAZEPAM CAP 30MG 00781220205 SANDOZ yTHIOTHIXENE CAP 1MG 00781222601 SANDOZ yTHIOTHIXENE CAP 2MG 00781222701 SANDOZ yTHIOTHIXENE CAP 5MG 00781222801 SANDOZ yTHIOTHIXENE CAP 10MG 00781222901 SANDOZ yOMEPRAZOLE CAP 10MG 00781223201 SANDOZ yOMEPRAZOLE CAP 10MG 00781223231 SANDOZ yOMEPRAZOLE CAP 20MG 00781223301 SANDOZ yOMEPRAZOLE CAP 20MG 00781223310 SANDOZ yOMEPRAZOLE CAP 20MG 00781223331 SANDOZ yDICLOXACILL CAP 250MG 00781224801 SANDOZ yDICLOXACILL CAP 500MG 00781225801 SANDOZ yDOXYCYCL HYC CAP 75MG 00781226860 SANDOZ yDOXYCYCL HYC CAP 100MG 00781226950 SANDOZ yAMOXICILLIN CAP 500MG 00781261301 SANDOZ yAMOXICILLIN CAP 500MG 00781261305 SANDOZ yAMOXICILLIN CAP 500MG 00781261331 SANDOZ yTRIAMT/HCTZ CAP 50-25MG 00781271501 SANDOZ yOXAZEPAM CAP 10MG 00781280901 SANDOZ yOXAZEPAM CAP 15MG 00781281001 SANDOZ yOXAZEPAM CAP 30MG 00781281101 SANDOZ yFLUOXETINE CAP 20MG 00781282201 SANDOZ yFLUOXETINE CAP 20MG 00781282210 SANDOZ yFLUOXETINE CAP 10MG 00781282301 SANDOZ yFLUOXETINE CAP 40MG 00781282401 SANDOZ yFLUOXETINE CAP 40MG 00781282431 SANDOZ yRANITIDINE CAP 150MG 00781285505 SANDOZ yRANITIDINE CAP 150MG 00781285560 SANDOZ yRANITIDINE CAP 300MG 00781286531 SANDOZ yCEFADROXIL CAP 500MG 00781293850 SANDOZ yFLUMAZENIL INJ 0.1MG/ML 00781300392 SANDOZ yFLUMAZENIL INJ 0.1MG/ML 00781300395 SANDOZ yAMP-SULBACTA INJ 1.5GM 00781303295 SANDOZ yAMP-SULBACTA INJ 3GM 00781303395 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMP-SULBACTA INJ 15GM 00781303446 SANDOZ yISONIAZID INJ 100MG/ML 00781305670 SANDOZ yONDANSETRON INJ 2MG/ML 00781305714 SANDOZ yONDANSETRON INJ 2MG/ML 00781305780 SANDOZ yTESTOST CYP INJ 100MG/ML 00781307370 SANDOZ yTESTOST CYP INJ 200MG/ML 00781307470 SANDOZ yTESTOST CYP INJ 200MG/ML 00781307471 SANDOZ yNAFCILLIN INJ 2GM 00781312595 SANDOZ yNAFCILLIN INJ 10GM 00781312695 SANDOZ yNAFCILLIN INJ 1GM 00781312892 SANDOZ yCEFAZOLIN INJ 1GM 00781315796 SANDOZ yCEFTRIAXONE INJ 250MG 00781320695 SANDOZ yCEFTRIAXONE INJ 500MG 00781320795 SANDOZ yCEFTRIAXONE INJ 1GM 00781320895 SANDOZ yCEFTRIAXONE INJ 2GM 00781320995 SANDOZ yCEFAZOLIN INJ 500MG 00781333885 SANDOZ yCEFAZOLIN INJ 500MG 00781333895 SANDOZ yCEFAZOLIN INJ 10GM 00781334646 SANDOZ yCEFAZOLIN INJ 10GM 00781334695 SANDOZ yAMPICILLIN INJ 250MG 00781340295 SANDOZ yAMPICILLIN INJ 1GM 00781340495 SANDOZ yAMPICILLIN INJ 500MG 00781340795 SANDOZ yAMPICILLIN INJ 2GM 00781340895 SANDOZ yAMPICILLIN INJ 10GM 00781340995 SANDOZ yCEFAZOLIN INJ 500MG 00781345095 SANDOZ yCEFAZOLIN INJ 1GM 00781345196 SANDOZ yCEFAZOLIN INJ 10GM 00781345295 SANDOZ yCEFUROXIME INJ 750MG 00781391870 SANDOZ yCEFUROXIME INJ 750MG 00781391896 SANDOZ yCEFUROXIME INJ 1.5GM 00781392280 SANDOZ yCEFUROXIME INJ 1.5GM 00781392296 SANDOZ yCEFUROXIME INJ 7.5GM 00781392646 SANDOZ yCEFUROXIME INJ 7.5GM 00781392695 SANDOZ yCARISOPRODOL TAB 350MG 00781500501 SANDOZ yCARISOPRODOL TAB 350MG 00781500505 SANDOZ yPYRIDOSTIGM TAB 60MG 00781501501 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROCHLORPER TAB 5MG 00781502001 SANDOZ yPROCHLORPER TAB 10MG 00781502101 SANDOZ yMETHYLPRED TAB 4MG 00781502201 SANDOZ yMETHYLPRED PAK 4MG 00781502207 SANDOZ yRIMANTADINE TAB 100MG 00781502901 SANDOZ yCYCLOBENZAPR TAB 5MG 00781503201 SANDOZ yCYCLOBENZAPR TAB 5MG 00781503210 SANDOZ yCEFPROZIL TAB 250MG 00781504301 SANDOZ yCEFPROZIL TAB 500MG 00781504401 SANDOZ yCEFPROZIL TAB 500MG 00781504450 SANDOZ yGLIMEPIRIDE TAB 1MG 00781504501 SANDOZ yGLIMEPIRIDE TAB 2MG 00781504601 SANDOZ yGLIMEPIRIDE TAB 4MG 00781504701 SANDOZ yMETFORMIN TAB 500MG 00781505001 SANDOZ yMETFORMIN TAB 500MG 00781505005 SANDOZ yMETFORMIN TAB 500MG 00781505010 SANDOZ yMETFORMIN TAB 850MG 00781505101 SANDOZ yMETFORMIN TAB 850MG 00781505105 SANDOZ yMETFORMIN TAB 1000MG 00781505201 SANDOZ yMETFORMIN TAB 1000MG 00781505205 SANDOZ yLEFLUNOMIDE TAB 10MG 00781505631 SANDOZ yLEFLUNOMIDE TAB 20MG 00781505731 SANDOZ yAMOXICILLIN TAB 500MG 00781506001 SANDOZ yAMOXICILLIN TAB 500MG 00781506020 SANDOZ yAMOXICILLIN TAB 875MG 00781506101 SANDOZ yAMOXICILLIN TAB 875MG 00781506120 SANDOZ ySIMVASTATIN TAB 5MG 00781507031 SANDOZ ySIMVASTATIN TAB 5MG 00781507092 SANDOZ ySIMVASTATIN TAB 10MG 00781507131 SANDOZ ySIMVASTATIN TAB 10MG 00781507192 SANDOZ ySIMVASTATIN TAB 20MG 00781507292 SANDOZ ySIMVASTATIN TAB 40MG 00781507331 SANDOZ ySIMVASTATIN TAB 40MG 00781507392 SANDOZ ySIMVASTATIN TAB 80MG 00781507431 SANDOZ ySIMVASTATIN TAB 80MG 00781507492 SANDOZ yAZATHIOPRINE TAB 50MG 00781507501 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MEFLOQUINE TAB 250MG 00781507686 SANDOZ yLORATADINE TAB 10MG 00781507701 SANDOZ yFOSINOPRIL TAB 10MG 00781508310 SANDOZ yFOSINOPRIL TAB 10MG 00781508392 SANDOZ yFOSINOPRIL TAB 20MG 00781508410 SANDOZ yFOSINOPRIL TAB 20MG 00781508492 SANDOZ yFOSINOPRIL TAB 40MG 00781508592 SANDOZ yCILOSTAZOL TAB 50MG 00781509560 SANDOZ yCILOSTAZOL TAB 100MG 00781509660 SANDOZ yPILOCARPINE TAB 5MG 00781510001 SANDOZ yDOXYCYCLINE TAB 20MG 00781511501 SANDOZ yBENAZEP/HCTZ TAB 5-6.25 00781513101 SANDOZ yBENAZEP/HCTZ TAB 10-12.5 00781513201 SANDOZ yBENAZEP/HCTZ TAB 20-12.5 00781513301 SANDOZ yBENAZEP/HCTZ TAB 20-25MG 00781513401 SANDOZ yGLYB/METFORM TAB 1.25/250 00781517001 SANDOZ yGLYB/METFORM TAB 2.5/500 00781517101 SANDOZ yGLYB/METFORM TAB 2.5/500 00781517105 SANDOZ yGLYB/METFORM TAB 5/500MG 00781517201 SANDOZ yGLYB/METFORM TAB 5/500MG 00781517205 SANDOZ yRIBAVIRIN TAB 200MG 00781517728 SANDOZ yLEVOTHYROXIN TAB 25MCG 00781518001 SANDOZ yLEVOTHYROXIN TAB 25MCG 00781518010 SANDOZ yLEVOTHYROXIN TAB 50MCG 00781518101 SANDOZ yLEVOTHYROXIN TAB 50MCG 00781518110 SANDOZ yLEVOTHYROXIN TAB 75MCG 00781518201 SANDOZ yLEVOTHYROXIN TAB 75MCG 00781518210 SANDOZ yLEVOTHYROXIN TAB 88MCG 00781518301 SANDOZ yLEVOTHYROXIN TAB 112MCG 00781518501 SANDOZ yLEVOTHYROXIN TAB 150MCG 00781518701 SANDOZ yLEVOTHYROXIN TAB 150MCG 00781518710 SANDOZ yLEVOTHYROXIN TAB 200MCG 00781518901 SANDOZ yLEVOTHYROXIN TAB 137MCG 00781519101 SANDOZ yMELOXICAM TAB 7.5MG 00781519501 SANDOZ yMELOXICAM TAB 7.5MG 00781519510 SANDOZ yMELOXICAM TAB 15MG 00781519601 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MELOXICAM TAB 15MG 00781519610 SANDOZ yPRAVASTATIN TAB 10MG 00781523110 SANDOZ yPRAVASTATIN TAB 10MG 00781523192 SANDOZ yPRAVASTATIN TAB 20MG 00781523210 SANDOZ yPRAVASTATIN TAB 20MG 00781523292 SANDOZ yPRAVASTATIN TAB 40MG 00781523410 SANDOZ yPRAVASTATIN TAB 40MG 00781523492 SANDOZ yGLIP/METFORM TAB 2.5-250M 00781530401 SANDOZ yGLIP/METFORM TAB 2.5-500M 00781530501 SANDOZ yGLIP/METFORM TAB 5-500MG 00781530601 SANDOZ yBROMOCRIPTIN TAB 2.5MG 00781532501 SANDOZ yBROMOCRIPTIN TAB 2.5MG 00781532531 SANDOZ yCAFERGOT TAB 1-100MG 00781599501 SANDOZ yAMOXICILLIN SUS 125/5ML 00781603946 SANDOZ yAMOXICILLIN SUS 125/5ML 00781603955 SANDOZ yAMOXICILLIN SUS 125/5ML 00781603958 SANDOZ yAMOXICILLIN SUS 250/5ML 00781604146 SANDOZ yAMOXICILLIN SUS 250/5ML 00781604155 SANDOZ yAMOXICILLIN SUS 250/5ML 00781604158 SANDOZ yAMOX/K CLAV SUS 200/5ML 00781610246 SANDOZ yAMOX/K CLAV SUS 400/5ML 00781610446 SANDOZ yPENICILLN VK SOL 125/5ML 00781612046 SANDOZ yPENICILLN VK SOL 250/5ML 00781612146 SANDOZ yPENICILLN VK SOL 250/5ML 00781612148 SANDOZ yPENICILLN GK INJ 5MU 00781613595 SANDOZ yPEN G SOD INJ 5000000 00781615395 SANDOZ yCEFPROZIL SUS 125/5ML 00781620246 SANDOZ yCEFPROZIL SUS 125/5ML 00781620257 SANDOZ yCEFPROZIL SUS 125/5ML 00781620291 SANDOZ yCEFPROZIL SUS 250/5ML 00781620346 SANDOZ yCEFPROZIL SUS 250/5ML 00781620357 SANDOZ yCEFPROZIL SUS 250/5ML 00781620391 SANDOZ yERYTHROMYCIN GEL /BENZOYL 00781705449 SANDOZ yERYTHROMYCIN GEL /BENZOYL 00781705459 SANDOZ yLIDOC/PRILOC CRE 2.5-2.5% 00781705803 SANDOZ yLIDOC/PRILOC CRE 2.5-2.5% 00781705805 SANDOZ y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIDOC/PRILOC CRE 2.5-2.5% 00781705839 SANDOZ yHC VALERATE CRE 0.2% 00781705919 SANDOZ yHC VALERATE CRE 0.2% 00781705935 SANDOZ yFLUTICASONE CRE 0.05% 00781706903 SANDOZ yFLUTICASONE CRE 0.05% 00781706927 SANDOZ yFLUTICASONE CRE 0.05% 00781706935 SANDOZ yAUG BETAMET CRE 0.05% 00781707427 SANDOZ yAUG BETAMET CRE 0.05% 00781707450 SANDOZ yMETRONIDAZOL GEL 0.75% 00781707787 SANDOZ yMETRONIDAZOL GEL 0.75% 00781707819 SANDOZ yKETOCONAZOLE SHA 2% 00781709004 SANDOZ yFENTANYL DIS 25MCG/HR 00781711155 SANDOZ yFENTANYL DIS 50MCG/HR 00781711255 SANDOZ yFENTANYL DIS 75MCG/HR 00781711355 SANDOZ yFENTANYL DIS 100MCG/H 00781711455 SANDOZ yMETHYLPHENID TAB 5MG 00781884001 SANDOZ yMETHYLPHENID TAB 20MG 00781884201 SANDOZ yOXACILLIN INJ 2GM 00781911195 SANDOZ yOXACILLIN INJ 10GM 00781911395 SANDOZ yNAFCILLIN INJ 1GM 00781912495 SANDOZ yOCTREOTIDE INJ 1MG/ML 00781916475 SANDOZ yOCTREOTIDE INJ 0.2MG/ML 00781916575 SANDOZ yCEFUROXIME INJ 750MG 00781920570 SANDOZ yNAFCILLIN INJ 1GM 00781922492 SANDOZ yNAFCILLIN INJ 2GM 00781922592 SANDOZ yCEFTRIAXONE INJ 250MG 00781932695 SANDOZ yCEFTRIAXONE INJ 500MG 00781932795 SANDOZ yCEFTRIAXONE INJ 1GM 00781932895 SANDOZ yCEFTRIAXONE INJ 2GM 00781932995 SANDOZ yCEFTRIAXONE INJ 10GM 00781933046 SANDOZ yARALEN TAB 500MG 00024008401 SANOFI-AVENTIS, US LLC yELIGARD INJ 22.5MG 00024022205 SANOFI-AVENTIS, US LLC yBRONCHOLATE SYP 6.25-100 00024028016 SANOFI-AVENTIS, US LLC yDEMEROL SYP 50MG/5ML 00024033206 SANOFI-AVENTIS, US LLC yDEMEROL TAB 50MG 00024033502 SANOFI-AVENTIS, US LLC yDEMEROL TAB 50MG 00024033504 SANOFI-AVENTIS, US LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DEMEROL TAB 100MG 00024033704 SANOFI-AVENTIS, US LLC yDRISDOL DRO 8000/ML 00024039102 SANOFI-AVENTIS, US LLC yDRISDOL CAP 50000UNT 00024039202 SANOFI-AVENTIS, US LLC yELOXATIN INJ 50MG 00024059010 SANOFI-AVENTIS, US LLC yELOXATIN INJ 100MG 00024059120 SANOFI-AVENTIS, US LLC yELOXATIN INJ 50MG 00024059602 SANOFI-AVENTIS, US LLC yELOXATIN INJ 100MG 00024059704 SANOFI-AVENTIS, US LLC yELIGARD INJ 45MG 00024060545 SANOFI-AVENTIS, US LLC yELIGARD INJ 30MG 00024061030 SANOFI-AVENTIS, US LLC yELIGARD INJ 7.5MG 00024079375 SANOFI-AVENTIS, US LLC yHISTUSSIN HC SYP 00024086016 SANOFI-AVENTIS, US LLC yHISTUSSIN D SOL 60-5/5ML 00024086416 SANOFI-AVENTIS, US LLC yKAYEXALATE POW 00024107501 SANOFI-AVENTIS, US LLC yPRIMACOR INJ 5MG/5ML 00024120006 SANOFI-AVENTIS, US LLC yPRIMACOR INJ 200MCG 00024120301 SANOFI-AVENTIS, US LLC yPRIMACOR INJ 200MCG 00024120302 SANOFI-AVENTIS, US LLC yPRIMACOR INJ 200MCG 00024120315 SANOFI-AVENTIS, US LLC yMYTELASE TAB 10MG 00024128704 SANOFI-AVENTIS, US LLC yPHISOHEX LIQ 3% 00024153502 SANOFI-AVENTIS, US LLC yPHISOHEX LIQ 3% 00024153505 SANOFI-AVENTIS, US LLC yPHISOHEX LIQ 3% 00024153506 SANOFI-AVENTIS, US LLC yPHISOHEX LIQ 3% 00024153508 SANOFI-AVENTIS, US LLC yPHISOHEX LIQ 3% 00024153524 SANOFI-AVENTIS, US LLC yPHISOHEX LIQ 3% 00024153548 SANOFI-AVENTIS, US LLC yPLAQUENIL TAB 200MG 00024156210 SANOFI-AVENTIS, US LLC yPRIMAQUINE TAB 26.3MG 00024159601 SANOFI-AVENTIS, US LLC yPOLY-HISTINE ELX 00024164716 SANOFI-AVENTIS, US LLC ySKELID TAB 200MG 00024180016 SANOFI-AVENTIS, US LLC yTALACEN TAB 00024193704 SANOFI-AVENTIS, US LLC yTALWIN NX TAB 00024195104 SANOFI-AVENTIS, US LLC yKERLONE TAB 20MG 00024230020 SANOFI-AVENTIS, US LLC yKERLONE TAB 10MG 00024230110 SANOFI-AVENTIS, US LLC yUROXATRAL TAB 10MG 00024420010 SANOFI-AVENTIS, US LLC yELITEK INJ 1.5MG 00024515010 SANOFI-AVENTIS, US LLC yELITEK INJ 7.5MG 00024515175 SANOFI-AVENTIS, US LLC yAMBIEN TAB 5MG 00024540110 SANOFI-AVENTIS, US LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMBIEN TAB 5MG 00024540131 SANOFI-AVENTIS, US LLC yAMBIEN TAB 5MG 00024540134 SANOFI-AVENTIS, US LLC yAMBIEN TAB 5MG 00024540150 SANOFI-AVENTIS, US LLC yAMBIEN TAB 10MG 00024542110 SANOFI-AVENTIS, US LLC yAMBIEN TAB 10MG 00024542131 SANOFI-AVENTIS, US LLC yAMBIEN TAB 10MG 00024542134 SANOFI-AVENTIS, US LLC yAMBIEN TAB 10MG 00024542150 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 6.25MG 00024550110 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 6.25MG 00024550131 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 6.25MG 00024550134 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 6.25MG 00024550150 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 12.5MG 00024552110 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 12.5MG 00024552131 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 12.5MG 00024552134 SANOFI-AVENTIS, US LLC yAMBIEN CR TAB 12.5MG 00024552150 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 500MG 00039001710 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 1GM 00039001810 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 1GM 00039001811 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 1GM 00039001825 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 1GM 00039001850 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 2GM 00039001910 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 2GM 00039001911 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 2GM 00039001925 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 2GM 00039001950 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 10GM 00039002001 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 1GM 00039002325 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 1GM 00039002350 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 2GM 00039002425 SANOFI-AVENTIS, US LLC yCLAFORAN INJ 2GM 00039002450 SANOFI-AVENTIS, US LLC yCLAFORAN/D5W INJ 1GM 00039003705 SANOFI-AVENTIS, US LLC yCLAFORAN/D5W INJ 2GM 00039003805 SANOFI-AVENTIS, US LLC yDIABETA TAB 2.5MG 00039005110 SANOFI-AVENTIS, US LLC yDIABETA TAB 2.5MG 00039005150 SANOFI-AVENTIS, US LLC yDIABETA TAB 5MG 00039005210 SANOFI-AVENTIS, US LLC yDIABETA TAB 5MG 00039005250 SANOFI-AVENTIS, US LLC yDIABETA TAB 5MG 00039005270 SANOFI-AVENTIS, US LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIABETA TAB 1.25MG 00039005305 SANOFI-AVENTIS, US LLC yLASIX TAB 40MG 00039006013 SANOFI-AVENTIS, US LLC yLASIX TAB 40MG 00039006050 SANOFI-AVENTIS, US LLC yLASIX TAB 40MG 00039006070 SANOFI-AVENTIS, US LLC yLASIX TAB 80MG 00039006605 SANOFI-AVENTIS, US LLC yLASIX TAB 80MG 00039006611 SANOFI-AVENTIS, US LLC yLASIX TAB 80MG 00039006650 SANOFI-AVENTIS, US LLC yLASIX TAB 20MG 00039006710 SANOFI-AVENTIS, US LLC yLASIX TAB 20MG 00039006711 SANOFI-AVENTIS, US LLC yLASIX TAB 20MG 00039006750 SANOFI-AVENTIS, US LLC yLASIX TAB 20MG 00039006770 SANOFI-AVENTIS, US LLC yTRENTAL TAB 400MG CR 00039007810 SANOFI-AVENTIS, US LLC yTRENTAL TAB 400MG CR 00039007880 SANOFI-AVENTIS, US LLC yAMARYL TAB 1MG 00039022110 SANOFI-AVENTIS, US LLC yAMARYL TAB 2MG 00039022210 SANOFI-AVENTIS, US LLC yAMARYL TAB 2MG 00039022211 SANOFI-AVENTIS, US LLC yAMARYL TAB 4MG 00039022310 SANOFI-AVENTIS, US LLC yAMARYL TAB 4MG 00039022311 SANOFI-AVENTIS, US LLC yHYDROXYCHLOR TAB 200MG 00955079001 SANOFI-SYNTHELABO INC. yHYDROXYCHLOR TAB 200MG 00955079005 SANOFI-SYNTHELABO INC. yZEGERID POW 20-1680 68012005201 SANTARUS, INC. yZEGERID POW 20-1680 68012005230 SANTARUS, INC. yZEGERID POW 40-1680 68012005430 SANTARUS, INC. yZEGERID CAP 20-1100 68012010230 SANTARUS, INC. yZEGERID CAP 40-1100 68012010430 SANTARUS, INC. yKAON-CL SF LIQ 20% 00281311351 SAVAGE LABORATORIES yKAON-CL-10 TAB 10MEQ CR 00281313117 SAVAGE LABORATORIES yKAON-CL-10 TAB 10MEQ CR 00281313118 SAVAGE LABORATORIES yKAON-CL-10 TAB 10MEQ CR 00281313123 SAVAGE LABORATORIES yKAON ELX 20MEQ/15 00281320351 SAVAGE LABORATORIES yETHIODOL INJ 37% 00281706237 SAVAGE LABORATORIES yDELATESTRYL INJ 200MG/ML 54396032840 SAVIENT PHARMACEUTICALS, INC. yIMDUR TAB 120MG ER 00085009101 SCHERING CORPORATION yK-DUR TAB 10MEQ CR 00085026301 SCHERING CORPORATION yK-DUR TAB 10MEQ CR 00085026381 SCHERING CORPORATION yELOCON OIN 0.1% 00085037001 SCHERING CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ELOCON OIN 0.1% 00085037002 SCHERING CORPORATION yGUANIDINE TAB 125MG 00085049201 SCHERING CORPORATION yDIPROLENE AF CRE 0.05% 00085051701 SCHERING CORPORATION yDIPROLENE AF CRE 0.05% 00085051704 SCHERING CORPORATION yINTRON-A INJ 50MU 00085053901 SCHERING CORPORATION yCELESTONE INJ SOLUSPAN 00085056605 SCHERING CORPORATION yELOCON CRE 0.1% 00085056701 SCHERING CORPORATION yELOCON CRE 0.1% 00085056702 SCHERING CORPORATION yINTRON-A INJ 10MU 00085057102 SCHERING CORPORATION yDIPROLENE OIN 0.05% 00085057502 SCHERING CORPORATION yDIPROLENE OIN 0.05% 00085057505 SCHERING CORPORATION yPROVENTIL AER 90MCG 00085061402 SCHERING CORPORATION yK-DUR TAB 20MEQ CR 00085078701 SCHERING CORPORATION yK-DUR TAB 20MEQ CR 00085078706 SCHERING CORPORATION yK-DUR TAB 20MEQ CR 00085078710 SCHERING CORPORATION yK-DUR TAB 20MEQ CR 00085078781 SCHERING CORPORATION yLOTRISONE LOT 00085080901 SCHERING CORPORATION yNITRO-DUR DIS 0.8MG/HR 00085081930 SCHERING CORPORATION yNITRO-DUR DIS 0.8MG/HR 00085081935 SCHERING CORPORATION yELOCON LOT 0.1% 00085085401 SCHERING CORPORATION yELOCON LOT 0.1% 00085085402 SCHERING CORPORATION yLOTRISONE CRE 00085092401 SCHERING CORPORATION yLOTRISONE CRE 00085092402 SCHERING CORPORATION yCELESTONE SOL 0.6MG/5 00085094205 SCHERING CORPORATION yDIPROLENE LOT 0.05% 00085096201 SCHERING CORPORATION yDIPROLENE LOT 0.05% 00085096202 SCHERING CORPORATION yINTRON-A INJ 18MU 00085111001 SCHERING CORPORATION yPROVENTIL AER HFA 00085113201 SCHERING CORPORATION yINTRON-A INJ 25MU 00085113301 SCHERING CORPORATION yIMDUR TAB 120MG ER 00085115304 SCHERING CORPORATION yINTRON-A INJ 18MU 00085116801 SCHERING CORPORATION yINTRON-A KIT 10MU/ML 00085117902 SCHERING CORPORATION yREBETOL CAP 200MG 00085119403 SCHERING CORPORATION yINTRON-A INJ 5MU PEN 00085123501 SCHERING CORPORATION yINTRON-A INJ 3MU PEN 00085124201 SCHERING CORPORATION yTEMODAR CAP 20MG 00085124401 SCHERING CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TEMODAR CAP 20MG 00085124402 SCHERING CORPORATION yTEMODAR CAP 5MG 00085124801 SCHERING CORPORATION yTEMODAR CAP 5MG 00085124802 SCHERING CORPORATION yTEMODAR CAP 250MG 00085125201 SCHERING CORPORATION yTEMODAR CAP 250MG 00085125202 SCHERING CORPORATION yINTRON-A INJ 10MU PEN 00085125401 SCHERING CORPORATION yTEMODAR CAP 100MG 00085125901 SCHERING CORPORATION yTEMODAR CAP 100MG 00085125902 SCHERING CORPORATION yCLARINEX TAB 5MG 00085126401 SCHERING CORPORATION yCLARINEX TAB 5MG 00085126402 SCHERING CORPORATION yCLARINEX TAB 5MG 00085126403 SCHERING CORPORATION yCLARINEX TAB 5MG 00085126404 SCHERING CORPORATION yPEG-INTRON KIT 150MCG 00085127901 SCHERING CORPORATION yCLARINEX RDT TAB 5MG 00085128001 SCHERING CORPORATION yNASONEX SPR 50MCG/AC 00085128801 SCHERING CORPORATION yPEG-INTRON KIT 80MCG 00085129101 SCHERING CORPORATION yPEG-INTRON KIT 120 RP 00085129701 SCHERING CORPORATION yPEG-INTRON KIT 120 RP 00085129702 SCHERING CORPORATION yPEG-INTRON KIT 120MCG 00085130401 SCHERING CORPORATION yPEG-INTRON KIT 80MCG RP 00085131601 SCHERING CORPORATION yPEG-INTRON KIT 80MCG RP 00085131602 SCHERING CORPORATION yCLARINEX-D TAB 5-240MG 00085131701 SCHERING CORPORATION yREBETOL SOL 40MG/ML 00085131801 SCHERING CORPORATION yCLARINEX-D TAB 2.5-120 00085132201 SCHERING CORPORATION yPEG-INTRON KIT 50MCG RP 00085132301 SCHERING CORPORATION yPEG-INTRON KIT 50MCG RP 00085132302 SCHERING CORPORATION yREBETOL CAP 200MG 00085132704 SCHERING CORPORATION yNOXAFIL SUS 40MG/ML 00085132801 SCHERING CORPORATION yCLARINEX SYP 0.5MG/ML 00085133401 SCHERING CORPORATION yCLARINEX SYP 0.5MG/ML 00085133402 SCHERING CORPORATION yASMANEX 120 AER 220MCG 00085134101 SCHERING CORPORATION yASMANEX 60 AER 220MCG 00085134102 SCHERING CORPORATION yASMANEX 30 AER 220MCG 00085134103 SCHERING CORPORATION yASMANEX 14 AER 220MCG 00085134104 SCHERING CORPORATION yREBETOL CAP 200MG 00085135105 SCHERING CORPORATION yPEG-INTRON KIT 50MCG 00085136801 SCHERING CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PEG-INTRON KIT 150 RP 00085137001 SCHERING CORPORATION yPEG-INTRON KIT 150 RP 00085137002 SCHERING CORPORATION yIMDUR TAB 30MG ER 00085137401 SCHERING CORPORATION yCLARINEX RDT TAB 5MG 00085138401 SCHERING CORPORATION yREBETOL CAP 200MG 00085138507 SCHERING CORPORATION yFORADIL CAP AEROLIZE 00085140101 SCHERING CORPORATION yFORADIL CAP AEROLIZE 00085140201 SCHERING CORPORATION yCLARINEX RDT TAB 2.5MG 00085140801 SCHERING CORPORATION yADALAT CC TAB 30MG ER 00085170101 SCHERING CORPORATION yADALAT CC TAB 30MG ER 00085170102 SCHERING CORPORATION yADALAT CC TAB 30MG ER 00085170103 SCHERING CORPORATION yADALAT CC TAB 60MG ER 00085171601 SCHERING CORPORATION yADALAT CC TAB 60MG ER 00085171602 SCHERING CORPORATION yADALAT CC TAB 60MG ER 00085171603 SCHERING CORPORATION yADALAT CC TAB 90MG ER 00085172201 SCHERING CORPORATION yADALAT CC TAB 90MG ER 00085172202 SCHERING CORPORATION yAVELOX TAB 400MG 00085173301 SCHERING CORPORATION yAVELOX TAB 400MG 00085173302 SCHERING CORPORATION yAVELOX ABC TAB 400MG 00085173303 SCHERING CORPORATION yAVELOX INJ 00085173701 SCHERING CORPORATION yCIPRO I.V. SOL 400MG 00085176201 SCHERING CORPORATION yCIPRO (10%) SUS 500MG/5 00085177301 SCHERING CORPORATION yCIPRO XR TAB 500MG 00085177502 SCHERING CORPORATION yCIPRO (5%) SUS 250MG/5 00085177701 SCHERING CORPORATION yCIPRO XR TAB 1000MG 00085177802 SCHERING CORPORATION yCIPRO XR TAB 1000MG 00085177803 SCHERING CORPORATION yLEVITRA TAB 10MG 00085190101 SCHERING CORPORATION yLEVITRA TAB 2.5MG 00085192301 SCHERING CORPORATION yLEVITRA TAB 20MG 00085193401 SCHERING CORPORATION yLEVITRA TAB 5MG 00085194501 SCHERING CORPORATION yIMDUR TAB 60MG ER 00085202801 SCHERING CORPORATION yNITRO-DUR DIS 0.1MG/HR 00085330530 SCHERING CORPORATION yNITRO-DUR DIS 0.1MG/HR 00085330535 SCHERING CORPORATION yNITRO-DUR DIS 0.2MG/HR 00085331030 SCHERING CORPORATION yNITRO-DUR DIS 0.2MG/HR 00085331035 SCHERING CORPORATION yNITRO-DUR DIS 0.3MG/HR 00085331530 SCHERING CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NITRO-DUR DIS 0.3MG/HR 00085331535 SCHERING CORPORATION yNITRO-DUR DIS 0.4MG/HR 00085332030 SCHERING CORPORATION yNITRO-DUR DIS 0.4MG/HR 00085332035 SCHERING CORPORATION yNITRO-DUR DIS 0.6MG/HR 00085333030 SCHERING CORPORATION yNITRO-DUR DIS 0.6MG/HR 00085333035 SCHERING CORPORATION yTINACTIN AER POWD 1% 11523077702 SCHERING HEALTHCARE PRODUCTS yCLARITIN RDT TAB 10MG 11523715701 SCHERING HEALTHCARE PRODUCTS yCLARITIN RDT TAB 10MG 11523715702 SCHERING HEALTHCARE PRODUCTS yCLARITIN RDT TAB 10MG 11523715704 SCHERING HEALTHCARE PRODUCTS yCLARITIN RDT TAB 10MG 11523715707 SCHERING HEALTHCARE PRODUCTS yCLARITIN TAB 10MG 11523716001 SCHERING HEALTHCARE PRODUCTS yCLARITIN TAB 10MG 11523716002 SCHERING HEALTHCARE PRODUCTS yCLARITIN TAB 10MG 11523716003 SCHERING HEALTHCARE PRODUCTS yCLARITIN TAB 10MG 11523716005 SCHERING HEALTHCARE PRODUCTS yCLARITIN TAB 10MG 11523716009 SCHERING HEALTHCARE PRODUCTS yCLARITIN-D TAB 10-240MG 11523716101 SCHERING HEALTHCARE PRODUCTS yCLARITIN-D TAB 10-240MG 11523716102 SCHERING HEALTHCARE PRODUCTS yCLARITIN-D TAB 10-240MG 11523716103 SCHERING HEALTHCARE PRODUCTS yCLARITIN-D TAB 5-120MG 11523716201 SCHERING HEALTHCARE PRODUCTS yCLARITIN-D TAB 5-120MG 11523716202 SCHERING HEALTHCARE PRODUCTS yCLARITIN-D TAB 5-120MG 11523716203 SCHERING HEALTHCARE PRODUCTS yCLARITIN SYP 5MG/5ML 11523716301 SCHERING HEALTHCARE PRODUCTS yCLARITIN SYP 5MG/5ML 11523719701 SCHERING HEALTHCARE PRODUCTS yCLARITIN SYP 5MG/5ML 11523719702 SCHERING HEALTHCARE PRODUCTS yCLARITIN CHW 5MG 11523719801 SCHERING HEALTHCARE PRODUCTS yCLARITIN CHW 5MG 11523719802 SCHERING HEALTHCARE PRODUCTS yLOTRIMIN AF CRE 1% 11523721501 SCHERING HEALTHCARE PRODUCTS yGUAIMAX-D TAB 120-600 00131205537 SCHWARZ PHARMA LLC yCO-GESIC TAB 500-5MG 00131210437 SCHWARZ PHARMA LLC yCODIMAL PH SYP 00131503864 SCHWARZ PHARMA LLC yCODIMAL PH SYP 00131503870 SCHWARZ PHARMA LLC yNIFEREX ELX 100/5ML 00131506668 SCHWARZ PHARMA LLC yCODIMAL DH SYP 00131512964 SCHWARZ PHARMA LLC yCODIMAL DH SYP 00131512970 SCHWARZ PHARMA LLC yCODIMAL DM SYP 00131513164 SCHWARZ PHARMA LLC yCODIMAL DM SYP 00131513170 SCHWARZ PHARMA LLC y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CODICLEAR DH SYP 5-100/5 00131513464 SCHWARZ PHARMA LLC yCODICLEAR DH SYP 5-100/5 00131513470 SCHWARZ PHARMA LLC yTRILYTE SOL 00091044723 SCHWARZ PHARMA, LLC yPROCTOFOAM AER -HC 1% 00091069010 SCHWARZ PHARMA, LLC yCORTIFOAM AER 90MG 00091069520 SCHWARZ PHARMA, LLC yEPIFOAM AER 1% 00091074010 SCHWARZ PHARMA, LLC yTRICHOTINE POW VAG DUCH 00091080105 SCHWARZ PHARMA, LLC yDILATRATE SR CAP 40MG 00091092001 SCHWARZ PHARMA, LLC yEDEX KIT 10MCG 00091111016 SCHWARZ PHARMA, LLC yEDEX KIT 10MCG 00091111020 SCHWARZ PHARMA, LLC yEDEX KIT 20MCG 00091112016 SCHWARZ PHARMA, LLC yEDEX KIT 20MCG 00091112020 SCHWARZ PHARMA, LLC yEDEX KIT 40MCG 00091114016 SCHWARZ PHARMA, LLC yEDEX KIT 40MCG 00091114020 SCHWARZ PHARMA, LLC yLEVSIN INJ 0.5MG/ML 00091153605 SCHWARZ PHARMA, LLC yVERELAN CAP 180MG 00091248923 SCHWARZ PHARMA, LLC yVERELAN CAP 120MG SR 00091249023 SCHWARZ PHARMA, LLC yVERELAN CAP 240MG SR 00091249123 SCHWARZ PHARMA, LLC yVERELAN CAP 360MG SR 00091249523 SCHWARZ PHARMA, LLC yNULEV TAB 0.125MG 00091311101 SCHWARZ PHARMA, LLC yNIRAVAM TAB 0.25MG 00091332101 SCHWARZ PHARMA, LLC yNIRAVAM TAB 0.5MG 00091332201 SCHWARZ PHARMA, LLC yNIRAVAM TAB 1MG 00091332301 SCHWARZ PHARMA, LLC yNIRAVAM TAB 2MG 00091332401 SCHWARZ PHARMA, LLC yPARCOPA TAB 10-100MG 00091334101 SCHWARZ PHARMA, LLC yPARCOPA TAB 25-100MG 00091334201 SCHWARZ PHARMA, LLC yPARCOPA TAB 25-250MG 00091334301 SCHWARZ PHARMA, LLC yLACTRASE CAP 250MG 00091350501 SCHWARZ PHARMA, LLC yKU-ZYME-HP CAP 00091352501 SCHWARZ PHARMA, LLC yLEVSIN TAB 0.125MG 00091353101 SCHWARZ PHARMA, LLC yLEVSIN TAB 0.125MG 00091353105 SCHWARZ PHARMA, LLC yLEVSIN/SL SUB 0.125MG 00091353201 SCHWARZ PHARMA, LLC yLEVSIN/SL SUB 0.125MG 00091353205 SCHWARZ PHARMA, LLC yLEVSINEX CAP 0.375 CR 00091353701 SCHWARZ PHARMA, LLC yLEVSINEX CAP 0.375 CR 00091353705 SCHWARZ PHARMA, LLC yLEVBID TAB 0.375 ER 00091353801 SCHWARZ PHARMA, LLC y

Page 612: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LEVBID TAB 0.375 ER 00091353805 SCHWARZ PHARMA, LLC yMONOKET TAB 10MG 00091361001 SCHWARZ PHARMA, LLC yMONOKET TAB 20MG 00091362001 SCHWARZ PHARMA, LLC yMONOKET TAB 20MG 00091362018 SCHWARZ PHARMA, LLC yUNIVASC TAB 7.5MG 00091370701 SCHWARZ PHARMA, LLC yUNIRETIC TAB 7.5/12.5 00091371201 SCHWARZ PHARMA, LLC yUNIVASC TAB 15MG 00091371501 SCHWARZ PHARMA, LLC yUNIRETIC TAB 15-12.5 00091372001 SCHWARZ PHARMA, LLC yUNIRETIC TAB 15/25MG 00091372501 SCHWARZ PHARMA, LLC yVERELAN PM CAP 100MG 00091408501 SCHWARZ PHARMA, LLC yVERELAN PM CAP 200MG 00091408601 SCHWARZ PHARMA, LLC yVERELAN PM CAP 300MG 00091408701 SCHWARZ PHARMA, LLC yKU-ZYME CAP 00091412201 SCHWARZ PHARMA, LLC yCALCIFEROL DRO 8000/ML 00091415060 SCHWARZ PHARMA, LLC yKUTRASE CAP 00091417501 SCHWARZ PHARMA, LLC yCOLYTE SOL 00091440123 SCHWARZ PHARMA, LLC yLEVATOL TAB 20MG 00091450015 SCHWARZ PHARMA, LLC yLEVSIN ELX 0.125/5 00091453216 SCHWARZ PHARMA, LLC yLEVSIN DRO 0.125/ML 00091453815 SCHWARZ PHARMA, LLC yPROCTOCREAM CRE HC 2.5% 00091464024 SCHWARZ PHARMA, LLC yPROCTOFOAM AER NS 1% 00091475020 SCHWARZ PHARMA, LLC yREGLAN TAB 10MG 00091670163 SCHWARZ PHARMA, LLC yREGLAN TAB 10MG 00091670170 SCHWARZ PHARMA, LLC yREGLAN TAB 5MG 00091670563 SCHWARZ PHARMA, LLC yCOLYTE/FLAVR SOL PACKS 00091703623 SCHWARZ PHARMA, LLC yROBAXIN TAB 500MG 00091742963 SCHWARZ PHARMA, LLC yROBAXIN-750 TAB 750MG 00091744963 SCHWARZ PHARMA, LLC yROBAXIN-750 TAB 750MG 00091744970 SCHWARZ PHARMA, LLC yTANAFED DM SUS 59630012504 SCIELE PHARMA, INC. yTANAFED DM SUS 59630012516 SCIELE PHARMA, INC. yZOTO-HC SOL OTIC 59630013501 SCIELE PHARMA, INC. yZEBUTAL CAP 59630017010 SCIELE PHARMA, INC. yCOGNEX CAP 10MG 59630019012 SCIELE PHARMA, INC. yCOGNEX CAP 20MG 59630019112 SCIELE PHARMA, INC. yCOGNEX CAP 30MG 59630019212 SCIELE PHARMA, INC. yCOGNEX CAP 40MG 59630019312 SCIELE PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ROBINUL TAB 1MG 59630020010 SCIELE PHARMA, INC. yROBINUL FORT TAB 2MG 59630020510 SCIELE PHARMA, INC. yNITROLINGUAL SPR PUMPSPRA 59630030020 SCIELE PHARMA, INC. yNITROLINGUAL SPR PUMPSPRA 59630030065 SCIELE PHARMA, INC. yPONSTEL CAP 250MG 59630040010 SCIELE PHARMA, INC. yPRENATE ELIT TAB 59630041190 SCIELE PHARMA, INC. yOPTINATE MIS 59630041230 SCIELE PHARMA, INC. yOSTIVA TAB 59630041360 SCIELE PHARMA, INC. yPRENATE TAB ADVANCE 59630042090 SCIELE PHARMA, INC. ySULAR TAB 10MG CR 59630044010 SCIELE PHARMA, INC. ySULAR TAB 20MG CR 59630044110 SCIELE PHARMA, INC. ySULAR TAB 30MG CR 59630044210 SCIELE PHARMA, INC. ySULAR TAB 40MG CR 59630044310 SCIELE PHARMA, INC. yFURADANTIN SUS 25MG/5ML 59630045016 SCIELE PHARMA, INC. yTANAFED DP SUS 59630046504 SCIELE PHARMA, INC. yTANAFED DP SUS 59630046516 SCIELE PHARMA, INC. yTANAFED DMX SUS 59630047004 SCIELE PHARMA, INC. yTANAFED DMX SUS 59630047016 SCIELE PHARMA, INC. yTRIGLIDE TAB 50MG 59630048090 SCIELE PHARMA, INC. yTRIGLIDE TAB 160MG 59630048590 SCIELE PHARMA, INC. yNATRECOR INJ 1.5MG 65847020525 SCIOS, INC. yDIPHENHYDRAM CAP 25MG 66424002001 SDA LABORATORIES yDIPHENHYDRAM CAP 25MG 66424002010 SDA LABORATORIES yDIPHENHYDRAM CAP 50MG 66424002101 SDA LABORATORIES yDIPHENHYDRAM CAP 50MG 66424002110 SDA LABORATORIES yURISEPTIC TAB 66424003201 SDA LABORATORIES yPHENAZOPYRID TAB 100MG 66424004301 SDA LABORATORIES yPHENAZOPYRID TAB 200MG 66424004501 SDA LABORATORIES yERGOCAFF PB SUP 66424031512 SDA LABORATORIES yAUROGUARD SOL 66424052035 SDA LABORATORIES yCOLDEC DM SYP 66424056040 SDA LABORATORIES yGG/PSE TAB 1200/120 66424064501 SDA LABORATORIES ySB GEN LAX TAB WOMEN 15127000230 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG EC 15127001105 SELECT BRAND DISTRIBUTORS yCHLORPHENIR TAB 4MG 15127001601 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127002030 SELECT BRAND DISTRIBUTORS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NON-ASPIRIN TAB 500MG 15127003630 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 325MG 15127007208 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 325MG 15127007224 SELECT BRAND DISTRIBUTORS ySB EAR WAX DRO 6.5% OT 15127011501 SELECT BRAND DISTRIBUTORS yCIMETIDINE TAB 200MG 15127013006 SELECT BRAND DISTRIBUTORS yCIMETIDINE TAB 200MG 15127013018 SELECT BRAND DISTRIBUTORS yCIMETIDINE TAB 200MG 15127013030 SELECT BRAND DISTRIBUTORS ySB BISACODYL TAB 5MG EC 15127017807 SELECT BRAND DISTRIBUTORS ySB BISMUTH TAB 262MG 15127018008 SELECT BRAND DISTRIBUTORS yCOUGH CONTRO SYP PE 15127020304 SELECT BRAND DISTRIBUTORS ySB ALLERGY TAB 25MG MED 15127020524 SELECT BRAND DISTRIBUTORS yLICE TREATME LIQ 15127020603 SELECT BRAND DISTRIBUTORS yLICE TREATME LIQ 15127020608 SELECT BRAND DISTRIBUTORS ySB ANTACID CHW EX STR 15127020737 SELECT BRAND DISTRIBUTORS ySB ANTACID CHW 500MG 15127021024 SELECT BRAND DISTRIBUTORS ySB ANTACID CHW ASSORTED 15127021124 SELECT BRAND DISTRIBUTORS ySB FIBER LAX TAB 625MG 15127021315 SELECT BRAND DISTRIBUTORS ySB FIBER LAX TAB 625MG 15127021320 SELECT BRAND DISTRIBUTORS ySB ASA LOW TAB 81MG EC 15127022894 SELECT BRAND DISTRIBUTORS ySB CHLD ASA CHW 81MG 15127024136 SELECT BRAND DISTRIBUTORS ySB MOTION TAB 50MG 15127026212 SELECT BRAND DISTRIBUTORS ySB ALLERGY CAP 25MG 15127028324 SELECT BRAND DISTRIBUTORS ySB ALLERGY CAP 25MG 15127028336 SELECT BRAND DISTRIBUTORS ySB ALLERGY CAP 25MG 15127028348 SELECT BRAND DISTRIBUTORS yDOCUSATE SOD CAP 100MG 15127028810 SELECT BRAND DISTRIBUTORS ySB PSEUDOEPH TAB PLUS 15127029424 SELECT BRAND DISTRIBUTORS y12HR NASAL SPR 0.05% 15127030405 SELECT BRAND DISTRIBUTORS y12HR NASAL SPR 0.05% 15127030410 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127031201 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127031207 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127031211 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127031224 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127031250 SELECT BRAND DISTRIBUTORS yIBUPROFEN TAB 200MG 15127031301 SELECT BRAND DISTRIBUTORS yIBUPROFEN TAB 200MG 15127031324 SELECT BRAND DISTRIBUTORS yIBUPROFEN TAB 200MG 15127031350 SELECT BRAND DISTRIBUTORS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SB IBUPROFEN TAB 200MG 15127033501 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127033511 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127033524 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127033550 SELECT BRAND DISTRIBUTORS yANTI-DIARRHE TAB 2MG 15127033812 SELECT BRAND DISTRIBUTORS yANTI-DIARRHE TAB 2MG 15127033866 SELECT BRAND DISTRIBUTORS ySB NIGHTIME CAP 15127035112 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127036401 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127036411 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127036424 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127036450 SELECT BRAND DISTRIBUTORS ySB DAYTIME CAP 15127036912 SELECT BRAND DISTRIBUTORS ySB COLD/COUG CAP 15127038312 SELECT BRAND DISTRIBUTORS ySB ALLERGY TAB SINUS/HA 15127039524 SELECT BRAND DISTRIBUTORS ySB BACKACHE TAB 500MG 15127044824 SELECT BRAND DISTRIBUTORS ySB ANTIHIST TAB 2.5-60MG 15127045006 SELECT BRAND DISTRIBUTORS ySB NON-ASA SUS 160/5ML 15127050861 SELECT BRAND DISTRIBUTORS ySB ANTACID SUS MINT 15127054073 SELECT BRAND DISTRIBUTORS ySB BISMUTH SUS 262/15ML 15127055068 SELECT BRAND DISTRIBUTORS ySB BISMUTH M SUS 525/15ML 15127055568 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127072013 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127073006 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127073021 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127073508 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127073509 SELECT BRAND DISTRIBUTORS yNON-ASPIRIN TAB 500MG 15127073516 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG 15127073801 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG 15127073805 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG 15127073809 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG 15127073810 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG 15127073816 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG 15127073821 SELECT BRAND DISTRIBUTORS yANTACID DS SUS 15127074552 SELECT BRAND DISTRIBUTORS ySB ASPIRIN TAB 325MG EC 15127076008 SELECT BRAND DISTRIBUTORS ySB NAT FIBER POW 49% 15127080313 SELECT BRAND DISTRIBUTORS ySB NAT FIBER POW 49% 15127080319 SELECT BRAND DISTRIBUTORS y

Page 616: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SB FIB LAX POW POWDER 15127080413 SELECT BRAND DISTRIBUTORS ySB FIB LAX POW POWDER 15127080419 SELECT BRAND DISTRIBUTORS ySB FIB LAX POW 30% 15127081513 SELECT BRAND DISTRIBUTORS ySB FIB LAX POW ORANGE 15127081710 SELECT BRAND DISTRIBUTORS ySB CHLORPHEN TAB 4MG 15127082109 SELECT BRAND DISTRIBUTORS ySB NON-ASA CHW 80MG FRT 15127083004 SELECT BRAND DISTRIBUTORS ySB NON-ASA CHW 80MG GRP 15127083204 SELECT BRAND DISTRIBUTORS ySB MILK MAGN SUS 15127083373 SELECT BRAND DISTRIBUTORS ySB MILK MAGN SUS MINT 15127083573 SELECT BRAND DISTRIBUTORS ySB ENHANCED TAB RELIEF 15127083809 SELECT BRAND DISTRIBUTORS yPAIN RELIEF TAB X-STR 15127085708 SELECT BRAND DISTRIBUTORS ySB NIGHTIME LIQ 15127087564 SELECT BRAND DISTRIBUTORS ySB NIGHTIME LIQ 15127087570 SELECT BRAND DISTRIBUTORS ySB NIGHTIME LIQ CHERRY 15127088064 SELECT BRAND DISTRIBUTORS ySB NIGHTIME LIQ CHERRY 15127088070 SELECT BRAND DISTRIBUTORS yANTACID SUS ANTI-GAS 15127088352 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127090550 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127090724 SELECT BRAND DISTRIBUTORS ySB IBUPROFEN TAB 200MG 15127090750 SELECT BRAND DISTRIBUTORS yCOUGH CONTRL SYP 100/5ML 15127094044 SELECT BRAND DISTRIBUTORS yCOUGH CONTRL SYP 100/5ML 15127094048 SELECT BRAND DISTRIBUTORS yCOUGH CONTRO SYP DM 15127094544 SELECT BRAND DISTRIBUTORS yCOUGH CONTRO SYP DM 15127094548 SELECT BRAND DISTRIBUTORS ySINUS/ALLERG TAB MAX STR 15127098209 SELECT BRAND DISTRIBUTORS yCAROMEGA TAB 47028000906 SENECA PHARMACEUTICALS, INC yLUNESTA TAB 1MG 63402019010 SEPRACOR, INC. yLUNESTA TAB 2MG 63402019109 SEPRACOR, INC. yLUNESTA TAB 2MG 63402019110 SEPRACOR, INC. yLUNESTA TAB 3MG 63402019309 SEPRACOR, INC. yLUNESTA TAB 3MG 63402019310 SEPRACOR, INC. yXOPENEX HFA AER 63402051001 SEPRACOR, INC. yXOPENEX NEB 0.31MG 63402051124 SEPRACOR, INC. yXOPENEX NEB 0.63MG 63402051224 SEPRACOR, INC. yXOPENEX NEB 1.25/3ML 63402051324 SEPRACOR, INC. yXOPENEX CONC NEB 1.25/0.5 63402051530 SEPRACOR, INC. ySEROSTIM INJ 4MG 44087000401 SERONO, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SEROSTIM INJ 4MG 44087000407 SERONO, INC. ySEROSTIM INJ 5MG 44087000501 SERONO, INC. ySEROSTIM INJ 5MG 44087000507 SERONO, INC. ySEROSTIM INJ 6MG 44087000601 SERONO, INC. ySEROSTIM INJ 6MG 44087000607 SERONO, INC. yREBIF INJ 22/0.5 44087002203 SERONO, INC. yREBIF INJ 44/0.5 44087004403 SERONO, INC. yCRINONE GEL 8% VAG 44087081808 SERONO, INC. ySAIZEN INJ 5MG 44087100502 SERONO, INC. ySAIZEN INJ 8.8MG 44087108001 SERONO, INC. ySAIZEN INJ 8.8MG 44087108002 SERONO, INC. ySAIZEN INJ 8.8MG 44087108801 SERONO, INC. yCETROTIDE KIT 3MG 44087120301 SERONO, INC. yCETROTIDE KIT 0.25MG 44087122501 SERONO, INC. yLUVERIS INJ 75UNIT 44087137501 SERONO, INC. yNOVANTRONE INJ 2MG/ML 44087152001 SERONO, INC. yNOVANTRONE INJ 2MG/ML 44087152501 SERONO, INC. yNOVANTRONE INJ 2MG/ML 44087153001 SERONO, INC. yZORBTIVE INJ 44087338807 SERONO, INC. ySEROPHENE TAB 50MG 44087809001 SERONO, INC. ySEROPHENE TAB 50MG 44087809006 SERONO, INC. yREBIF TITRTN SOL PACK 44087882201 SERONO, INC. yGONAL-F RFF INJ 75UNIT 44087900501 SERONO, INC. yGONAL-F RFF INJ 75UNIT 44087900506 SERONO, INC. yGONAL-F INJ 450UNIT 44087903001 SERONO, INC. yBENSAL HP OIN 63801010705 SEVEN OAKS PHARMACEUTICAL CORP. yBENSAL HP OIN 63801010709 SEVEN OAKS PHARMACEUTICAL CORP. yTHERMAZENE CRE 1% 08880950502 SHERWOOD MEDICAL yTHERMAZENE CRE 1% 08880950505 SHERWOOD MEDICAL yTHERMAZENE CRE 1% 08880950510 SHERWOOD MEDICAL yTHERMAZENE CRE 1% 08880950540 SHERWOOD MEDICAL yTHERMAZENE CRE 1% 08880950550 SHERWOOD MEDICAL yTHERMAZENE CRE 1% 08880950585 SHERWOOD MEDICAL yPROAMATINE TAB 2.5MG 54092000301 SHIRE US, INC. yPROAMATINE TAB 5MG 54092000401 SHIRE US, INC. yPROAMATINE TAB 10MG 54092000701 SHIRE US, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ETHMOZINE TAB 200MG 54092004601 SHIRE US, INC. yETHMOZINE TAB 250MG 54092004701 SHIRE US, INC. yETHMOZINE TAB 300MG 54092004801 SHIRE US, INC. yAGRYLIN CAP 0.5MG 54092006301 SHIRE US, INC. yAGRYLIN CAP 1MG 54092006401 SHIRE US, INC. yCARBATROL CAP 100MG 54092017112 SHIRE US, INC. yCARBATROL CAP 200MG 54092017212 SHIRE US, INC. yCARBATROL CAP 300MG 54092017312 SHIRE US, INC. yPENTASA CAP 250MG CR 54092018980 SHIRE US, INC. yPENTASA CAP 250MG CR 54092018981 SHIRE US, INC. yPENTASA CAP 500MG CR 54092019112 SHIRE US, INC. yPENTASA CAP 500MG CR 54092019180 SHIRE US, INC. yFOSRENOL CHW 250MG 54092024701 SHIRE US, INC. yFOSRENOL CHW 500MG 54092024901 SHIRE US, INC. yFOSRENOL CHW 500MG 54092025290 SHIRE US, INC. yADDERALL TAB 5MG 54092037101 SHIRE US, INC. yADDERALL TAB 7.5MG 54092037201 SHIRE US, INC. yADDERALL TAB 10MG 54092037301 SHIRE US, INC. yADDERALL TAB 12.5MG 54092037401 SHIRE US, INC. yADDERALL TAB 15MG 54092037501 SHIRE US, INC. yADDERALL TAB 20MG 54092037601 SHIRE US, INC. yADDERALL TAB 30MG 54092037701 SHIRE US, INC. yADDERALL XR CAP 5MG 54092038101 SHIRE US, INC. yADDERALL XR CAP 10MG 54092038301 SHIRE US, INC. yADDERALL XR CAP 15MG 54092038501 SHIRE US, INC. yADDERALL XR CAP 20MG 54092038701 SHIRE US, INC. yADDERALL XR CAP 25MG 54092038901 SHIRE US, INC. yADDERALL XR CAP 30MG 54092039101 SHIRE US, INC. yEQUETRO CAP 100MG 54092041912 SHIRE US, INC. yEQUETRO CAP 200MG 54092042112 SHIRE US, INC. yEQUETRO CAP 300MG 54092042312 SHIRE US, INC. yDEXTROSTAT TAB 5MG 54092044801 SHIRE US, INC. yDEXTROSTAT TAB 10MG 54092045201 SHIRE US, INC. yDAYTRANA DIS 10MG/9HR 54092055210 SHIRE US, INC. yDAYTRANA DIS 10MG/9HR 54092055230 SHIRE US, INC. yDAYTRANA DIS 15MG/9HR 54092055310 SHIRE US, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DAYTRANA DIS 15MG/9HR 54092055330 SHIRE US, INC. yDAYTRANA DIS 20MG/9HR 54092055410 SHIRE US, INC. yDAYTRANA DIS 20MG/9HR 54092055430 SHIRE US, INC. yDAYTRANA DIS 30MG/9HR 54092055510 SHIRE US, INC. yDAYTRANA DIS 30MG/9HR 54092055530 SHIRE US, INC. yELAPRASE INJ 6MG/3ML 54092070001 SHIRE US, INC. yMETHYLPR ACE INJ 40MG/ML 00703003101 SICOR PHARMACEUTICALS, INC. yMETHYLPR ACE INJ 40MG/ML 00703003104 SICOR PHARMACEUTICALS, INC. yMETHYLPR ACE INJ 40MG/ML 00703004301 SICOR PHARMACEUTICALS, INC. yMETHYLPR ACE INJ 40MG/ML 00703004501 SICOR PHARMACEUTICALS, INC. yMETHYLPR ACE INJ 80MG/ML 00703005101 SICOR PHARMACEUTICALS, INC. yMETHYLPR ACE INJ 80MG/ML 00703005104 SICOR PHARMACEUTICALS, INC. yMETHYLPR ACE INJ 80MG/ML 00703006301 SICOR PHARMACEUTICALS, INC. yLEVOCARNITIN INJ 200MG/ML 00703040401 SICOR PHARMACEUTICALS, INC. yLEVOCARNITIN INJ 200MG/ML 00703040402 SICOR PHARMACEUTICALS, INC. yLEVOCARNITIN INJ 200MG/ML 00703040502 SICOR PHARMACEUTICALS, INC. yCIPROFLOXACN INJ 200MG 00703095603 SICOR PHARMACEUTICALS, INC. yCIPROFLOXACN INJ 400MG 00703095803 SICOR PHARMACEUTICALS, INC. yFLUCONAZOLE/ INJ NACL 400 00703101009 SICOR PHARMACEUTICALS, INC. yFLUCONAZOLE/ INJ NACL 200 00703101909 SICOR PHARMACEUTICALS, INC. yFLUCONAZOLE/ INJ NACL 400 00703102030 SICOR PHARMACEUTICALS, INC. yFLUCONAZOLE/ INJ NACL 200 00703102930 SICOR PHARMACEUTICALS, INC. yNOREPINEPHR INJ 1MG/ML 00703115303 SICOR PHARMACEUTICALS, INC. yTERBUTALINE INJ 1MG/ML 00703127104 SICOR PHARMACEUTICALS, INC. yAMIODARONE INJ 50MG/ML 00703133501 SICOR PHARMACEUTICALS, INC. yALPROSTADIL INJ 500MCG 00703150102 SICOR PHARMACEUTICALS, INC. yDIPYRIDAMOLE INJ 5MG/ML 00703165202 SICOR PHARMACEUTICALS, INC. yDIPYRIDAMOLE INJ 5MG/ML 00703165401 SICOR PHARMACEUTICALS, INC. yDIPYRIDAMOLE INJ 5MG/ML 00703165402 SICOR PHARMACEUTICALS, INC. yFLUMAZENIL INJ 0.1MG/ML 00703208403 SICOR PHARMACEUTICALS, INC. yFLUMAZENIL INJ 0.1MG/ML 00703208503 SICOR PHARMACEUTICALS, INC. yPROMETHAZINE INJ 25MG/ML 00703219104 SICOR PHARMACEUTICALS, INC. yPROMETHAZINE INJ 50MG/ML 00703220104 SICOR PHARMACEUTICALS, INC. yNEOSTIG METH INJ 1MG/ML 00703270403 SICOR PHARMACEUTICALS, INC. yNEOSTIG METH INJ 0.5MG/ML 00703271103 SICOR PHARMACEUTICALS, INC. yNEOSTIG METH INJ 0.5MG/ML 00703271403 SICOR PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PANCURONIUM INJ 1MG/ML 00703280403 SICOR PHARMACEUTICALS, INC. yPANCURONIUM INJ 2MG/ML 00703281204 SICOR PHARMACEUTICALS, INC. yPANCURONIUM INJ 2MG/ML 00703282304 SICOR PHARMACEUTICALS, INC. yVECURONIUM INJ 10MG 00703291403 SICOR PHARMACEUTICALS, INC. yVECURONIUM INJ 20MG 00703292503 SICOR PHARMACEUTICALS, INC. yADRUCIL INJ 50MG/ML 00703301513 SICOR PHARMACEUTICALS, INC. yADRUCIL INJ 50MG/ML 00703301812 SICOR PHARMACEUTICALS, INC. yADRUCIL INJ 50MG/ML 00703301912 SICOR PHARMACEUTICALS, INC. yBLEOMYCIN INJ 15UNIT 00703315401 SICOR PHARMACEUTICALS, INC. yBLEOMYCIN INJ 30UNIT 00703315501 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 150/15ML 00703324611 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 10MG/ML 00703324911 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 150MG 00703326601 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 450MG 00703326801 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 450MG 00703326871 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 150MG 00703327601 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 450MG 00703327801 SICOR PHARMACEUTICALS, INC. yOCTREOTIDE INJ 50MCG/ML 00703330104 SICOR PHARMACEUTICALS, INC. yOCTREOTIDE INJ 100MCG 00703331104 SICOR PHARMACEUTICALS, INC. yOCTREOTIDE INJ 500MCG 00703332104 SICOR PHARMACEUTICALS, INC. yOCTREOTIDE INJ 0.2MG/ML 00703333301 SICOR PHARMACEUTICALS, INC. yOCTREOTIDE INJ 1MG/ML 00703334301 SICOR PHARMACEUTICALS, INC. yDEXAMETH PHO INJ 10MG/ML 00703352401 SICOR PHARMACEUTICALS, INC. yDEXAMETH PHO INJ 10MG/ML 00703352403 SICOR PHARMACEUTICALS, INC. yLEUPROLIDE INJ 1MG/0.2 00703401418 SICOR PHARMACEUTICALS, INC. yLEUPROLIDE INJ 1MG/0.2 00703401419 SICOR PHARMACEUTICALS, INC. yLEUPROLIDE INJ 1MG/0.2 00703402419 SICOR PHARMACEUTICALS, INC. yPAMIDRONATE SOL 3MG/ML 00703407519 SICOR PHARMACEUTICALS, INC. yPAMIDRONATE SOL 3MG/ML 00703407559 SICOR PHARMACEUTICALS, INC. yPAMIDRONATE SOL 9MG/ML 00703408511 SICOR PHARMACEUTICALS, INC. yPAMIDRONATE SOL 9MG/ML 00703408551 SICOR PHARMACEUTICALS, INC. yIFOSFAMIDE KIT MESNA 00703410048 SICOR PHARMACEUTICALS, INC. yIFOSFAMIDE KIT MESNA 00703410058 SICOR PHARMACEUTICALS, INC. yIFOSFAMIDE KIT MESNA 00703410068 SICOR PHARMACEUTICALS, INC. yIDARUBICIN INJ 5MG/5ML 00703415411 SICOR PHARMACEUTICALS, INC. yIDARUBICIN INJ 10MG/10M 00703415511 SICOR PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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IDARUBICIN INJ 5MG/5ML 00703415611 SICOR PHARMACEUTICALS, INC. yVINORELBINE INJ 10MG/ML 00703418201 SICOR PHARMACEUTICALS, INC. yVINORELBINE INJ 10MG/ML 00703418301 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 10MG/ML 00703424401 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 10MG/ML 00703424601 SICOR PHARMACEUTICALS, INC. yCARBOPLATIN INJ 450/45ML 00703424801 SICOR PHARMACEUTICALS, INC. yTHIOTEPA INJ 15MG 00703430102 SICOR PHARMACEUTICALS, INC. yTHIOTEPA INJ 30MG 00703430301 SICOR PHARMACEUTICALS, INC. yVINCASAR PFS INJ 1MG/ML 00703440211 SICOR PHARMACEUTICALS, INC. yVINCASAR PFS INJ 1MG/ML 00703441211 SICOR PHARMACEUTICALS, INC. yMETOCLOPRAM INJ 5MG/ML 00703450204 SICOR PHARMACEUTICALS, INC. yZANOSAR INJ 1GM 00703463601 SICOR PHARMACEUTICALS, INC. yMITOXANTRON INJ 2MG/ML 00703468001 SICOR PHARMACEUTICALS, INC. yMITOXANTRON INJ 2MG/ML 00703468501 SICOR PHARMACEUTICALS, INC. yMITOXANTRON INJ 2MG/ML 00703468601 SICOR PHARMACEUTICALS, INC. yMESNA INJ 1GM 00703480503 SICOR PHARMACEUTICALS, INC. yFLUDARABINE INJ 50MG/2ML 00703485211 SICOR PHARMACEUTICALS, INC. yFLUPHENAZ DE INJ 25MG/ML 00703500301 SICOR PHARMACEUTICALS, INC. yDOXORUBICIN INJ 200MG 00703504001 SICOR PHARMACEUTICALS, INC. yDOXORUBICIN INJ 10MG 00703504303 SICOR PHARMACEUTICALS, INC. yDOXORUBICIN INJ 50MG 00703504601 SICOR PHARMACEUTICALS, INC. yDESMOPRESSIN INJ 4MCG/ML 00703505101 SICOR PHARMACEUTICALS, INC. yDESMOPRESSIN INJ 4MCG/ML 00703505103 SICOR PHARMACEUTICALS, INC. yDESMOPRESSIN INJ 4MCG/ML 00703505401 SICOR PHARMACEUTICALS, INC. yDACARBAZINE INJ 200MG 00703507501 SICOR PHARMACEUTICALS, INC. yDACARBAZINE INJ 200MG 00703507503 SICOR PHARMACEUTICALS, INC. yLEUCOVOR CA INJ 100MG 00703514001 SICOR PHARMACEUTICALS, INC. yLEUCOVOR CA INJ 350MG 00703514501 SICOR PHARMACEUTICALS, INC. yDAUNORUBICIN INJ 20MG 00703523313 SICOR PHARMACEUTICALS, INC. yL-CYSTEINE INJ 50MG/ML 00703532401 SICOR PHARMACEUTICALS, INC. yL-CYSTEINE INJ 50MG/ML 00703532403 SICOR PHARMACEUTICALS, INC. yL-CYSTEINE INJ 50MG/ML 00703532801 SICOR PHARMACEUTICALS, INC. yL-CYSTEINE INJ 50MG/ML 00703532803 SICOR PHARMACEUTICALS, INC. yTOPOSAR INJ 100/5ML 00703565301 SICOR PHARMACEUTICALS, INC. yTOPOSAR INJ 500/25ML 00703565601 SICOR PHARMACEUTICALS, INC. yTOPOSAR INJ 1GM/50ML 00703565701 SICOR PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CISPLATIN INJ AQ 00703574711 SICOR PHARMACEUTICALS, INC. yCISPLATIN INJ AQ 00703574811 SICOR PHARMACEUTICALS, INC. yFLUDARABINE INJ 50MG 00703585401 SICOR PHARMACEUTICALS, INC. yMEDROXYPR AC INJ 150MG/ML 00703680101 SICOR PHARMACEUTICALS, INC. yMEDROXYPR AC INJ 150MG/ML 00703680104 SICOR PHARMACEUTICALS, INC. yMEDROXYPR AC INJ 150MG/ML 00703681121 SICOR PHARMACEUTICALS, INC. yHALOPER DEC INJ 50MG/ML 00703701101 SICOR PHARMACEUTICALS, INC. yHALOPER DEC INJ 50MG/ML 00703701103 SICOR PHARMACEUTICALS, INC. yHALOPER DEC INJ 50MG/ML 00703701301 SICOR PHARMACEUTICALS, INC. yHALOPER DEC INJ 100MG/ML 00703702101 SICOR PHARMACEUTICALS, INC. yHALOPER DEC INJ 100MG/ML 00703702103 SICOR PHARMACEUTICALS, INC. yHALOPER DEC INJ 100MG/ML 00703702301 SICOR PHARMACEUTICALS, INC. yHALOPER LAC INJ 5MG/ML 00703704101 SICOR PHARMACEUTICALS, INC. yHALOPER LAC INJ 5MG/ML 00703704103 SICOR PHARMACEUTICALS, INC. yHALOPER LAC INJ 5MG/ML 00703704501 SICOR PHARMACEUTICALS, INC. yPROCHLORPER INJ 5MG/ML 00703717104 SICOR PHARMACEUTICALS, INC. yPROCHLORPER INJ 5MG/ML 00703717501 SICOR PHARMACEUTICALS, INC. yONDANSETRON INJ 2MG/ML 00703722102 SICOR PHARMACEUTICALS, INC. yONDANSETRON INJ 2MG/ML 00703722103 SICOR PHARMACEUTICALS, INC. yONDANSETRON INJ 2MG/ML 00703722104 SICOR PHARMACEUTICALS, INC. yONDANSETRON INJ 2MG/ML 00703722601 SICOR PHARMACEUTICALS, INC. yONDANSETRON INJ 2MG/ML 00703722603 SICOR PHARMACEUTICALS, INC. yONDANSETRON SOL 32/50ML 00703723939 SICOR PHARMACEUTICALS, INC. yCALCITRIOL INJ 1MCG/ML 00703731104 SICOR PHARMACEUTICALS, INC. yMILRINONE INJ 1MG/ML 00703800503 SICOR PHARMACEUTICALS, INC. yMILRINONE INJ 1MG/ML 00703800603 SICOR PHARMACEUTICALS, INC. yMILRINONE INJ 1MG/ML 00703800801 SICOR PHARMACEUTICALS, INC. yENALAPRILAT INJ 1.25/ML 00703840101 SICOR PHARMACEUTICALS, INC. yENALAPRILAT INJ 1.25/ML 00703841101 SICOR PHARMACEUTICALS, INC. yDEFEROXAMINE INJ 500MG 00703846309 SICOR PHARMACEUTICALS, INC. yDEFEROXAMIN INJ 2GM 00703846501 SICOR PHARMACEUTICALS, INC. yADENOSINE INJ 3MG/ML 00703877103 SICOR PHARMACEUTICALS, INC. yADENOSINE INJ 3MG/ML 00703877301 SICOR PHARMACEUTICALS, INC. yAMIKACIN INJ 500/2ML 00703903201 SICOR PHARMACEUTICALS, INC. yAMIKACIN INJ 500/2ML 00703903203 SICOR PHARMACEUTICALS, INC. yAMIKACIN INJ 500/2ML 00703904003 SICOR PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TOBRAMYCIN INJ 40MG/ML 00703940201 SICOR PHARMACEUTICALS, INC. yTOBRAMYCIN INJ 40MG/ML 00703940204 SICOR PHARMACEUTICALS, INC. yTOBRAMYCIN INJ 40MG/ML 00703941601 SICOR PHARMACEUTICALS, INC. ySMZ-TMP INJ 400-80/5 00703950301 SICOR PHARMACEUTICALS, INC. ySMZ-TMP INJ 400-80/5 00703950303 SICOR PHARMACEUTICALS, INC. ySMZ-TMP INJ 400-80/5 00703951401 SICOR PHARMACEUTICALS, INC. ySMZ-TMP INJ 400-80/5 00703951403 SICOR PHARMACEUTICALS, INC. ySMZ-TMP INJ 400-80/5 00703952601 SICOR PHARMACEUTICALS, INC. yMATULANE CAP 50MG 54482005301 SIGMA-TAU PHARMACEUTICALS yCARNITOR TAB 330MG 54482014407 SIGMA-TAU PHARMACEUTICALS yCARNITOR SOL 1GM/10ML 54482014508 SIGMA-TAU PHARMACEUTICALS yCARNITOR INJ 1GM/5ML 54482014701 SIGMA-TAU PHARMACEUTICALS yPOLY-VITAMIN DRO 54838000350 SILARX PHARMACEUTICALS, INC. yPOLY-VITAMIN DRO /IRON 54838000450 SILARX PHARMACEUTICALS, INC. yAQUEOUS E DRO 15/0.3ML 54838000530 SILARX PHARMACEUTICALS, INC. yGERIATON LIQ 54838000780 SILARX PHARMACEUTICALS, INC. yMULTI-DELYN LIQ 54838000870 SILARX PHARMACEUTICALS, INC. yMULTI-DELYN LIQ 54838000880 SILARX PHARMACEUTICALS, INC. yMULTI-DELYN LIQ /IRON 54838000970 SILARX PHARMACEUTICALS, INC. yMULTI-DELYN LIQ /IRON 54838000980 SILARX PHARMACEUTICALS, INC. yCENTAMIN LIQ 54838001070 SILARX PHARMACEUTICALS, INC. ySILAFED SYP 1.25-30 54838010140 SILARX PHARMACEUTICALS, INC. ySILAFED SYP 1.25-30 54838010170 SILARX PHARMACEUTICALS, INC. yCHILD SILFED LIQ 15MG/5ML 54838010440 SILARX PHARMACEUTICALS, INC. yCHILD SILFED LIQ 15MG/5ML 54838010470 SILARX PHARMACEUTICALS, INC. ySILPHEN DM SYP 10MG/5ML 54838010540 SILARX PHARMACEUTICALS, INC. ySILACE SYP 60/15ML 54838010780 SILARX PHARMACEUTICALS, INC. yPEDIATRIC LIQ CGH/COLD 54838011540 SILARX PHARMACEUTICALS, INC. ySILACE LIQ 10MG/ML 54838011680 SILARX PHARMACEUTICALS, INC. ySILTUSSIN SA SYP 100/5ML 54838011740 SILARX PHARMACEUTICALS, INC. ySILTUSSIN SA SYP 100/5ML 54838011770 SILARX PHARMACEUTICALS, INC. ySILTUSSIN SA SYP 100/5ML 54838011780 SILARX PHARMACEUTICALS, INC. yPEDIATRIC DRO DCON/CGH 54838012015 SILARX PHARMACEUTICALS, INC. yGUAIFENESIN LIQ NR 54838012380 SILARX PHARMACEUTICALS, INC. yGG/DM NR LIQ 100-10/5 54838012480 SILARX PHARMACEUTICALS, INC. yBROTAPP LIQ 54838012540 SILARX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BROTAPP LIQ 54838012570 SILARX PHARMACEUTICALS, INC. yBROTAPP LIQ 54838012580 SILARX PHARMACEUTICALS, INC. ySILTUSS DAS LIQ 100/5ML 54838013040 SILARX PHARMACEUTICALS, INC. ySILTUSSIN DM LIQ DAS 54838013340 SILARX PHARMACEUTICALS, INC. ySILADRYL SA ELX 12.5/5ML 54838013540 SILARX PHARMACEUTICALS, INC. ySILADRYL SA ELX 12.5/5ML 54838013570 SILARX PHARMACEUTICALS, INC. ySILADRYL SA ELX 12.5/5ML 54838013580 SILARX PHARMACEUTICALS, INC. yBROTAPP DM LIQ 15-1-5/5 54838013640 SILARX PHARMACEUTICALS, INC. yBROTAPP DM LIQ 15-1-5/5 54838013670 SILARX PHARMACEUTICALS, INC. ySILTUSS DAS LIQ 100/5ML 54838013840 SILARX PHARMACEUTICALS, INC. ySILTUSSIN-DM LIQ DIABETIC 54838013940 SILARX PHARMACEUTICALS, INC. ySILTUSSIN-DM LIQ MAX ST 54838014040 SILARX PHARMACEUTICALS, INC. yCHLD SILAPAP LIQ 160/5ML 54838014440 SILARX PHARMACEUTICALS, INC. yCHLD SILAPAP LIQ 160/5ML 54838014470 SILARX PHARMACEUTICALS, INC. yCHLD SILAPAP LIQ 160/5ML 54838014480 SILARX PHARMACEUTICALS, INC. yINF SILAPAP DRO 80/0.8ML 54838014515 SILARX PHARMACEUTICALS, INC. yINF SILAPAP DRO 80/0.8ML 54838014530 SILARX PHARMACEUTICALS, INC. ySILPHEN COUG SYP 12.5/5ML 54838015440 SILARX PHARMACEUTICALS, INC. ySILPHEN COUG SYP 12.5/5ML 54838015470 SILARX PHARMACEUTICALS, INC. ySILPHEN COUG SYP 12.5/5ML 54838015480 SILARX PHARMACEUTICALS, INC. ySILTUSSIN-DM SYP ALC FREE 54838020940 SILARX PHARMACEUTICALS, INC. ySILTUSSIN-DM SYP ALC FREE 54838020970 SILARX PHARMACEUTICALS, INC. ySILTUSSIN-DM SYP ALC FREE 54838020980 SILARX PHARMACEUTICALS, INC. yHALOPERIDOL CON 2MG/ML 54838050115 SILARX PHARMACEUTICALS, INC. yHALOPERIDOL CON 2MG/ML 54838050140 SILARX PHARMACEUTICALS, INC. yHYOSYNE DRO 0.125/ML 54838050615 SILARX PHARMACEUTICALS, INC. yMETAPROTEREN SYP 10MG/5ML 54838050780 SILARX PHARMACEUTICALS, INC. yMETOCLOPRAM SOL 5MG/5ML 54838050880 SILARX PHARMACEUTICALS, INC. yOXYBUTYNIN SYP 5MG/5ML 54838051080 SILARX PHARMACEUTICALS, INC. yHYOSYNE ELX 0.125/5 54838051180 SILARX PHARMACEUTICALS, INC. yDOXEPIN HCL CON 10MG/ML 54838051240 SILARX PHARMACEUTICALS, INC. yDYPHYLLIN-GG ELX 100-100 54838051380 SILARX PHARMACEUTICALS, INC. yCLEMASTINE SYP 0.5/5ML 54838051440 SILARX PHARMACEUTICALS, INC. yTRI-VIT/FL DRO 0.25MG 54838051550 SILARX PHARMACEUTICALS, INC. yPOLY-VIT/FL DRO 0.25MG 54838051850 SILARX PHARMACEUTICALS, INC. yPOLY-VIT/FL DRO 0.5MG 54838051950 SILARX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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POLY-VIT/FE DRO FL 0.25 54838052050 SILARX PHARMACEUTICALS, INC. yCHO MAG TRIS LIQ 500/5ML 54838052270 SILARX PHARMACEUTICALS, INC. ySILDEC SYP 4-45/5ML 54838053480 SILARX PHARMACEUTICALS, INC. ySILDEC DM SYP 54838053680 SILARX PHARMACEUTICALS, INC. ySIL-TEX SYP 7.5-100 54838053980 SILARX PHARMACEUTICALS, INC. yCITALOPRAM SOL 10MG/5ML 54838054070 SILARX PHARMACEUTICALS, INC. ySILDEC-PE DRO 54838054130 SILARX PHARMACEUTICALS, INC. ySILDEC-PE SYP 54838054280 SILARX PHARMACEUTICALS, INC. ySILDEC PE-DM DRO 54838054330 SILARX PHARMACEUTICALS, INC. ySILDEC PE-DM SYP 54838054480 SILARX PHARMACEUTICALS, INC. yAVAR GEL 10-5% 65880000145 SIRIUS LABORATORIES, INC. yAVAR GEL GREEN 65880000245 SIRIUS LABORATORIES, INC. yAVAR EMU CLEANSER 65880020008 SIRIUS LABORATORIES, INC. yPSORIATEC CRE 1% 65880041550 SIRIUS LABORATORIES, INC. yNICOMIDE TAB 65880079260 SIRIUS LABORATORIES, INC. yPSORIACAP CAP 65880094212 SIRIUS LABORATORIES, INC. yEPIQUIN MICR CRE 4% 67402001030 SKIN MEDICA yNEOBENZ MICR CRE 3.5% 67402002006 SKIN MEDICA yNEOBENZ MICR CRE 3.5% 67402002045 SKIN MEDICA yNEOBENZ MICR CRE 8.5% 67402002245 SKIN MEDICA yVANIQA CRE 13.9% 67402004030 SKIN MEDICA yVANIQA CRE 13.9% 67402004032 SKIN MEDICA yGLADASE OIN 0.83/G 50484010030 SMITH & NEPHEW, INC. yIV PREP WIPE PAD 50484021000 SMITH & NEPHEW, INC. yIV PREP SWAB PAD 50484021300 SMITH & NEPHEW, INC. yGLADASE-C OIN 50484022030 SMITH & NEPHEW, INC. yMYOBLOC INJ 2500/0.5 10454071010 SOLSTICE NEUROSCIENCES, INC. yMYOBLOC INJ 5000/ML 10454071110 SOLSTICE NEUROSCIENCES, INC. yMYOBLOC INJ 10000/2 10454071210 SOLSTICE NEUROSCIENCES, INC. yESTRATEST HS TAB 00032102301 SOLVAY PHARMACEUTICALS, INC. yESTRATEST TAB 00032102601 SOLVAY PHARMACEUTICALS, INC. yESTRATEST TAB 00032102610 SOLVAY PHARMACEUTICALS, INC. yACEON TAB 2MG 00032110101 SOLVAY PHARMACEUTICALS, INC. yACEON TAB 4MG 00032110201 SOLVAY PHARMACEUTICALS, INC. yACEON TAB 8MG 00032110301 SOLVAY PHARMACEUTICALS, INC. yCREON 5 CAP 00032120501 SOLVAY PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CREON 5 CAP 00032120507 SOLVAY PHARMACEUTICALS, INC. yCREON 10 CAP EC 00032121001 SOLVAY PHARMACEUTICALS, INC. yCREON 10 CAP EC 00032121007 SOLVAY PHARMACEUTICALS, INC. yCREON 20 CAP 00032122001 SOLVAY PHARMACEUTICALS, INC. yCREON 20 CAP 00032122007 SOLVAY PHARMACEUTICALS, INC. yPROMETRIUM CAP 100MG 00032170801 SOLVAY PHARMACEUTICALS, INC. yPROMETRIUM CAP 200MG 00032171101 SOLVAY PHARMACEUTICALS, INC. yCORTENEMA ENE 100MG 00032190473 SOLVAY PHARMACEUTICALS, INC. yCORTENEMA ENE 100MG 00032190482 SOLVAY PHARMACEUTICALS, INC. yROWASA ENE 4GM 00032192428 SOLVAY PHARMACEUTICALS, INC. yROWASA ENE 4GM 00032192482 SOLVAY PHARMACEUTICALS, INC. yBALNEOL LOT 00032196071 SOLVAY PHARMACEUTICALS, INC. yELDEPRYL CAP 5MG 39506002260 SOMERSET PHARMACEUTICALS INC yEMSAM DIS 6MG/24HR 39506003330 SOMERSET PHARMACEUTICALS INC yEMSAM DIS 9MG/24HR 39506004430 SOMERSET PHARMACEUTICALS INC yEMSAM DIS 12MG/24H 39506005530 SOMERSET PHARMACEUTICALS INC yTRETINOIN CRE 0.1% 66530024120 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN CRE 0.1% 66530024145 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN CRE 0.05% 66530024220 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN CRE 0.05% 66530024245 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN CRE 0.025% 66530024320 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN CRE 0.025% 66530024345 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN GEL 0.025% 66530024415 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN GEL 0.025% 66530024445 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN GEL 0.01% 66530024515 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN GEL 0.01% 66530024545 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN EM CRE 0.05% 66530024740 SPEAR DERMATOLOGY PRODUCTS, INC. yTRETINOIN EM CRE 0.05% 66530024760 SPEAR DERMATOLOGY PRODUCTS, INC. yCIMETIDINE TAB 400MG 55370013607 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 55370013608 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 55370013907 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 55370013909 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 55370014007 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 55370014009 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 55370014103 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 55370014105 STADA PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NAPROXEN TAB 500MG 55370014107 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 55370014108 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 1.5MG 55370014607 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 1.5MG 55370014608 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 1.5MG 55370014609 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 55370014707 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 55370014708 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 55370014709 STADA PHARMACEUTICALS, INC. yCIMETIDINE INJ 150MG/ML 55370020202 STADA PHARMACEUTICALS, INC. yCIMETIDINE INJ 150MG/ML 55370020204 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 55370050607 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 55370050608 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 55370050609 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 200MG 55370053607 STADA PHARMACEUTICALS, INC. yETODOLAC TAB 400MG 55370055207 STADA PHARMACEUTICALS, INC. yETODOLAC TAB 400MG 55370055208 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 400MG 55370055507 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 400MG 55370055509 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 55370055607 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 55370055608 STADA PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 55370055707 STADA PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 55370055709 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 250MG 55370088007 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 250MG 55370088008 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 500MG 55370088107 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 500MG 55370088108 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 125/5ML 55370088213 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 125/5ML 55370088240 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 250/5ML 55370088313 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 250/5ML 55370088340 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 250MG 55370088407 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 250MG 55370088408 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 500MG 55370088507 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 500MG 55370088508 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 125/5ML 55370088613 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 125/5ML 55370088614 STADA PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMOXICILLIN SUS 125/5ML 55370088680 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 55370088713 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 55370088714 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 55370088780 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CHW 250MG 55370089207 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CHW 250MG 55370089208 STADA PHARMACEUTICALS, INC. yCEFACLOR SUS 125/5ML 55370089714 STADA PHARMACEUTICALS, INC. yCEFACLOR SUS 125/5ML 55370089775 STADA PHARMACEUTICALS, INC. yCEFACLOR SUS 187/5ML 55370089913 STADA PHARMACEUTICALS, INC. yCEFACLOR SUS 187/5ML 55370089921 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 55370090007 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 55370090008 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 55370090107 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 55370090108 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 250/5ML 55370090213 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 250/5ML 55370090240 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 125/5ML 55370090313 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 125/5ML 55370090340 STADA PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 55370092207 STADA PHARMACEUTICALS, INC. yENALAPRIL TAB 2.5MG 55370092209 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 64860010507 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 64860010508 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 125/5ML 64860030613 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 125/5ML 64860030640 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 250/5ML 64860030713 STADA PHARMACEUTICALS, INC. yCEPHALEXIN SUS 250/5ML 64860030740 STADA PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 67253010010 STADA PHARMACEUTICALS, INC. yACYCLOVIR CAP 200MG 67253010011 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 400MG 67253010110 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 400MG 67253010111 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 67253010210 STADA PHARMACEUTICALS, INC. yACYCLOVIR TAB 800MG 67253010250 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 67253010404 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 67253010504 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 250MG 67253014010 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 250MG 67253014050 STADA PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMOXICILLIN CAP 500MG 67253014110 STADA PHARMACEUTICALS, INC. yAMOXICILLIN CAP 500MG 67253014150 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 125/5ML 67253014215 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 67253014308 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 67253014310 STADA PHARMACEUTICALS, INC. yAMOXICILLIN SUS 250/5ML 67253014315 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 250MG 67253018010 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 500MG 67253018110 STADA PHARMACEUTICALS, INC. yAMPICILLIN CAP 500MG 67253018150 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 125/5ML 67253018210 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 125/5ML 67253018220 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 250/5ML 67253018310 STADA PHARMACEUTICALS, INC. yAMPICILLIN SUS 250/5ML 67253018320 STADA PHARMACEUTICALS, INC. yPENICILLN VK TAB 250MG 67253020010 STADA PHARMACEUTICALS, INC. yPENICILLN VK TAB 250MG 67253020011 STADA PHARMACEUTICALS, INC. yPENICILLN VK TAB 500MG 67253020110 STADA PHARMACEUTICALS, INC. yPENICILLN VK TAB 500MG 67253020150 STADA PHARMACEUTICALS, INC. yPENICILLN VK SOL 125/5ML 67253020210 STADA PHARMACEUTICALS, INC. yPENICILLN VK SOL 125/5ML 67253020220 STADA PHARMACEUTICALS, INC. yPENICILLN VK SOL 250/5ML 67253020310 STADA PHARMACEUTICALS, INC. yPENICILLN VK SOL 250/5ML 67253020320 STADA PHARMACEUTICALS, INC. yCEFACLOR CAP 250MG 67253022010 STADA PHARMACEUTICALS, INC. yCEFACLOR CAP 500MG 67253022110 STADA PHARMACEUTICALS, INC. yCLONIDINE TAB 0.1MG 67253026310 STADA PHARMACEUTICALS, INC. yCLONIDINE TAB 0.1MG 67253026311 STADA PHARMACEUTICALS, INC. yCLONIDINE TAB 0.2MG 67253026410 STADA PHARMACEUTICALS, INC. yCLONIDINE TAB 0.2MG 67253026411 STADA PHARMACEUTICALS, INC. yCLONIDINE TAB 0.3MG 67253026510 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 67253030004 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 67253030010 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 250MG 67253030050 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 67253030104 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 67253030110 STADA PHARMACEUTICALS, INC. yCEPHALEXIN CAP 500MG 67253030150 STADA PHARMACEUTICALS, INC. yMETHOTREXATE TAB 2.5MG 67253032010 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 67253034010 STADA PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIMETIDINE TAB 300MG 67253034011 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 300MG 67253034050 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 67253034110 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 67253034111 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 400MG 67253034150 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 67253034210 STADA PHARMACEUTICALS, INC. yCIMETIDINE TAB 800MG 67253034225 STADA PHARMACEUTICALS, INC. yMETHYLPRED TAB 4MG 67253036010 STADA PHARMACEUTICALS, INC. yMETHYLPRED PAK 4MG 67253036021 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 1MG 67253038010 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 1MG 67253038011 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 2MG 67253038110 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 2MG 67253038111 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 4MG 67253038210 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 4MG 67253038211 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 8MG 67253038310 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 8MG 67253038311 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 1MG 67253038410 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 2MG 67253038510 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 4MG 67253038610 STADA PHARMACEUTICALS, INC. yDOXAZOSIN TAB 8MG 67253038710 STADA PHARMACEUTICALS, INC. yATENOLOL TAB 25MG 67253042010 STADA PHARMACEUTICALS, INC. yATENOLOL TAB 25MG 67253042011 STADA PHARMACEUTICALS, INC. yATENOLOL TAB 50MG 67253042110 STADA PHARMACEUTICALS, INC. yATENOLOL TAB 50MG 67253042111 STADA PHARMACEUTICALS, INC. yATENOLOL TAB 100MG 67253042210 STADA PHARMACEUTICALS, INC. yATENOLOL TAB 100MG 67253042211 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 1.5MG 67253046010 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 1.5MG 67253046050 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 67253046110 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 67253046111 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 3MG 67253046150 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 67253046210 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 67253046211 STADA PHARMACEUTICALS, INC. yGLYBURID MCR TAB 6MG 67253046250 STADA PHARMACEUTICALS, INC. yKETOCONAZOLE TAB 200MG 67253050010 STADA PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FUROSEMIDE TAB 20MG 67253054010 STADA PHARMACEUTICALS, INC. yFUROSEMIDE TAB 20MG 67253054011 STADA PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 67253054110 STADA PHARMACEUTICALS, INC. yFUROSEMIDE TAB 40MG 67253054111 STADA PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 67253054210 STADA PHARMACEUTICALS, INC. yFUROSEMIDE TAB 80MG 67253054250 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 67253062010 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 250MG 67253062011 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 67253062103 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 67253062105 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 67253062110 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 375MG 67253062111 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 67253062203 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 67253062205 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 67253062210 STADA PHARMACEUTICALS, INC. yNAPROXEN TAB 500MG 67253062250 STADA PHARMACEUTICALS, INC. yPYRAZINAMIDE TAB 500MG 67253066010 STADA PHARMACEUTICALS, INC. yPYRAZINAMIDE TAB 500MG 67253066050 STADA PHARMACEUTICALS, INC. ySELEGILINE CAP 5MG 67253070006 STADA PHARMACEUTICALS, INC. ySELEGILINE TAB 5MG 67253070106 STADA PHARMACEUTICALS, INC. yGEMFIBROZIL TAB 600MG 67253074106 STADA PHARMACEUTICALS, INC. yGEMFIBROZIL TAB 600MG 67253074150 STADA PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 67253082010 STADA PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 25MG 67253082011 STADA PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 50MG 67253082110 STADA PHARMACEUTICALS, INC. yHYDROCHLOROT TAB 50MG 67253082111 STADA PHARMACEUTICALS, INC. yFOLIC ACID TAB 1MG 67253098110 STADA PHARMACEUTICALS, INC. yFOLIC ACID TAB 1MG 67253098111 STADA PHARMACEUTICALS, INC. yPROSED/DS TAB 00076080503 STAR PHARMACEUTICALS, INC. yMYAMBUTOL TAB 100MG 68850001001 STAT-TRADE, INC. yMYAMBUTOL TAB 400MG 68850001201 STAT-TRADE, INC. yMYAMBUTOL TAB 400MG 68850001202 STAT-TRADE, INC. yMYAMBUTOL TAB 400MG 68850001203 STAT-TRADE, INC. yDIFIL G FORT LIQ 100-100 45985063308 STEWART-JACKSON PHARMACAL, INC. yBIDEX-DM TAB 30-800CR 45985063801 STEWART-JACKSON PHARMACAL, INC. yMEDENT DM TAB 45985064101 STEWART-JACKSON PHARMACAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MEDENT LD TAB 45985064201 STEWART-JACKSON PHARMACAL, INC. yUTA CAP 45985064601 STEWART-JACKSON PHARMACAL, INC. yDIFIL-G TAB 200-300 45985064701 STEWART-JACKSON PHARMACAL, INC. yCARDIOTEK RX TAB 45985065130 STEWART-JACKSON PHARMACAL, INC. yNOTUSS PD LIQ 45985065216 STEWART-JACKSON PHARMACAL, INC. yBIDEX TAB 400MG 45985065401 STEWART-JACKSON PHARMACAL, INC. yRYNEZE TAB 8-2.5MG 45985065901 STEWART-JACKSON PHARMACAL, INC. yEXCOF LIQ 45985066016 STEWART-JACKSON PHARMACAL, INC. yEXCOF-SF LIQ 45985066116 STEWART-JACKSON PHARMACAL, INC. yLUXIQ AER 0.12% 63032002100 STIEFEL LABORATORIES yLUXIQ AER 0.12% 63032002101 STIEFEL LABORATORIES yLUXIQ AER 0.12% 63032002150 STIEFEL LABORATORIES yOLUX AER 0.05% 63032003100 STIEFEL LABORATORIES yOLUX AER 0.05% 63032003150 STIEFEL LABORATORIES yEVOCLIN AER 1% 63032006100 STIEFEL LABORATORIES yEVOCLIN AER 1% 63032006150 STIEFEL LABORATORIES ySORIATANE CAP 10MG 63032009025 STIEFEL LABORATORIES ySORIATANE CAP 25MG 63032009125 STIEFEL LABORATORIES yVERDESO AER 0.05% 63032011100 STIEFEL LABORATORIES yVERDESO AER 0.05% 63032011150 STIEFEL LABORATORIES yPOLYTAR SHA 00145041106 STIEFEL LABORATORIES, INC, ySARNOL-HC LOT 1% 00145062202 STIEFEL LABORATORIES, INC, ySARNA LOT 00145062805 STIEFEL LABORATORIES, INC, yOILATUM-AD LOT 00145115708 STIEFEL LABORATORIES, INC, yZEASORB-AF GEL 00145150508 STIEFEL LABORATORIES, INC, yZEASORB-AF POW 2% 00145150605 STIEFEL LABORATORIES, INC, yZEASORB-AF LOT 2% 00145160603 STIEFEL LABORATORIES, INC, yDUAC GEL 1-5% 00145237105 STIEFEL LABORATORIES, INC, yBREVOXYL GEL 4% 00145237406 STIEFEL LABORATORIES, INC, yBREVOXYL GEL 4% 00145237408 STIEFEL LABORATORIES, INC, yBREVOXYL GEL 8% 00145238406 STIEFEL LABORATORIES, INC, yBREVOXYL GEL 8% 00145238408 STIEFEL LABORATORIES, INC, yCLINDETS PAD 1% 00145247280 STIEFEL LABORATORIES, INC, yBREVOXYL-4 LIQ CREM WSH 00145247406 STIEFEL LABORATORIES, INC, yBREVOXYL-8 LIQ CREM WSH 00145248406 STIEFEL LABORATORIES, INC, yCLARIPEL CRE 4% 00145251603 STIEFEL LABORATORIES, INC, y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLARIPEL CRE 4% 00145251605 STIEFEL LABORATORIES, INC, yBREVOXYL-4 KIT ACNE WSH 00145257406 STIEFEL LABORATORIES, INC, yBREVOXYL-8 KIT ACNE WSH 00145258406 STIEFEL LABORATORIES, INC, yROSAC CRE 10-5% 00145261705 STIEFEL LABORATORIES, INC, yPANOXYL AQUA GEL 10% 00145265702 STIEFEL LABORATORIES, INC, yCLOBEVATE GEL 00145279004 STIEFEL LABORATORIES, INC, yZETACET EMU 00145296106 STIEFEL LABORATORIES, INC, yZETACET EMU 00145296108 STIEFEL LABORATORIES, INC, yZETACET SUS 00145297103 STIEFEL LABORATORIES, INC, ySULFOXYL LOT 00145351807 STIEFEL LABORATORIES, INC, ySULFOXYL LOT STRONG 00145351907 STIEFEL LABORATORIES, INC, yCLEERAVUE-M KIT 50MG 14168261002 STONEBRIDGE PHARMA, LLC yOCUCLENZ SOL 57706076310 STORZ INSTRUMENT COMPANY yOCUCLENZ SOL OP 57706076358 STORZ INSTRUMENT COMPANY yHYPERCARE SOL 20% 58980015010 STRATUS PHARMACEUTICALS INC. yHYPERCARE SOL 20% 58980015011 STRATUS PHARMACEUTICALS INC. yHYPERCARE SOL 20% 58980015020 STRATUS PHARMACEUTICALS INC. yMELQUIN HP CRE 4% 58980047205 STRATUS PHARMACEUTICALS INC. yMELQUIN HP CRE 4% 58980047210 STRATUS PHARMACEUTICALS INC. yMELPAQUE HP CRE 4% 58980047305 STRATUS PHARMACEUTICALS INC. yMELPAQUE HP CRE 4% 58980047310 STRATUS PHARMACEUTICALS INC. yNUQUIN HP CRE 4% 58980047405 STRATUS PHARMACEUTICALS INC. yNUQUIN HP CRE 4% 58980047410 STRATUS PHARMACEUTICALS INC. yNUQUIN HP CRE 4% 58980047420 STRATUS PHARMACEUTICALS INC. yNUQUIN HP GEL 4% 58980047505 STRATUS PHARMACEUTICALS INC. yNUQUIN HP GEL 4% 58980047510 STRATUS PHARMACEUTICALS INC. yMELQUIN 3 SOL 3% 58980047610 STRATUS PHARMACEUTICALS INC. yNUQUIN HP CRE 4% 58980057405 STRATUS PHARMACEUTICALS INC. yNUQUIN HP CRE 4% 58980057410 STRATUS PHARMACEUTICALS INC. yNUQUIN HP CRE 4% 58980057420 STRATUS PHARMACEUTICALS INC. yALPHAQUIN HP CRE 4% 58980058010 STRATUS PHARMACEUTICALS INC. yALPHAQUIN HP CRE 4% 58980058020 STRATUS PHARMACEUTICALS INC. yX-VIATE CRE 40% 58980062530 STRATUS PHARMACEUTICALS INC. yX-VIATE CRE 40% 58980062570 STRATUS PHARMACEUTICALS INC. yKOVIA OIN 0.83/G 58980071111 STRATUS PHARMACEUTICALS INC. yKOVIA OIN 0.83/G 58980071135 STRATUS PHARMACEUTICALS INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KOVIA 6.5 OIN 58980072211 STRATUS PHARMACEUTICALS INC. yPEVIDERM SOL WOUND 58980073121 STRATUS PHARMACEUTICALS INC. yPEVIDERM SOL WOUND 58980073161 STRATUS PHARMACEUTICALS INC. yZIOX OIN 58980076511 STRATUS PHARMACEUTICALS INC. yZIOX OIN 58980076535 STRATUS PHARMACEUTICALS INC. yZIOX 405 OIN 58980077611 STRATUS PHARMACEUTICALS INC. yDERMAZENE CRE 1% 58980081110 STRATUS PHARMACEUTICALS INC. yDERMAZENE CRE 1% 58980081112 STRATUS PHARMACEUTICALS INC. yGABAPENTIN CAP 100MG 62756013702 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN CAP 100MG 62756013705 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN CAP 300MG 62756013802 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN CAP 300MG 62756013805 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN CAP 400MG 62756013902 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN CAP 400MG 62756013905 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN TAB 600MG 62756020203 SUN PHARMACEUTICAL INDUSTRIES, LTD yGABAPENTIN TAB 800MG 62756020403 SUN PHARMACEUTICAL INDUSTRIES, LTD yZONISAMIDE CAP 25MG 62756025802 SUN PHARMACEUTICAL INDUSTRIES, LTD yZONISAMIDE CAP 50MG 62756025902 SUN PHARMACEUTICAL INDUSTRIES, LTD yZONISAMIDE CAP 100MG 62756026002 SUN PHARMACEUTICAL INDUSTRIES, LTD yPHENYTOIN EX CAP 100MG 62756040201 SUN PHARMACEUTICAL INDUSTRIES, LTD yPEXEVA TAB 10MG 63672201001 SYNTHON PHARMACEUTICALS, LTD. yPEXEVA TAB 20MG 63672202001 SYNTHON PHARMACEUTICALS, LTD. yPEXEVA TAB 30MG 63672203001 SYNTHON PHARMACEUTICALS, LTD. yPEXEVA TAB 40MG 63672204001 SYNTHON PHARMACEUTICALS, LTD. yACTOS TAB 15MG 64764015104 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 15MG 64764015105 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 15MG 64764015106 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOPLUS MET TAB 15/500MG 64764015518 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOPLUS MET TAB 15/500MG 64764015560 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOPLUS MET TAB 15/850MG 64764015818 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOPLUS MET TAB 15/850MG 64764015860 TAKEDA PHARMACEUTICALS AMERICA, INC. yAMITIZA CAP 24MCG 64764024010 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 30MG 64764030114 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 30MG 64764030115 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 30MG 64764030116 TAKEDA PHARMACEUTICALS AMERICA, INC. yDUETACT TAB 30-2MG 64764030230 TAKEDA PHARMACEUTICALS AMERICA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DUETACT TAB 30-4MG 64764030430 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 45MG 64764045124 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 45MG 64764045125 TAKEDA PHARMACEUTICALS AMERICA, INC. yACTOS TAB 45MG 64764045126 TAKEDA PHARMACEUTICALS AMERICA, INC. yROZEREM TAB 8MG 64764080510 TAKEDA PHARMACEUTICALS AMERICA, INC. yROZEREM TAB 8MG 64764080530 TAKEDA PHARMACEUTICALS AMERICA, INC. yPROLASTIN INJ 500MG 13533060130 TALECRIS BIOTHERAPEUTICS, INC. yPROLASTIN INJ 1000MG 13533060135 TALECRIS BIOTHERAPEUTICS, INC. yTHROMBAT III INJ 500UNIT 13533060320 TALECRIS BIOTHERAPEUTICS, INC. yTHROMBAT III INJ 1000UNIT 13533060330 TALECRIS BIOTHERAPEUTICS, INC. yPLASMANATE INJ 5% 13533061320 TALECRIS BIOTHERAPEUTICS, INC. yPLASMANATE INJ 5% 13533061325 TALECRIS BIOTHERAPEUTICS, INC. yHYPERRAB S/D INJ 150/ML 13533061802 TALECRIS BIOTHERAPEUTICS, INC. yHYPERRAB S/D INJ 150/ML 13533061810 TALECRIS BIOTHERAPEUTICS, INC. yHYPERRHO S/D INJ 300MCG 13533063102 TALECRIS BIOTHERAPEUTICS, INC. yHYPERRHO S/D INJ 50MCG 13533063106 TALECRIS BIOTHERAPEUTICS, INC. yGAMASTAN S/D INJ 13533063504 TALECRIS BIOTHERAPEUTICS, INC. yGAMASTAN S/D INJ 13533063512 TALECRIS BIOTHERAPEUTICS, INC. yHYPERHEP B INJ S/D 13533063601 TALECRIS BIOTHERAPEUTICS, INC. yHYPERHEP B INJ S/D 13533063602 TALECRIS BIOTHERAPEUTICS, INC. yHYPERHEP B INJ S/D 13533063603 TALECRIS BIOTHERAPEUTICS, INC. yHYPERHEP B INJ S/D 13533063605 TALECRIS BIOTHERAPEUTICS, INC. yGAMUNEX INJ 10% 13533064512 TALECRIS BIOTHERAPEUTICS, INC. yGAMUNEX INJ 10% 13533064515 TALECRIS BIOTHERAPEUTICS, INC. yGAMUNEX INJ 10% 13533064520 TALECRIS BIOTHERAPEUTICS, INC. yGAMUNEX INJ 10% 13533064524 TALECRIS BIOTHERAPEUTICS, INC. yGAMUNEX INJ 10% 13533064571 TALECRIS BIOTHERAPEUTICS, INC. yKOATE-DVI INJ 250UNIT 13533066520 TALECRIS BIOTHERAPEUTICS, INC. yKOATE-DVI INJ 500UNIT 13533066530 TALECRIS BIOTHERAPEUTICS, INC. yKOATE-DVI INJ 1000UNIT 13533066550 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-25 INJ 25% 13533068416 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-25 INJ 25% 13533068420 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-25 INJ 25% 13533068471 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-5 INJ 5% 13533068520 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-5 INJ 5% 13533068525 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-5 INJ 5% 13533069020 TALECRIS BIOTHERAPEUTICS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PLASBUMIN-5 INJ 5% 13533069025 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-25 INJ 25% 13533069216 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-25 INJ 25% 13533069220 TALECRIS BIOTHERAPEUTICS, INC. yPLASBUMIN-25 INJ 25% 13533069271 TALECRIS BIOTHERAPEUTICS, INC. yPREVACID CAP 15MG DR 00300154111 TAP PHARMACEUTICALS INC yPREVACID CAP 15MG DR 00300154119 TAP PHARMACEUTICALS INC yPREVACID CAP 15MG DR 00300154130 TAP PHARMACEUTICALS INC yPREVACID TAB 15MG STB 00300154330 TAP PHARMACEUTICALS INC yPREVACID TAB 30MG STB 00300154430 TAP PHARMACEUTICALS INC yPREVACID NAP KIT 500MG 00300154607 TAP PHARMACEUTICALS INC yPREVACID NAP KIT 500MG 00300154630 TAP PHARMACEUTICALS INC yLUPR DEP-PED INJ 7.5MG 00300210801 TAP PHARMACEUTICALS INC yLUPR DEP-PED INJ 11.25MG 00300228201 TAP PHARMACEUTICALS INC yLUPR DEP-PED INJ 15MG 00300244001 TAP PHARMACEUTICALS INC yPREVACID CAP 30MG DR 00300304611 TAP PHARMACEUTICALS INC yPREVACID CAP 30MG DR 00300304613 TAP PHARMACEUTICALS INC yPREVACID CAP 30MG DR 00300304619 TAP PHARMACEUTICALS INC yLUPRON DEPOT INJ 22.5MG 00300334601 TAP PHARMACEUTICALS INC yLUPRON 6-PK INJ 5MG/ML 00300361224 TAP PHARMACEUTICALS INC yLUPRON INJ 2 WEEK 00300361228 TAP PHARMACEUTICALS INC yLUPRON DEPOT INJ 3.75MG 00300364101 TAP PHARMACEUTICALS INC yLUPRON DEPOT INJ 7.5MG 00300364201 TAP PHARMACEUTICALS INC yLUPRON DEPOT INJ 11.25MG 00300366301 TAP PHARMACEUTICALS INC yLUPRON DEPOT INJ 30MG 00300368301 TAP PHARMACEUTICALS INC yPREVPAC MIS 00300370201 TAP PHARMACEUTICALS INC yPREVACID I.V INJ 30MG 00300395425 TAP PHARMACEUTICALS INC yPREVACID GRA 15MG 00300730930 TAP PHARMACEUTICALS INC yPREVACID GRA 30MG 00300731130 TAP PHARMACEUTICALS INC yINVERSINE TAB 2.5MG 17205062601 TARGACEPT yFLUOCINONIDE CRE 0.05% 51672125301 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE 0.05% 51672125302 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE 0.05% 51672125303 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE 0.05% 51672125304 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE -E 0.05% 51672125401 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE -E 0.05% 51672125402 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE -E 0.05% 51672125403 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLOBETASOL CRE 0.05% 51672125801 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL CRE 0.05% 51672125802 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL CRE 0.05% 51672125803 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL CRE 0.05% 51672125806 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 51672125901 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 51672125902 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 51672125903 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 51672125906 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE SOL 1% 51672126003 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS GEL 0.05% 51672126101 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS GEL 0.05% 51672126103 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS OIN 0.25% 51672126201 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS OIN 0.25% 51672126203 TARO PHARMACEUTICALS USA, INC. yNYSTAT/TRIAM CRE 51672126301 TARO PHARMACEUTICALS USA, INC. yNYSTAT/TRIAM CRE 51672126302 TARO PHARMACEUTICALS USA, INC. yNYSTAT/TRIAM CRE 51672126303 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE OIN 0.05% 51672126401 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE OIN 0.05% 51672126402 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE OIN 0.05% 51672126403 TARO PHARMACEUTICALS USA, INC. yTRIAMCIN/ORA PST 0.1% 51672126705 TARO PHARMACEUTICALS USA, INC. yBETAMETH VAL CRE 0.1% 51672126901 TARO PHARMACEUTICALS USA, INC. yBETAMETH VAL CRE 0.1% 51672126906 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS CRE 0.25% 51672127001 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS CRE 0.25% 51672127003 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS CRE 0.05% 51672127101 TARO PHARMACEUTICALS USA, INC. yDESOXIMETAS CRE 0.05% 51672127103 TARO PHARMACEUTICALS USA, INC. yNYSTAT/TRIAM OIN 51672127201 TARO PHARMACEUTICALS USA, INC. yNYSTAT/TRIAM OIN 51672127202 TARO PHARMACEUTICALS USA, INC. yNYSTAT/TRIAM OIN 51672127203 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE SOL 0.05% 51672127302 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE SOL 0.05% 51672127304 TARO PHARMACEUTICALS USA, INC. yBETAMETH DIP CRE 0.05% 51672127401 TARO PHARMACEUTICALS USA, INC. yBETAMETH DIP CRE 0.05% 51672127406 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE CRE 1% 51672127501 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE CRE 1% 51672127502 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE CRE 1% 51672127506 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLOTRIMAZOLE CRE 1% 51672127507 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE GEL 0.05% 51672127901 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE GEL 0.05% 51672127902 TARO PHARMACEUTICALS USA, INC. yFLUOCINONIDE GEL 0.05% 51672127903 TARO PHARMACEUTICALS USA, INC. yDESONIDE CRE 0.05% 51672128001 TARO PHARMACEUTICALS USA, INC. yDESONIDE CRE 0.05% 51672128003 TARO PHARMACEUTICALS USA, INC. yDESONIDE OIN 0.05% 51672128101 TARO PHARMACEUTICALS USA, INC. yDESONIDE OIN 0.05% 51672128103 TARO PHARMACEUTICALS USA, INC. yTRIAMCINOLON CRE 0.1% 51672128201 TARO PHARMACEUTICALS USA, INC. yTRIAMCINOLON CRE 0.1% 51672128202 TARO PHARMACEUTICALS USA, INC. yTRIAMCINOLON CRE 0.1% 51672128208 TARO PHARMACEUTICALS USA, INC. yNYSTATIN CRE 100000 51672128901 TARO PHARMACEUTICALS USA, INC. yNYSTATIN CRE 100000 51672128902 TARO PHARMACEUTICALS USA, INC. yHC VALERATE CRE 0.2% 51672129001 TARO PHARMACEUTICALS USA, INC. yHC VALERATE CRE 0.2% 51672129003 TARO PHARMACEUTICALS USA, INC. yHC VALERATE CRE 0.2% 51672129006 TARO PHARMACEUTICALS USA, INC. yHC VALERATE OIN 0.2% 51672129201 TARO PHARMACEUTICALS USA, INC. yHC VALERATE OIN 0.2% 51672129203 TARO PHARMACEUTICALS USA, INC. yHC VALERATE OIN 0.2% 51672129206 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL SOL 0.05% 51672129302 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL SOL 0.05% 51672129303 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL GEL 0.05% 51672129401 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL GEL 0.05% 51672129402 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL GEL 0.05% 51672129403 TARO PHARMACEUTICALS USA, INC. yDIFLORASONE OIN 0.05% 51672129501 TARO PHARMACEUTICALS USA, INC. yDIFLORASONE OIN 0.05% 51672129502 TARO PHARMACEUTICALS USA, INC. yDIFLORASONE OIN 0.05% 51672129503 TARO PHARMACEUTICALS USA, INC. yDIFLORASONE CRE 0.05% 51672129601 TARO PHARMACEUTICALS USA, INC. yDIFLORASONE CRE 0.05% 51672129602 TARO PHARMACEUTICALS USA, INC. yDIFLORASONE CRE 0.05% 51672129603 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL E CRE 0.05% 51672129701 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL E CRE 0.05% 51672129702 TARO PHARMACEUTICALS USA, INC. yCLOBETASOL E CRE 0.05% 51672129703 TARO PHARMACEUTICALS USA, INC. yKETOCONAZOLE CRE 2% 51672129801 TARO PHARMACEUTICALS USA, INC. yKETOCONAZOLE CRE 2% 51672129802 TARO PHARMACEUTICALS USA, INC. yKETOCONAZOLE CRE 2% 51672129803 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMMONIUM LAC LOT 12% 51672130005 TARO PHARMACEUTICALS USA, INC. yAMMONIUM LAC LOT 12% 51672130009 TARO PHARMACEUTICALS USA, INC. yAMMONIUM LAC CRE 12% 51672130100 TARO PHARMACEUTICALS USA, INC. yAMMONIUM LAC CRE 12% 51672130104 TARO PHARMACEUTICALS USA, INC. yTERCONAZOLE CRE 0.8% 51672130200 TARO PHARMACEUTICALS USA, INC. yECONAZOLE CRE 1% 51672130301 TARO PHARMACEUTICALS USA, INC. yECONAZOLE CRE 1% 51672130302 TARO PHARMACEUTICALS USA, INC. yECONAZOLE CRE 1% 51672130308 TARO PHARMACEUTICALS USA, INC. yTERCONAZOLE CRE 0.4% 51672130406 TARO PHARMACEUTICALS USA, INC. yMOMETASONE SOL 0.1% 51672130503 TARO PHARMACEUTICALS USA, INC. yMOMETASONE SOL 0.1% 51672130504 TARO PHARMACEUTICALS USA, INC. yALCLOMETASON CRE 0.05% 51672130601 TARO PHARMACEUTICALS USA, INC. yALCLOMETASON CRE 0.05% 51672130603 TARO PHARMACEUTICALS USA, INC. yALCLOMETASON CRE 0.05% 51672130606 TARO PHARMACEUTICALS USA, INC. yCLOTRIM/BETA LOT DIPROP 51672130803 TARO PHARMACEUTICALS USA, INC. yAUG BETAMET GEL 0.05% 51672130901 TARO PHARMACEUTICALS USA, INC. yAUG BETAMET GEL 0.05% 51672130903 TARO PHARMACEUTICALS USA, INC. yAUG BETAMET CRE 0.05% 51672131001 TARO PHARMACEUTICALS USA, INC. yAUG BETAMET CRE 0.05% 51672131003 TARO PHARMACEUTICALS USA, INC. yMOMETASONE OIN 0.1% 51672131101 TARO PHARMACEUTICALS USA, INC. yMOMETASONE OIN 0.1% 51672131106 TARO PHARMACEUTICALS USA, INC. yMUPIROCIN OIN 2% 51672131200 TARO PHARMACEUTICALS USA, INC. yMOMETASONE CRE 0.1% 51672131501 TARO PHARMACEUTICALS USA, INC. yMOMETASONE CRE 0.1% 51672131506 TARO PHARMACEUTICALS USA, INC. yALCLOMETASON OIN 0.05% 51672131601 TARO PHARMACEUTICALS USA, INC. yALCLOMETASON OIN 0.05% 51672131603 TARO PHARMACEUTICALS USA, INC. yALCLOMETASON OIN 0.05% 51672131606 TARO PHARMACEUTICALS USA, INC. yAUG BETAMET OIN 0.05% 51672131701 TARO PHARMACEUTICALS USA, INC. yAUG BETAMET OIN 0.05% 51672131703 TARO PHARMACEUTICALS USA, INC. yCICLOPIROX CRE 0.77% 51672131801 TARO PHARMACEUTICALS USA, INC. yCICLOPIROX CRE 0.77% 51672131802 TARO PHARMACEUTICALS USA, INC. yCICLOPIROX CRE 0.77% 51672131808 TARO PHARMACEUTICALS USA, INC. yHALOBETASOL CRE 0.05% 51672132101 TARO PHARMACEUTICALS USA, INC. yHALOBETASOL CRE 0.05% 51672132103 TARO PHARMACEUTICALS USA, INC. yHALOBETASOL OIN 0.05% 51672132201 TARO PHARMACEUTICALS USA, INC. yHALOBETASOL OIN 0.05% 51672132203 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CICLOPIROX SUS 0.77% 51672132303 TARO PHARMACEUTICALS USA, INC. yCICLOPIROX SUS 0.77% 51672132304 TARO PHARMACEUTICALS USA, INC. yLUSTRA CRE 4% 51672132603 TARO PHARMACEUTICALS USA, INC. yMICONAZOLE CRE 2% 51672200101 TARO PHARMACEUTICALS USA, INC. yMICONAZOLE CRE 2% 51672200102 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE CRE 1% 51672200201 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE CRE 1% 51672200202 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE CRE 1% VAG 51672200306 TARO PHARMACEUTICALS USA, INC. yBACITRACIN OIN 500/GM 51672200501 TARO PHARMACEUTICALS USA, INC. yBACITRACIN OIN 500/GM 51672200502 TARO PHARMACEUTICALS USA, INC. yBACITRACIN OIN 500/GM 51672200503 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 0.5/ALOE 51672201001 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 0.5/ALOE 51672201002 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 1% 51672201301 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 1% 51672201302 TARO PHARMACEUTICALS USA, INC. yHYDROCORT OIN 0.5% 51672201501 TARO PHARMACEUTICALS USA, INC. yHYDROCORT OIN 0.5% 51672201502 TARO PHARMACEUTICALS USA, INC. yTRIPLE ANTIB OIN 51672201601 TARO PHARMACEUTICALS USA, INC. yTRIPLE ANTIB OIN 51672201602 TARO PHARMACEUTICALS USA, INC. yHYDROCORT OIN 1% 51672201801 TARO PHARMACEUTICALS USA, INC. yHYDROCORT OIN 1% 51672201802 TARO PHARMACEUTICALS USA, INC. yTOLNAFTATE CRE 1% 51672202001 TARO PHARMACEUTICALS USA, INC. yTOLNAFTATE CRE 1% 51672202002 TARO PHARMACEUTICALS USA, INC. yNASAL DECONG SPR 0.05% 51672203003 TARO PHARMACEUTICALS USA, INC. yNASAL DECONG SPR 0.05% 51672203005 TARO PHARMACEUTICALS USA, INC. yMICONAZOLE CRE 2% 51672203506 TARO PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE SOL 1% 51672203701 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 1% 51672206302 TARO PHARMACEUTICALS USA, INC. yANTI-ITCH CRE 2-0.1% 51672206602 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 1% 51672206902 TARO PHARMACEUTICALS USA, INC. yLORATADINE SYP 5MG/5ML 51672207308 TARO PHARMACEUTICALS USA, INC. yPOVIDONE-IOD OIN 10% 51672207402 TARO PHARMACEUTICALS USA, INC. yBACITR ZINC OIN 500/GM 51672207502 TARO PHARMACEUTICALS USA, INC. yELIXSURE IB SUS 100/5ML 51672250508 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 2.5% 51672300300 TARO PHARMACEUTICALS USA, INC. yHYDROCORT CRE 2.5% 51672300302 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCORT CRE 1% 51672300402 TARO PHARMACEUTICALS USA, INC. yANTIPY/BENZO SOL OTIC 51672300605 TARO PHARMACEUTICALS USA, INC. yACETIC ACID SOL /HC OTIC 51672300701 TARO PHARMACEUTICALS USA, INC. yLIDOCAINE OIN 5% 51672300802 TARO PHARMACEUTICALS USA, INC. yLIDOCAINE OIN 5% 51672300803 TARO PHARMACEUTICALS USA, INC. yU-CORT CRE 1% 51672300902 TARO PHARMACEUTICALS USA, INC. yGENTAMICIN CRE 0.1% 51672301001 TARO PHARMACEUTICALS USA, INC. yGENTAMICIN CRE 0.1% 51672301002 TARO PHARMACEUTICALS USA, INC. yGENTAMICIN OIN 0.1% 51672301101 TARO PHARMACEUTICALS USA, INC. yGENTAMICIN OIN 0.1% 51672301102 TARO PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 10MG 51672400105 TARO PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 25MG 51672400205 TARO PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 50MG 51672400305 TARO PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 50MG 51672400306 TARO PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 75MG 51672400405 TARO PHARMACEUTICALS USA, INC. yCARBAMAZEPIN TAB 200MG 51672400501 TARO PHARMACEUTICALS USA, INC. yCARBAMAZEPIN TAB 200MG 51672400502 TARO PHARMACEUTICALS USA, INC. yCARBAMAZEPIN TAB 200MG 51672400503 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 25MG 51672401101 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 25MG 51672401105 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 25MG 51672401106 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 50MG 51672401201 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 50MG 51672401205 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 50MG 51672401206 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 75MG 51672401301 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 75MG 51672401305 TARO PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 75MG 51672401306 TARO PHARMACEUTICALS USA, INC. yETODOLAC CAP 200MG 51672401601 TARO PHARMACEUTICALS USA, INC. yETODOLAC CAP 300MG 51672401701 TARO PHARMACEUTICALS USA, INC. yETODOLAC TAB 400MG 51672401801 TARO PHARMACEUTICALS USA, INC. yACETAZOLAMID TAB 125MG 51672402201 TARO PHARMACEUTICALS USA, INC. yACETAZOLAMID TAB 250MG 51672402301 TARO PHARMACEUTICALS USA, INC. yAMIODARONE TAB 200MG 51672402504 TARO PHARMACEUTICALS USA, INC. yKETOCONAZOLE TAB 200MG 51672402601 TARO PHARMACEUTICALS USA, INC. yKETOCONAZOLE TAB 200MG 51672402606 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 1MG 51672402701 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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WARFARIN TAB 1MG 51672402703 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 1MG 51672402707 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 2MG 51672402801 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 2MG 51672402803 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 2MG 51672402807 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 2.5MG 51672402901 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 2.5MG 51672402903 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 2.5MG 51672402907 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 3MG 51672403001 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 3MG 51672403003 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 3MG 51672403007 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 4MG 51672403101 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 4MG 51672403103 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 4MG 51672403107 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 5MG 51672403201 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 5MG 51672403203 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 5MG 51672403207 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 6MG 51672403301 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 6MG 51672403303 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 7.5MG 51672403401 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 7.5MG 51672403403 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 10MG 51672403501 TARO PHARMACEUTICALS USA, INC. yWARFARIN TAB 10MG 51672403503 TARO PHARMACEUTICALS USA, INC. yETODOLAC TAB 500MG 51672403601 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 2.5MG 51672403701 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 2.5MG 51672403703 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 5MG 51672403801 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 5MG 51672403803 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 10MG 51672403901 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 10MG 51672403903 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 20MG 51672404001 TARO PHARMACEUTICALS USA, INC. yENALAPRIL TAB 20MG 51672404003 TARO PHARMACEUTICALS USA, INC. yCARBAMAZEPIN CHW 100MG 51672404101 TARO PHARMACEUTICALS USA, INC. yCARBAMAZEPIN CHW 100MG 51672404102 TARO PHARMACEUTICALS USA, INC. yCLORAZ DIPOT TAB 3.75MG 51672404201 TARO PHARMACEUTICALS USA, INC. yCLORAZ DIPOT TAB 3.75MG 51672404202 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLORAZ DIPOT TAB 7.5MG 51672404301 TARO PHARMACEUTICALS USA, INC. yCLORAZ DIPOT TAB 7.5MG 51672404302 TARO PHARMACEUTICALS USA, INC. yCLORAZ DIPOT TAB 15MG 51672404401 TARO PHARMACEUTICALS USA, INC. yENALAPR/HCTZ TAB 5-12.5MG 51672404501 TARO PHARMACEUTICALS USA, INC. yENALAPR/HCTZ TAB 10-25MG 51672404601 TARO PHARMACEUTICALS USA, INC. yCARBAMAZEPIN SUS 100/5ML 51672404709 TARO PHARMACEUTICALS USA, INC. yCLOTRIM/BETA CRE DIPROP 51672404801 TARO PHARMACEUTICALS USA, INC. yCLOTRIM/BETA CRE DIPROP 51672404806 TARO PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 400MG 51672405101 TARO PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 400MG 51672405104 TARO PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 500MG 51672405201 TARO PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 500MG 51672405204 TARO PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 600MG 51672405301 TARO PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 600MG 51672405304 TARO PHARMACEUTICALS USA, INC. yAMCINONIDE CRE 0.1% 51672405401 TARO PHARMACEUTICALS USA, INC. yAMCINONIDE CRE 0.1% 51672405402 TARO PHARMACEUTICALS USA, INC. yAMCINONIDE CRE 0.1% 51672405403 TARO PHARMACEUTICALS USA, INC. yAMIODARONE TAB 400MG 51672405700 TARO PHARMACEUTICALS USA, INC. yAMIODARONE TAB 400MG 51672405706 TARO PHARMACEUTICALS USA, INC. yAMCINONIDE OIN 0.1% 51672406001 TARO PHARMACEUTICALS USA, INC. yAMCINONIDE OIN 0.1% 51672406002 TARO PHARMACEUTICALS USA, INC. yAMCINONIDE OIN 0.1% 51672406003 TARO PHARMACEUTICALS USA, INC. yHYDROCORT SOL BUTYRATE 51672406102 TARO PHARMACEUTICALS USA, INC. yHYDROCORT SOL BUTYRATE 51672406104 TARO PHARMACEUTICALS USA, INC. yFLUOROURACIL SOL 2% 51672406201 TARO PHARMACEUTICALS USA, INC. yFLUOROURACIL SOL 5% 51672406301 TARO PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 50MG 51672406406 TARO PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 100MG 51672406500 TARO PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 100MG 51672406506 TARO PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 150MG 51672406607 TARO PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 200MG 51672406706 TARO PHARMACEUTICALS USA, INC. yPHENYTOIN SUS 125/5ML 51672406901 TARO PHARMACEUTICALS USA, INC. yHC BUTYRATE CRE 0.1% 51672407401 TARO PHARMACEUTICALS USA, INC. yHC BUTYRATE CRE 0.1% 51672407406 TARO PHARMACEUTICALS USA, INC. yCLINDAMYCIN SOL 1% 51672408103 TARO PHARMACEUTICALS USA, INC. yCLINDAMYCIN SOL 1% 51672408104 TARO PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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HC BUTYRATE OIN 0.1% 51672408301 TARO PHARMACEUTICALS USA, INC. yHC BUTYRATE OIN 0.1% 51672408306 TARO PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 250MG 51672408500 TARO PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 250MG 51672408501 TARO PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 500MG 51672408600 TARO PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 500MG 51672408601 TARO PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 750MG 51672408700 TARO PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 750MG 51672408704 TARO PHARMACEUTICALS USA, INC. yPHENYTOIN EX CAP 100MG 51672411101 TARO PHARMACEUTICALS USA, INC. yPHENYTOIN EX CAP 100MG 51672411103 TARO PHARMACEUTICALS USA, INC. yMETRONIDAZOL GEL 0.75% 51672411606 TARO PHARMACEUTICALS USA, INC. yNYSTATIN SUS 100000U 51672411704 TARO PHARMACEUTICALS USA, INC. yNYSTATIN SUS 100000U 51672411709 TARO PHARMACEUTICALS USA, INC. yTOPICORT GEL 0.05% 51672520201 TARO PHARMACEUTICALS USA, INC. yTOPICORT GEL 0.05% 51672520203 TARO PHARMACEUTICALS USA, INC. yTOPICORT OIN 0.25% 51672520301 TARO PHARMACEUTICALS USA, INC. yTOPICORT OIN 0.25% 51672520303 TARO PHARMACEUTICALS USA, INC. yTOPICORT CRE 0.25% 51672520401 TARO PHARMACEUTICALS USA, INC. yTOPICORT CRE 0.25% 51672520403 TARO PHARMACEUTICALS USA, INC. yTOPICORT LP CRE 0.05% 51672520501 TARO PHARMACEUTICALS USA, INC. yTOPICORT LP CRE 0.05% 51672520503 TARO PHARMACEUTICALS USA, INC. yFLUTICASONE CRE 0.05% 51672521601 TARO PHARMACEUTICALS USA, INC. yFLUTICASONE CRE 0.05% 51672521602 TARO PHARMACEUTICALS USA, INC. yFLUTICASONE CRE 0.05% 51672521603 TARO PHARMACEUTICALS USA, INC. yFLUTICASONE OIN 0.005% 51672521701 TARO PHARMACEUTICALS USA, INC. yFLUTICASONE OIN 0.005% 51672521702 TARO PHARMACEUTICALS USA, INC. yFLUTICASONE OIN 0.005% 51672521703 TARO PHARMACEUTICALS USA, INC. yOVIDE LOT 0.5% 51672527604 TARO PHARMACEUTICALS USA, INC. yINAPSINE INJ 2.5MG/ML 11098001001 TAYLOR PHARMACEUTICALS yINAPSINE INJ 2.5MG/ML 11098001002 TAYLOR PHARMACEUTICALS ySUBLIMAZE INJ 0.05MG/1 11098003002 TAYLOR PHARMACEUTICALS ySUBLIMAZE INJ 0.05MG/1 11098003005 TAYLOR PHARMACEUTICALS ySUBLIMAZE INJ 0.05MG/1 11098003010 TAYLOR PHARMACEUTICALS ySUBLIMAZE INJ 0.05MG/1 11098003020 TAYLOR PHARMACEUTICALS ySUFENTA INJ 50MCG/ML 11098005001 TAYLOR PHARMACEUTICALS ySUFENTA INJ 50MCG/ML 11098005002 TAYLOR PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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SUFENTA INJ 50MCG/ML 11098005005 TAYLOR PHARMACEUTICALS yALFENTA INJ 500/ML 11098006002 TAYLOR PHARMACEUTICALS yALFENTA INJ 500/ML 11098006005 TAYLOR PHARMACEUTICALS yALFENTA INJ 500/ML 11098006010 TAYLOR PHARMACEUTICALS yMETHYLENE BL INJ 1% 11098050401 TAYLOR PHARMACEUTICALS yMETHYLENE BL INJ 1% 11098050410 TAYLOR PHARMACEUTICALS yINDIGO CARMI SOL 8MG/ML 11098050805 TAYLOR PHARMACEUTICALS yPHYSOS SALIC INJ 1MG/ML 11098051002 TAYLOR PHARMACEUTICALS yEPHEDRINE SU INJ 50MG/ML 11098051501 TAYLOR PHARMACEUTICALS yBAL IN OIL INJ 100MG/ML 11098052603 TAYLOR PHARMACEUTICALS yMYOCHRYSINE INJ 50MG/ML 11098053301 TAYLOR PHARMACEUTICALS yMYOCHRYSINE INJ 50MG/ML 11098053310 TAYLOR PHARMACEUTICALS yHISTEX IE CAP 67336005060 TEAMM PHARMACEUTICALS, INC. yHISTEX SR CAP 67336008901 TEAMM PHARMACEUTICALS, INC. yRESPI-TANN SUS 67336015616 TEAMM PHARMACEUTICALS, INC. yRESPI-TANN CHW 67336015701 TEAMM PHARMACEUTICALS, INC. yRESPI-TANN SUS PD 67336018716 TEAMM PHARMACEUTICALS, INC. yRESPI-TANN G SUS 67336018816 TEAMM PHARMACEUTICALS, INC. yHISTEX PD LIQ 4MG/5ML 67336025416 TEAMM PHARMACEUTICALS, INC. yHISTEX LIQ 67336027516 TEAMM PHARMACEUTICALS, INC. yHISTEX PD 12 SUS 2-6MG 67336053204 TEAMM PHARMACEUTICALS, INC. yHISTEX PD 12 SUS 2-6MG 67336053216 TEAMM PHARMACEUTICALS, INC. yHISTEX HC LIQ 67336091016 TEAMM PHARMACEUTICALS, INC. yXODOL TAB 67336091101 TEAMM PHARMACEUTICALS, INC. yXODOL TAB 67336091105 TEAMM PHARMACEUTICALS, INC. yXODOL TAB 5-300MG 67336091201 TEAMM PHARMACEUTICALS, INC. yXODOL TAB 7.5/300 67336091301 TEAMM PHARMACEUTICALS, INC. yINCRELEX INJ 40MG/4ML 15054104005 TERCICA, INC. yAZILECT TAB 0.5MG 68546014256 TEVA NEUROSCIENCE, INC. yAZILECT TAB 1MG 68546022956 TEVA NEUROSCIENCE, INC. yCHLORHEX GLU SOL 0.12% 00093001416 TEVA PHARMACEUTICALS USA, INC. yMOEXIPRIL TAB 7.5MG 00093001701 TEVA PHARMACEUTICALS USA, INC. yOXYCODONE TAB 10MG ER 00093002401 TEVA PHARMACEUTICALS USA, INC. yENALAPRIL TAB 2.5MG 00093002601 TEVA PHARMACEUTICALS USA, INC. yENALAPRIL TAB 5MG 00093002701 TEVA PHARMACEUTICALS USA, INC. yENALAPRIL TAB 10MG 00093002801 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

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ENALAPRIL TAB 10MG 00093002810 TEVA PHARMACEUTICALS USA, INC. yENALAPRIL TAB 20MG 00093002901 TEVA PHARMACEUTICALS USA, INC. yENALAPRIL TAB 20MG 00093002910 TEVA PHARMACEUTICALS USA, INC. yOXYCODONE TAB 20MG ER 00093003101 TEVA PHARMACEUTICALS USA, INC. yOXYCODONE TAB 40MG ER 00093003201 TEVA PHARMACEUTICALS USA, INC. yCLOMIPHENE TAB 50MG 00093004103 TEVA PHARMACEUTICALS USA, INC. yCLOMIPHENE TAB 50MG 00093004156 TEVA PHARMACEUTICALS USA, INC. yAPAP/CODEINE TAB 300-15MG 00093005001 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 5MG 00093005301 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 5MG 00093005305 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 10MG 00093005401 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 10MG 00093005405 TEVA PHARMACEUTICALS USA, INC. yTRAMADOL HCL TAB 50MG 00093005801 TEVA PHARMACEUTICALS USA, INC. yTRAMADOL HCL TAB 50MG 00093005805 TEVA PHARMACEUTICALS USA, INC. yISOSORB MONO TAB 20MG 00093007601 TEVA PHARMACEUTICALS USA, INC. yISOSORB MONO TAB 20MG 00093007605 TEVA PHARMACEUTICALS USA, INC. ySMZ-TMP TAB 400-80MG 00093008801 TEVA PHARMACEUTICALS USA, INC. ySMZ-TMP TAB 400-80MG 00093008805 TEVA PHARMACEUTICALS USA, INC. ySMZ/TMP DS TAB 800-160 00093008901 TEVA PHARMACEUTICALS USA, INC. ySMZ/TMP DS TAB 800-160 00093008905 TEVA PHARMACEUTICALS USA, INC. yEPITOL TAB 200MG 00093009001 TEVA PHARMACEUTICALS USA, INC. yCARBAMAZEPIN TAB 200MG 00093010901 TEVA PHARMACEUTICALS USA, INC. yCARBAMAZEPIN TAB 200MG 00093010910 TEVA PHARMACEUTICALS USA, INC. yESTAZOLAM TAB 1MG 00093012901 TEVA PHARMACEUTICALS USA, INC. yESTAZOLAM TAB 2MG 00093013001 TEVA PHARMACEUTICALS USA, INC. yLAMOTRIGINE CHW 25MG 00093013201 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 250MG 00093014701 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 250MG 00093014705 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 375MG 00093014801 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 375MG 00093014805 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 500MG 00093014901 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 500MG 00093014905 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN TAB 500MG 00093014910 TEVA PHARMACEUTICALS USA, INC. yAPAP/CODEINE TAB 300-30MG 00093015001 TEVA PHARMACEUTICALS USA, INC. yAPAP/CODEINE TAB 300-30MG 00093015010 TEVA PHARMACEUTICALS USA, INC. yTICLOPIDINE TAB 250MG 00093015401 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TICLOPIDINE TAB 250MG 00093015405 TEVA PHARMACEUTICALS USA, INC. yLEFLUNOMIDE TAB 10MG 00093017356 TEVA PHARMACEUTICALS USA, INC. yLEFLUNOMIDE TAB 20MG 00093017456 TEVA PHARMACEUTICALS USA, INC. yCAPTOPR/HCTZ TAB 25-15MG 00093017601 TEVA PHARMACEUTICALS USA, INC. yCAPTOPR/HCTZ TAB 25-25MG 00093017701 TEVA PHARMACEUTICALS USA, INC. yCAPTOPR/HCTZ TAB 50-15MG 00093018101 TEVA PHARMACEUTICALS USA, INC. yCAPTOPR/HCTZ TAB 50-25MG 00093018201 TEVA PHARMACEUTICALS USA, INC. yVENLAFAXINE TAB 25MG 00093019901 TEVA PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 50MG 00093023756 TEVA PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE SOL 1% 00093024831 TEVA PHARMACEUTICALS USA, INC. yCLOTRIMAZOLE SOL 1% 00093024843 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE 0.05% 00093026215 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE 0.05% 00093026230 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE 0.05% 00093026292 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE -E 0.05% 00093026315 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE -E 0.05% 00093026330 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE CRE -E 0.05% 00093026392 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE OIN 0.05% 00093026415 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE OIN 0.05% 00093026430 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE OIN 0.05% 00093026492 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE GEL 0.05% 00093026592 TEVA PHARMACEUTICALS USA, INC. yFLUOCINONIDE SOL 0.05% 00093026639 TEVA PHARMACEUTICALS USA, INC. yCLOZAPINE TAB 25MG 00093027501 TEVA PHARMACEUTICALS USA, INC. yCLOZAPINE TAB 100MG 00093027601 TEVA PHARMACEUTICALS USA, INC. yCLOZAPINE TAB 100MG 00093027605 TEVA PHARMACEUTICALS USA, INC. yBUPROPION TAB 75MG 00093028001 TEVA PHARMACEUTICALS USA, INC. yBUPROPION TAB 75MG 00093028005 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 10-100MG 00093029201 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 10-100MG 00093029205 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 25-100MG 00093029301 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 25-100MG 00093029305 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 25-100MG 00093029310 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 25-250MG 00093029401 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 25-250MG 00093029405 TEVA PHARMACEUTICALS USA, INC. yCARB/LEVO TAB 25-250MG 00093029410 TEVA PHARMACEUTICALS USA, INC. yBETAMETH DIP LOT 0.05% 00093030239 TEVA PHARMACEUTICALS USA, INC. y

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CLEMASTINE TAB 2.68MG 00093030801 TEVA PHARMACEUTICALS USA, INC. yCLEMASTINE SYP 0.5/5ML 00093030912 TEVA PHARMACEUTICALS USA, INC. yLOPERAMIDE CAP 2MG 00093031101 TEVA PHARMACEUTICALS USA, INC. yLOPERAMIDE CAP 2MG 00093031105 TEVA PHARMACEUTICALS USA, INC. yKETOROLAC TAB 10MG 00093031401 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM TAB 30MG 00093031801 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM TAB 30MG 00093031805 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM TAB 60MG 00093031901 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM TAB 60MG 00093031905 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM TAB 90MG 00093032001 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM TAB 120MG 00093032101 TEVA PHARMACEUTICALS USA, INC. yAPAP/CODEINE TAB 300-60MG 00093035001 TEVA PHARMACEUTICALS USA, INC. yAPAP/CODEINE TAB 300-60MG 00093035005 TEVA PHARMACEUTICALS USA, INC. yAPAP/CODEINE TAB 300-60MG 00093035010 TEVA PHARMACEUTICALS USA, INC. yPROPO-N/APAP TAB 100-650 00093049001 TEVA PHARMACEUTICALS USA, INC. yPROPO-N/APAP TAB 100-650 00093049005 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE SOL 300/5ML 00093050687 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN SOD TAB 275MG 00093053601 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN SOD TAB 275MG 00093053605 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN SOD TAB 275MG 00093053610 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN SOD TAB 550MG 00093053701 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN SOD TAB 550MG 00093053705 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN SOD TAB 550MG 00093053710 TEVA PHARMACEUTICALS USA, INC. yCHLORZOXAZON TAB 500MG 00093054201 TEVA PHARMACEUTICALS USA, INC. yCHLORZOXAZON TAB 500MG 00093054205 TEVA PHARMACEUTICALS USA, INC. yLOVASTATIN TAB 20MG 00093057606 TEVA PHARMACEUTICALS USA, INC. yLOVASTATIN TAB 20MG 00093057610 TEVA PHARMACEUTICALS USA, INC. yTRAZODONE TAB 50MG 00093063701 TEVA PHARMACEUTICALS USA, INC. yTRAZODONE TAB 50MG 00093063710 TEVA PHARMACEUTICALS USA, INC. yTRAZODONE TAB 100MG 00093063801 TEVA PHARMACEUTICALS USA, INC. yTRAZODONE TAB 100MG 00093063810 TEVA PHARMACEUTICALS USA, INC. yCALCITRIOL CAP 0.25MCG 00093065701 TEVA PHARMACEUTICALS USA, INC. yCALCITRIOL CAP 0.5MCG 00093065801 TEVA PHARMACEUTICALS USA, INC. yGEMFIBROZIL TAB 600MG 00093067005 TEVA PHARMACEUTICALS USA, INC. yGEMFIBROZIL TAB 600MG 00093067006 TEVA PHARMACEUTICALS USA, INC. yBETA-VAL LOT 0.1% 00093067139 TEVA PHARMACEUTICALS USA, INC. y

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BETA-VAL CRE 0.1% 00093067315 TEVA PHARMACEUTICALS USA, INC. yBETA-VAL CRE 0.1% 00093067395 TEVA PHARMACEUTICALS USA, INC. yLAMOTRIGINE CHW 5MG 00093068801 TEVA PHARMACEUTICALS USA, INC. yFLURBIPROFEN TAB 100MG 00093071101 TEVA PHARMACEUTICALS USA, INC. yFLURBIPROFEN TAB 100MG 00093071105 TEVA PHARMACEUTICALS USA, INC. yMETOPROLOL TAB 50MG 00093073301 TEVA PHARMACEUTICALS USA, INC. yMETOPROLOL TAB 50MG 00093073310 TEVA PHARMACEUTICALS USA, INC. yMETOPROLOL TAB 100MG 00093073401 TEVA PHARMACEUTICALS USA, INC. yMETOPROLOL TAB 100MG 00093073410 TEVA PHARMACEUTICALS USA, INC. yPROPOXY HCL CAP 65MG 00093074101 TEVA PHARMACEUTICALS USA, INC. yPROPOXY HCL CAP 65MG 00093074110 TEVA PHARMACEUTICALS USA, INC. yATENOLOL TAB 50MG 00093075201 TEVA PHARMACEUTICALS USA, INC. yATENOLOL TAB 50MG 00093075210 TEVA PHARMACEUTICALS USA, INC. yATENOLOL TAB 100MG 00093075301 TEVA PHARMACEUTICALS USA, INC. yDIFLUNISAL TAB 500MG 00093075501 TEVA PHARMACEUTICALS USA, INC. yDIFLUNISAL TAB 500MG 00093075505 TEVA PHARMACEUTICALS USA, INC. yDIFLUNISAL TAB 500MG 00093075506 TEVA PHARMACEUTICALS USA, INC. yPIROXICAM CAP 10MG 00093075601 TEVA PHARMACEUTICALS USA, INC. yPIROXICAM CAP 20MG 00093075701 TEVA PHARMACEUTICALS USA, INC. yPIROXICAM CAP 20MG 00093075705 TEVA PHARMACEUTICALS USA, INC. yTERAZOSIN CAP 1MG 00093076001 TEVA PHARMACEUTICALS USA, INC. yTERAZOSIN CAP 2MG 00093076101 TEVA PHARMACEUTICALS USA, INC. yTERAZOSIN CAP 5MG 00093076201 TEVA PHARMACEUTICALS USA, INC. yTERAZOSIN CAP 10MG 00093076301 TEVA PHARMACEUTICALS USA, INC. yPRAVASTATIN TAB 10MG 00093077198 TEVA PHARMACEUTICALS USA, INC. yCARBAMAZEPIN CHW 100MG 00093077801 TEVA PHARMACEUTICALS USA, INC. yTAMOXIFEN TAB 20MG 00093078201 TEVA PHARMACEUTICALS USA, INC. yTAMOXIFEN TAB 20MG 00093078256 TEVA PHARMACEUTICALS USA, INC. yTAMOXIFEN TAB 10MG 00093078406 TEVA PHARMACEUTICALS USA, INC. yTAMOXIFEN TAB 10MG 00093078486 TEVA PHARMACEUTICALS USA, INC. yATENOLOL TAB 25MG 00093078701 TEVA PHARMACEUTICALS USA, INC. yATENOLOL TAB 25MG 00093078710 TEVA PHARMACEUTICALS USA, INC. yNICARDIPINE CAP 20MG 00093079301 TEVA PHARMACEUTICALS USA, INC. yNICARDIPINE CAP 30MG 00093079401 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 10MG 00093081001 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 10MG 00093081005 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NORTRIPTYLIN CAP 25MG 00093081101 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 25MG 00093081105 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 50MG 00093081201 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 50MG 00093081205 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 75MG 00093081301 TEVA PHARMACEUTICALS USA, INC. yNORTRIPTYLIN CAP 75MG 00093081305 TEVA PHARMACEUTICALS USA, INC. yNIFEDICAL XL TAB 30MG 00093081901 TEVA PHARMACEUTICALS USA, INC. yNIFEDICAL XL TAB 30MG 00093081955 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 0.5MG 00093083201 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 0.5MG 00093083205 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 0.5MG 00093083210 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 1MG 00093083301 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 1MG 00093083305 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 1MG 00093083310 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 2MG 00093083401 TEVA PHARMACEUTICALS USA, INC. yCLONAZEPAM TAB 2MG 00093083405 TEVA PHARMACEUTICALS USA, INC. yKETOCONAZOLE CRE 2% 00093084015 TEVA PHARMACEUTICALS USA, INC. yKETOCONAZOLE CRE 2% 00093084030 TEVA PHARMACEUTICALS USA, INC. yKETOCONAZOLE CRE 2% 00093084092 TEVA PHARMACEUTICALS USA, INC. yMETRONIDAZOL TAB 250MG 00093085101 TEVA PHARMACEUTICALS USA, INC. yMETRONIDAZOL TAB 250MG 00093085105 TEVA PHARMACEUTICALS USA, INC. yMETRONIDAZOL TAB 250MG 00093085152 TEVA PHARMACEUTICALS USA, INC. yMETRONIDAZOL TAB 500MG 00093085205 TEVA PHARMACEUTICALS USA, INC. yMETRONIDAZOL TAB 500MG 00093085253 TEVA PHARMACEUTICALS USA, INC. yBUT/APAP/CAF TAB 00093085401 TEVA PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 250MG 00093086301 TEVA PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 500MG 00093086401 TEVA PHARMACEUTICALS USA, INC. yCIPROFLOXACN TAB 750MG 00093086553 TEVA PHARMACEUTICALS USA, INC. yPROPO-N/APAP TAB 100-650 00093089001 TEVA PHARMACEUTICALS USA, INC. yPROPO-N/APAP TAB 100-650 00093089005 TEVA PHARMACEUTICALS USA, INC. yETODOLAC TAB 400MG 00093089201 TEVA PHARMACEUTICALS USA, INC. yFAMOTIDINE TAB 20MG 00093089601 TEVA PHARMACEUTICALS USA, INC. yFAMOTIDINE TAB 20MG 00093089610 TEVA PHARMACEUTICALS USA, INC. yFAMOTIDINE TAB 40MG 00093089701 TEVA PHARMACEUTICALS USA, INC. yFAMOTIDINE TAB 40MG 00093089710 TEVA PHARMACEUTICALS USA, INC. yKETOCONAZOLE TAB 200MG 00093090001 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KETOCONAZOLE TAB 200MG 00093090005 TEVA PHARMACEUTICALS USA, INC. yOXAPROZIN TAB 600MG 00093092401 TEVA PHARMACEUTICALS USA, INC. yOXAPROZIN TAB 600MG 00093092405 TEVA PHARMACEUTICALS USA, INC. yLOVASTATIN TAB 10MG 00093092606 TEVA PHARMACEUTICALS USA, INC. yLOVASTATIN TAB 10MG 00093092610 TEVA PHARMACEUTICALS USA, INC. yLOVASTATIN TAB 40MG 00093092806 TEVA PHARMACEUTICALS USA, INC. yLOVASTATIN TAB 40MG 00093092810 TEVA PHARMACEUTICALS USA, INC. yDICLOFEN POT TAB 50MG 00093094801 TEVA PHARMACEUTICALS USA, INC. yDICLOFEN POT TAB 50MG 00093094805 TEVA PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 25MG 00093095601 TEVA PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 50MG 00093095801 TEVA PHARMACEUTICALS USA, INC. yCLOMIPRAMINE CAP 75MG 00093096001 TEVA PHARMACEUTICALS USA, INC. yNYSTATIN TAB 500000 00093098301 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 15MG 00093100301 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 15MG 00093100305 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN DR TAB 375MG 00093100501 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN DR TAB 375MG 00093100505 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN DR TAB 500MG 00093100601 TEVA PHARMACEUTICALS USA, INC. yNAPROXEN DR TAB 500MG 00093100605 TEVA PHARMACEUTICALS USA, INC. yMUPIROCIN OIN 2% 00093101042 TEVA PHARMACEUTICALS USA, INC. yNABUMETONE TAB 500MG 00093101501 TEVA PHARMACEUTICALS USA, INC. yNABUMETONE TAB 500MG 00093101510 TEVA PHARMACEUTICALS USA, INC. yNABUMETONE TAB 750MG 00093101601 TEVA PHARMACEUTICALS USA, INC. yNABUMETONE TAB 750MG 00093101610 TEVA PHARMACEUTICALS USA, INC. yNIFEDIAC CC TAB 60MG ER 00093102201 TEVA PHARMACEUTICALS USA, INC. yNIFEDIAC CC TAB 60MG ER 00093102255 TEVA PHARMACEUTICALS USA, INC. yNIFEDIAC CC TAB 90MG ER 00093102301 TEVA PHARMACEUTICALS USA, INC. yNEFAZODONE TAB 100MG 00093102406 TEVA PHARMACEUTICALS USA, INC. yNEFAZODONE TAB 200MG 00093102506 TEVA PHARMACEUTICALS USA, INC. yNEFAZODONE TAB 250MG 00093102606 TEVA PHARMACEUTICALS USA, INC. yLISINOP/HCTZ TAB 20-12.5 00093103601 TEVA PHARMACEUTICALS USA, INC. yLISINOP/HCTZ TAB 20-12.5 00093103605 TEVA PHARMACEUTICALS USA, INC. yLISINOP/HCTZ TAB 20-25MG 00093103701 TEVA PHARMACEUTICALS USA, INC. yLISINOP/HCTZ TAB 20-25MG 00093103705 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN CAP 300MG 00093103901 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN CAP 300MG 00093103905 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GABAPENTIN CAP 400MG 00093104001 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN CAP 400MG 00093104005 TEVA PHARMACEUTICALS USA, INC. yDICLOFENAC TAB 100MG ER 00093104101 TEVA PHARMACEUTICALS USA, INC. yFLUOXETINE CAP 10MG 00093104201 TEVA PHARMACEUTICALS USA, INC. yFLUOXETINE CAP 20MG 00093104301 TEVA PHARMACEUTICALS USA, INC. yENALAPR/HCTZ TAB 5-12.5MG 00093104401 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 500MG 00093104801 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 500MG 00093104805 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 500MG 00093104810 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 850MG 00093104901 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 850MG 00093104905 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 850MG 00093104910 TEVA PHARMACEUTICALS USA, INC. yENALAPR/HCTZ TAB 10-25MG 00093105201 TEVA PHARMACEUTICALS USA, INC. ySOTALOL HCL TAB 120MG 00093106001 TEVA PHARMACEUTICALS USA, INC. ySOTALOL HCL TAB 80MG 00093106101 TEVA PHARMACEUTICALS USA, INC. ySOTALOL HCL TAB 240MG 00093106301 TEVA PHARMACEUTICALS USA, INC. yNIZATIDINE CAP 150MG 00093106505 TEVA PHARMACEUTICALS USA, INC. yNIZATIDINE CAP 150MG 00093106506 TEVA PHARMACEUTICALS USA, INC. yNIZATIDINE CAP 300MG 00093106656 TEVA PHARMACEUTICALS USA, INC. yCEFUROXIME TAB 250MG 00093107334 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL SUS 125/5ML 00093107573 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL SUS 125/5ML 00093107576 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL SUS 125/5ML 00093107578 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL SUS 250/5ML 00093107673 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL SUS 250/5ML 00093107676 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL SUS 250/5ML 00093107678 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL TAB 250MG 00093107701 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL TAB 500MG 00093107801 TEVA PHARMACEUTICALS USA, INC. yCEFPROZIL TAB 500MG 00093107853 TEVA PHARMACEUTICALS USA, INC. yCEFACLOR ER TAB 00093108701 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 2.5MG 00093111101 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 5MG 00093111201 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 5MG 00093111210 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 10MG 00093111301 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 10MG 00093111310 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 20MG 00093111401 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOPRIL TAB 20MG 00093111410 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 40MG 00093111501 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 40MG 00093111505 TEVA PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 600MG 00093111801 TEVA PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 400MG 00093112201 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 250MG 00093117201 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 250MG 00093117210 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 500MG 00093117401 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 500MG 00093117410 TEVA PHARMACEUTICALS USA, INC. yNEOMYCIN TAB 500MG 00093117701 TEVA PHARMACEUTICALS USA, INC. yCROMOLYN SOD SOL 4% OP 00093138943 TEVA PHARMACEUTICALS USA, INC. yTRIMETHOPRIM TAB 100MG 00093215801 TEVA PHARMACEUTICALS USA, INC. yMETOCLOPRAM TAB 10MG 00093220301 TEVA PHARMACEUTICALS USA, INC. yMETOCLOPRAM TAB 10MG 00093220305 TEVA PHARMACEUTICALS USA, INC. yMETOCLOPRAM TAB 10MG 00093220310 TEVA PHARMACEUTICALS USA, INC. yMETOCLOPRAM TAB 5MG 00093220401 TEVA PHARMACEUTICALS USA, INC. yMETOCLOPRAM TAB 5MG 00093220405 TEVA PHARMACEUTICALS USA, INC. ySUCRALFATE TAB 1GM 00093221001 TEVA PHARMACEUTICALS USA, INC. ySUCRALFATE TAB 1GM 00093221005 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN TAB 250MG 00093223801 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN TAB 500MG 00093224001 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN TAB 500MG 00093226301 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN TAB 875MG 00093226401 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CHW 125MG 00093226701 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CHW 250MG 00093226801 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CHW 250MG 00093226805 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV CHW 200MG 00093227034 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV CHW 400MG 00093227234 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV TAB 500MG 00093227434 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV TAB 875MG 00093227534 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV SUS 200/5ML 00093227773 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV SUS 400/5ML 00093227973 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CAP 250MG 00093310701 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CAP 250MG 00093310705 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CAP 500MG 00093310905 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN CAP 500MG 00093310953 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DICLOXACILL CAP 250MG 00093312301 TEVA PHARMACEUTICALS USA, INC. yDICLOXACILL CAP 500MG 00093312501 TEVA PHARMACEUTICALS USA, INC. yDISOPYRAMIDE CAP 100MG 00093312701 TEVA PHARMACEUTICALS USA, INC. yDISOPYRAMIDE CAP 150MG 00093312901 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN CAP 250MG 00093314501 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN CAP 250MG 00093314505 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN CAP 500MG 00093314701 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN CAP 500MG 00093314705 TEVA PHARMACEUTICALS USA, INC. yMINOCYCLINE CAP 50MG 00093316501 TEVA PHARMACEUTICALS USA, INC. yMINOCYCLINE CAP 100MG 00093316753 TEVA PHARMACEUTICALS USA, INC. yCLINDAMYCIN CAP 150MG 00093317101 TEVA PHARMACEUTICALS USA, INC. yKETOPROFEN CAP 50MG 00093319301 TEVA PHARMACEUTICALS USA, INC. yKETOPROFEN CAP 75MG 00093319501 TEVA PHARMACEUTICALS USA, INC. yKETOPROFEN CAP 75MG 00093319505 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 125/5ML 00093412573 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 125/5ML 00093412574 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 250/5ML 00093412773 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 250/5ML 00093412774 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 125/5ML 00093415073 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 125/5ML 00093415079 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 125/5ML 00093415080 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 250/5ML 00093415573 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 250/5ML 00093415579 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 250/5ML 00093415580 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 200/5ML 00093416073 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 200/5ML 00093416076 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 200/5ML 00093416078 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 400/5ML 00093416173 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 400/5ML 00093416176 TEVA PHARMACEUTICALS USA, INC. yAMOXICILLIN SUS 400/5ML 00093416178 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN SUS 125/5ML 00093417573 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN SUS 125/5ML 00093417574 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN SUS 250/5ML 00093417773 TEVA PHARMACEUTICALS USA, INC. yCEPHALEXIN SUS 250/5ML 00093417774 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM CAP 120MG ER 00093511298 TEVA PHARMACEUTICALS USA, INC. yPENTOXIFYLLI TAB 400MG ER 00093511601 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PENTOXIFYLLI TAB 400MG ER 00093511605 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM CAP 180MG ER 00093511798 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM CAP 240MG ER 00093511898 TEVA PHARMACEUTICALS USA, INC. yDILTIAZEM CAP 300MG ER 00093511998 TEVA PHARMACEUTICALS USA, INC. yBENAZEPRIL TAB 5MG 00093512401 TEVA PHARMACEUTICALS USA, INC. yBENAZEPRIL TAB 10MG 00093512501 TEVA PHARMACEUTICALS USA, INC. yBENAZEPRIL TAB 10MG 00093512505 TEVA PHARMACEUTICALS USA, INC. yBENAZEPRIL TAB 20MG 00093512601 TEVA PHARMACEUTICALS USA, INC. yBENAZEPRIL TAB 20MG 00093512605 TEVA PHARMACEUTICALS USA, INC. yBENAZEPRIL TAB 40MG 00093512701 TEVA PHARMACEUTICALS USA, INC. yAMPICILLIN CAP 250MG 00093514501 TEVA PHARMACEUTICALS USA, INC. yAMPICILLIN CAP 250MG 00093514505 TEVA PHARMACEUTICALS USA, INC. yAMPICILLIN CAP 500MG 00093514601 TEVA PHARMACEUTICALS USA, INC. yAMPICILLIN CAP 500MG 00093514605 TEVA PHARMACEUTICALS USA, INC. yMOEXIPRIL TAB 15MG 00093515001 TEVA PHARMACEUTICALS USA, INC. yLISINOPRIL TAB 30MG 00093515701 TEVA PHARMACEUTICALS USA, INC. yTIZANIDINE TAB 4MG 00093516051 TEVA PHARMACEUTICALS USA, INC. yHYDROCOD/IBU TAB 7.5-200 00093516101 TEVA PHARMACEUTICALS USA, INC. yTIZANIDINE TAB 2MG 00093516351 TEVA PHARMACEUTICALS USA, INC. yNIFEDICAL XL TAB 60MG 00093517301 TEVA PHARMACEUTICALS USA, INC. yNIFEDICAL XL TAB 60MG 00093517355 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 250MG 00093519401 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 250MG 00093519410 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 500MG 00093519501 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK TAB 500MG 00093519505 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 125/5ML 00093519873 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 125/5ML 00093519874 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 250/5ML 00093519973 TEVA PHARMACEUTICALS USA, INC. yPENICILLN VK SOL 250/5ML 00093519974 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 30MG 00093520005 TEVA PHARMACEUTICALS USA, INC. yBUSPIRONE TAB 30MG 00093520006 TEVA PHARMACEUTICALS USA, INC. yOXYBUTYNIN TAB 15MG ER 00093520801 TEVA PHARMACEUTICALS USA, INC. yOMEPRAZOLE CAP 10MG 00093521001 TEVA PHARMACEUTICALS USA, INC. yOMEPRAZOLE CAP 20MG 00093521101 TEVA PHARMACEUTICALS USA, INC. yOMEPRAZOLE CAP 20MG 00093521110 TEVA PHARMACEUTICALS USA, INC. yOMEPRAZOLE CAP 20MG 00093521156 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLINDAMYCIN CAP 300MG 00093525601 TEVA PHARMACEUTICALS USA, INC. yCLINDAMYCIN CAP 300MG 00093525668 TEVA PHARMACEUTICALS USA, INC. yBISOPROL FUM TAB 10MG 00093527156 TEVA PHARMACEUTICALS USA, INC. yNIFEDIAC CC TAB 30MG ER 00093527201 TEVA PHARMACEUTICALS USA, INC. yNIFEDIAC CC TAB 30MG ER 00093527255 TEVA PHARMACEUTICALS USA, INC. yPOLYETH GLYC POW 3350 NF 00093529922 TEVA PHARMACEUTICALS USA, INC. yPOLYETH GLYC POW 3350 NF 00093529925 TEVA PHARMACEUTICALS USA, INC. yPOLYETH GLYC POW 3350 NF 00093529982 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 10MEQ CR 00093531001 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 10MEQ CR 00093531010 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 20MEQ CR 00093531101 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 20MEQ CR 00093531105 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 20MEQ CR 00093531110 TEVA PHARMACEUTICALS USA, INC. yTRI-PREVIFEM TAB 00093531528 TEVA PHARMACEUTICALS USA, INC. yTRI-PREVIFEM TAB 00093531581 TEVA PHARMACEUTICALS USA, INC. yPREVIFEM TAB 00093531628 TEVA PHARMACEUTICALS USA, INC. yPREVIFEM TAB 00093531681 TEVA PHARMACEUTICALS USA, INC. yBUDEPRION XL TAB 300MG 00093535105 TEVA PHARMACEUTICALS USA, INC. yBUDEPRION XL TAB 300MG 00093535156 TEVA PHARMACEUTICALS USA, INC. yQUINAPRIL TAB 5MG 00093545698 TEVA PHARMACEUTICALS USA, INC. yQUINAPRIL TAB 10MG 00093545798 TEVA PHARMACEUTICALS USA, INC. yQUINAPRIL TAB 20MG 00093545898 TEVA PHARMACEUTICALS USA, INC. yQUINAPRIL TAB 40MG 00093545998 TEVA PHARMACEUTICALS USA, INC. ySMZ-TMP SUS 200-40/5 00093547616 TEVA PHARMACEUTICALS USA, INC. yBUDEPRION TAB 100MG SR 00093550101 TEVA PHARMACEUTICALS USA, INC. yBUDEPRION TAB 150MG SR 00093550201 TEVA PHARMACEUTICALS USA, INC. yMERCAPTOPUR TAB 50MG 00093551006 TEVA PHARMACEUTICALS USA, INC. yZIDOVUDINE TAB 300MG 00093553006 TEVA PHARMACEUTICALS USA, INC. yBUPROBAN TAB 150MG 00093570301 TEVA PHARMACEUTICALS USA, INC. yLAMOTRIGINE CHW 5MG 00093571501 TEVA PHARMACEUTICALS USA, INC. yLAMOTRIGINE CHW 25MG 00093571601 TEVA PHARMACEUTICALS USA, INC. yFINASTERIDE TAB 5MG 00093582501 TEVA PHARMACEUTICALS USA, INC. yFINASTERIDE TAB 5MG 00093582505 TEVA PHARMACEUTICALS USA, INC. yFINASTERIDE TAB 5MG 00093582556 TEVA PHARMACEUTICALS USA, INC. yFINASTERIDE TAB 5MG 00093582598 TEVA PHARMACEUTICALS USA, INC. yFLUOXETINE SOL 20MG/5ML 00093610812 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PREDNISOLONE SYP 15MG/5ML 00093611816 TEVA PHARMACEUTICALS USA, INC. yPREDNISOLONE SYP 15MG/5ML 00093611887 TEVA PHARMACEUTICALS USA, INC. yMESALAMINE ENE 4GM 00093688871 TEVA PHARMACEUTICALS USA, INC. yNEFAZODONE TAB 150MG 00093711306 TEVA PHARMACEUTICALS USA, INC. yPAROXETINE TAB 10MG 00093711456 TEVA PHARMACEUTICALS USA, INC. yPAROXETINE TAB 10MG 00093711498 TEVA PHARMACEUTICALS USA, INC. yPAROXETINE TAB 30MG 00093711656 TEVA PHARMACEUTICALS USA, INC. yPAROXETINE TAB 30MG 00093711698 TEVA PHARMACEUTICALS USA, INC. yFLUTAMIDE CAP 125MG 00093712005 TEVA PHARMACEUTICALS USA, INC. yFLUTAMIDE CAP 125MG 00093712086 TEVA PHARMACEUTICALS USA, INC. yPAROXETINE TAB 40MG 00093712156 TEVA PHARMACEUTICALS USA, INC. yPAROXETINE TAB 40MG 00093712198 TEVA PHARMACEUTICALS USA, INC. yTORSEMIDE TAB 5MG 00093712701 TEVA PHARMACEUTICALS USA, INC. yTORSEMIDE TAB 10MG 00093712801 TEVA PHARMACEUTICALS USA, INC. yTORSEMIDE TAB 20MG 00093712901 TEVA PHARMACEUTICALS USA, INC. yTORSEMIDE TAB 100MG 00093713001 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 250MG 00093714609 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 250MG 00093714618 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 250MG 00093714656 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 600MG 00093714756 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 5MG 00093715256 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 5MG 00093715298 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 10MG 00093715310 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 10MG 00093715356 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 10MG 00093715398 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 20MG 00093715410 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 20MG 00093715456 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 20MG 00093715498 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 40MG 00093715510 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 40MG 00093715556 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 40MG 00093715598 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 80MG 00093715610 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 80MG 00093715656 TEVA PHARMACEUTICALS USA, INC. ySIMVASTATIN TAB 80MG 00093715698 TEVA PHARMACEUTICALS USA, INC. yCLARITHROMYC TAB 250MG 00093715706 TEVA PHARMACEUTICALS USA, INC. yCLARITHROMYC TAB 500MG 00093715806 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PERGOLIDE TAB 0.25MG 00093715901 TEVA PHARMACEUTICALS USA, INC. yPERGOLIDE TAB 1MG 00093716101 TEVA PHARMACEUTICALS USA, INC. yZONISAMIDE CAP 100MG 00093716201 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 500MG 00093716933 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 500MG 00093716956 TEVA PHARMACEUTICALS USA, INC. yAZITHROMYCIN TAB 500MG 00093716990 TEVA PHARMACEUTICALS USA, INC. yETODOLAC ER TAB 500MG 00093717201 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN TAB 600MG 00093717301 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN TAB 600MG 00093717305 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN TAB 800MG 00093717401 TEVA PHARMACEUTICALS USA, INC. yGABAPENTIN TAB 800MG 00093717405 TEVA PHARMACEUTICALS USA, INC. ySERTRALINE TAB 25MG 00093717556 TEVA PHARMACEUTICALS USA, INC. ySERTRALINE TAB 50MG 00093717610 TEVA PHARMACEUTICALS USA, INC. ySERTRALINE TAB 50MG 00093717656 TEVA PHARMACEUTICALS USA, INC. ySERTRALINE TAB 100MG 00093717710 TEVA PHARMACEUTICALS USA, INC. ySERTRALINE TAB 100MG 00093717756 TEVA PHARMACEUTICALS USA, INC. yNEFAZODONE TAB 50MG 00093717801 TEVA PHARMACEUTICALS USA, INC. yOFLOXACIN TAB 200MG 00093718001 TEVA PHARMACEUTICALS USA, INC. yOFLOXACIN TAB 300MG 00093718101 TEVA PHARMACEUTICALS USA, INC. yOFLOXACIN TAB 400MG 00093718201 TEVA PHARMACEUTICALS USA, INC. yFLUOXETINE TAB 10MG 00093718856 TEVA PHARMACEUTICALS USA, INC. yFLUOXETINE CAP 40MG 00093719856 TEVA PHARMACEUTICALS USA, INC. yPRAVASTATIN TAB 20MG 00093720110 TEVA PHARMACEUTICALS USA, INC. yPRAVASTATIN TAB 20MG 00093720198 TEVA PHARMACEUTICALS USA, INC. yPRAVASTATIN TAB 40MG 00093720210 TEVA PHARMACEUTICALS USA, INC. yPRAVASTATIN TAB 40MG 00093720298 TEVA PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 100MG 00093720356 TEVA PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 150MG 00093720419 TEVA PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 150MG 00093720422 TEVA PHARMACEUTICALS USA, INC. yFLUCONAZOLE TAB 200MG 00093720556 TEVA PHARMACEUTICALS USA, INC. yMIRTAZAPINE TAB 15MG 00093720656 TEVA PHARMACEUTICALS USA, INC. yMIRTAZAPINE TAB 30MG 00093720756 TEVA PHARMACEUTICALS USA, INC. yMIRTAZAPINE TAB 45MG 00093720856 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 750MG ER 00093721201 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 1000MG 00093721401 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 1000MG 00093721405 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METFORMIN TAB 1000MG 00093721410 TEVA PHARMACEUTICALS USA, INC. yMETOLAZONE TAB 10MG 00093721701 TEVA PHARMACEUTICALS USA, INC. yFOSINOPRIL TAB 10MG 00093722210 TEVA PHARMACEUTICALS USA, INC. yFOSINOPRIL TAB 10MG 00093722298 TEVA PHARMACEUTICALS USA, INC. yFOSINOPRIL TAB 20MG 00093722310 TEVA PHARMACEUTICALS USA, INC. yFOSINOPRIL TAB 20MG 00093722398 TEVA PHARMACEUTICALS USA, INC. yFOSINOPRIL TAB 40MG 00093722410 TEVA PHARMACEUTICALS USA, INC. yFOSINOPRIL TAB 40MG 00093722498 TEVA PHARMACEUTICALS USA, INC. yRIBAVIRIN CAP 200MG 00093722758 TEVA PHARMACEUTICALS USA, INC. yRIBAVIRIN CAP 200MG 00093722763 TEVA PHARMACEUTICALS USA, INC. yRIBAVIRIN CAP 200MG 00093722772 TEVA PHARMACEUTICALS USA, INC. yRIBAVIRIN CAP 200MG 00093722777 TEVA PHARMACEUTICALS USA, INC. yCILOSTAZOL TAB 50MG 00093723006 TEVA PHARMACEUTICALS USA, INC. yCILOSTAZOL TAB 100MG 00093723106 TEVA PHARMACEUTICALS USA, INC. yRIBAVIRIN TAB 200MG 00093723281 TEVA PHARMACEUTICALS USA, INC. yMELOXICAM TAB 7.5MG 00093723401 TEVA PHARMACEUTICALS USA, INC. yCLARITHROMYC TAB 500MG 00093724406 TEVA PHARMACEUTICALS USA, INC. yFEXOFENADINE TAB 30MG 00093725101 TEVA PHARMACEUTICALS USA, INC. yFEXOFENADINE TAB 60MG 00093725201 TEVA PHARMACEUTICALS USA, INC. yFEXOFENADINE TAB 60MG 00093725205 TEVA PHARMACEUTICALS USA, INC. yFEXOFENADINE TAB 180MG 00093725301 TEVA PHARMACEUTICALS USA, INC. yFEXOFENADINE TAB 180MG 00093725305 TEVA PHARMACEUTICALS USA, INC. yGLIMEPIRIDE TAB 1MG 00093725401 TEVA PHARMACEUTICALS USA, INC. yGLIMEPIRIDE TAB 2MG 00093725501 TEVA PHARMACEUTICALS USA, INC. yGLIMEPIRIDE TAB 4MG 00093725601 TEVA PHARMACEUTICALS USA, INC. yGLIMEPIRIDE TAB 4MG 00093725652 TEVA PHARMACEUTICALS USA, INC. yGLYB/METFORM TAB 1.25/250 00093726001 TEVA PHARMACEUTICALS USA, INC. yGLYB/METFORM TAB 2.5/500 00093726101 TEVA PHARMACEUTICALS USA, INC. yGLYB/METFORM TAB 2.5/500 00093726105 TEVA PHARMACEUTICALS USA, INC. yGLYB/METFORM TAB 5/500MG 00093726201 TEVA PHARMACEUTICALS USA, INC. yGLYB/METFORM TAB 5/500MG 00093726205 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 500MG ER 00093726701 TEVA PHARMACEUTICALS USA, INC. yMETFORMIN TAB 500MG ER 00093726710 TEVA PHARMACEUTICALS USA, INC. yMELOXICAM TAB 15MG 00093729901 TEVA PHARMACEUTICALS USA, INC. yMINOCYCLINE CAP 75MG 00093730001 TEVA PHARMACEUTICALS USA, INC. yMIRTAZAPINE TAB 15MG ODT 00093730365 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MIRTAZAPINE TAB 30MG ODT 00093730465 TEVA PHARMACEUTICALS USA, INC. yMIRTAZAPINE TAB 45MG ODT 00093730565 TEVA PHARMACEUTICALS USA, INC. yDESMOPRESSIN TAB 0.1MG 00093731601 TEVA PHARMACEUTICALS USA, INC. yDESMOPRESSIN TAB 0.2MG 00093731701 TEVA PHARMACEUTICALS USA, INC. yFINASTERIDE TAB 5MG 00093735556 TEVA PHARMACEUTICALS USA, INC. yVENLAFAXINE TAB 37.5MG 00093738001 TEVA PHARMACEUTICALS USA, INC. yVENLAFAXINE TAB 50MG 00093738101 TEVA PHARMACEUTICALS USA, INC. yVENLAFAXINE TAB 75MG 00093738201 TEVA PHARMACEUTICALS USA, INC. yVENLAFAXINE TAB 100MG 00093738301 TEVA PHARMACEUTICALS USA, INC. ySOTALOL AF TAB 80MG 00093740106 TEVA PHARMACEUTICALS USA, INC. ySOTALOL AF TAB 120MG 00093740206 TEVA PHARMACEUTICALS USA, INC. ySOTALOL AF TAB 160MG 00093740306 TEVA PHARMACEUTICALS USA, INC. yGLIP/METFORM TAB 2.5-250M 00093745501 TEVA PHARMACEUTICALS USA, INC. yGLIP/METFORM TAB 2.5-500M 00093745601 TEVA PHARMACEUTICALS USA, INC. yGLIP/METFORM TAB 5-500MG 00093745701 TEVA PHARMACEUTICALS USA, INC. yZONISAMIDE CAP 25MG 00093750801 TEVA PHARMACEUTICALS USA, INC. yZONISAMIDE CAP 50MG 00093750901 TEVA PHARMACEUTICALS USA, INC. yGLYBURID MCR TAB 1.5MG 00093803401 TEVA PHARMACEUTICALS USA, INC. yGLYBURID MCR TAB 3MG 00093803501 TEVA PHARMACEUTICALS USA, INC. yGLYBURID MCR TAB 3MG 00093803505 TEVA PHARMACEUTICALS USA, INC. yGLYBURID MCR TAB 6MG 00093803601 TEVA PHARMACEUTICALS USA, INC. yDOXAZOSIN TAB 1MG 00093812001 TEVA PHARMACEUTICALS USA, INC. yDOXAZOSIN TAB 2MG 00093812101 TEVA PHARMACEUTICALS USA, INC. yDOXAZOSIN TAB 4MG 00093812201 TEVA PHARMACEUTICALS USA, INC. yDOXAZOSIN TAB 8MG 00093812301 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 12.5MG 00093813201 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 12.5MG 00093813210 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 25MG 00093813301 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 25MG 00093813310 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 50MG 00093813401 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 50MG 00093813410 TEVA PHARMACEUTICALS USA, INC. yCAPTOPRIL TAB 100MG 00093813501 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE TAB 200MG 00093818101 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE TAB 300MG 00093819201 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE TAB 300MG 00093819205 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE TAB 400MG 00093820401 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIMETIDINE TAB 400MG 00093820405 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE TAB 800MG 00093830501 TEVA PHARMACEUTICALS USA, INC. yCIMETIDINE TAB 800MG 00093830505 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 1.25MG 00093834201 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 2.5MG 00093834301 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 2.5MG 00093834305 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 2.5MG 00093834310 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 5MG 00093834401 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 5MG 00093834405 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 5MG 00093834410 TEVA PHARMACEUTICALS USA, INC. yETODOLAC CAP 300MG 00093839701 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 150MG 00093854401 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 150MG 00093854405 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 150MG 00093854406 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 150MG 00093854410 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 300MG 00093854701 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 300MG 00093854752 TEVA PHARMACEUTICALS USA, INC. yRANITIDINE TAB 300MG 00093854756 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV SUS 600/5ML 00093867574 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV SUS 600/5ML 00093867575 TEVA PHARMACEUTICALS USA, INC. yAMOX/K CLAV SUS 600/5ML 00093867578 TEVA PHARMACEUTICALS USA, INC. yMEXILETINE CAP 150MG 00093873901 TEVA PHARMACEUTICALS USA, INC. yMEXILETINE CAP 200MG 00093874001 TEVA PHARMACEUTICALS USA, INC. yMEXILETINE CAP 250MG 00093874101 TEVA PHARMACEUTICALS USA, INC. yTOLMETIN SOD CAP 400MG 00093881501 TEVA PHARMACEUTICALS USA, INC. yACYCLOVIR CAP 200MG 00093894001 TEVA PHARMACEUTICALS USA, INC. yACYCLOVIR CAP 200MG 00093894005 TEVA PHARMACEUTICALS USA, INC. yACYCLOVIR TAB 400MG 00093894301 TEVA PHARMACEUTICALS USA, INC. yACYCLOVIR TAB 400MG 00093894305 TEVA PHARMACEUTICALS USA, INC. yACYCLOVIR TAB 800MG 00093894701 TEVA PHARMACEUTICALS USA, INC. yACYCLOVIR TAB 800MG 00093894705 TEVA PHARMACEUTICALS USA, INC. yMEBENDAZOLE CHW 100MG 00093910729 TEVA PHARMACEUTICALS USA, INC. yPRENATAL TAB PLUS 00093911101 TEVA PHARMACEUTICALS USA, INC. yPRENATAL TAB PLUS 00093911105 TEVA PHARMACEUTICALS USA, INC. yPROCAINAMIDE TAB 750MG ER 00093911401 TEVA PHARMACEUTICALS USA, INC. yPROCAINAMIDE TAB 750MG ER 00093911405 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROCAINAMIDE TAB 1000 ER 00093911701 TEVA PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 00093912815 TEVA PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 00093912830 TEVA PHARMACEUTICALS USA, INC. yCLOBETASOL OIN 0.05% 00093912895 TEVA PHARMACEUTICALS USA, INC. yAMIODARONE TAB 200MG 00093913306 TEVA PHARMACEUTICALS USA, INC. yAMIODARONE TAB 200MG 00093913352 TEVA PHARMACEUTICALS USA, INC. yPRENATAL RX TAB BETA-CAR 00093916505 TEVA PHARMACEUTICALS USA, INC. yHYDROCORT ENE 100MG 00093916871 TEVA PHARMACEUTICALS USA, INC. yQUINIDINE SU TAB 300MG ER 00093917501 TEVA PHARMACEUTICALS USA, INC. yQUINIDINE SU TAB 300MG ER 00093917552 TEVA PHARMACEUTICALS USA, INC. yPROCAINAMIDE TAB 500MG CR 00093918801 TEVA PHARMACEUTICALS USA, INC. yPROCAINAMIDE TAB 500MG CR 00093918805 TEVA PHARMACEUTICALS USA, INC. yLIDOCAINE GEL 2% JELLY 00093920031 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 8MEQ SA 00093922501 TEVA PHARMACEUTICALS USA, INC. yPOT CHLORIDE TAB 8MEQ SA 00093922510 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 5MG 00093936401 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 5MG 00093936405 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 5MG 00093936410 TEVA PHARMACEUTICALS USA, INC. yURSODIOL CAP 300MG 00093938001 TEVA PHARMACEUTICALS USA, INC. yMETHAZOLAMID TAB 25MG 00093941101 TEVA PHARMACEUTICALS USA, INC. yMETHAZOLAMID TAB 50MG 00093942401 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 2.5MG 00093943301 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 2.5MG 00093943305 TEVA PHARMACEUTICALS USA, INC. yGLYBURIDE TAB 1.25MG 00093947753 TEVA PHARMACEUTICALS USA, INC. yHALOPERIDOL CON 2MG/ML 00093960412 TEVA PHARMACEUTICALS USA, INC. yHALOPERIDOL CON 2MG/ML 00093960423 TEVA PHARMACEUTICALS USA, INC. yDOXEPIN HCL CON 10MG/ML 00093961212 TEVA PHARMACEUTICALS USA, INC. ySILVER NITRA SOL 0.5% 00093961413 TEVA PHARMACEUTICALS USA, INC. yVALPROIC ACD SYP 250/5ML 00093963316 TEVA PHARMACEUTICALS USA, INC. yPROCHLORPER TAB 5MG 00093964301 TEVA PHARMACEUTICALS USA, INC. yCLOBETASOL CRE 0.05% 00093965015 TEVA PHARMACEUTICALS USA, INC. yCLOBETASOL CRE 0.05% 00093965030 TEVA PHARMACEUTICALS USA, INC. yCLOBETASOL CRE 0.05% 00093965095 TEVA PHARMACEUTICALS USA, INC. yPROCHLORPER TAB 10MG 00093965201 TEVA PHARMACEUTICALS USA, INC. ySOD FLUORIDE DRO 0.5MG/ML 00093965457 TEVA PHARMACEUTICALS USA, INC. yETHOSUXIMIDE SOL 250/5ML 00093966016 TEVA PHARMACEUTICALS USA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROXYCHLOR TAB 200MG 00093977401 TEVA PHARMACEUTICALS USA, INC. yHYDROXYCHLOR TAB 200MG 00093977405 TEVA PHARMACEUTICALS USA, INC. yHYDROCORT CRE 1% 49158010107 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 49158010108 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 49158010112 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 49158010116 THAMES PHARMACEUTICALS, INC. yHYDROCORT OIN 1% 49158010308 THAMES PHARMACEUTICALS, INC. yCLIOQUIN/HC CRE 3-1% 49158010408 THAMES PHARMACEUTICALS, INC. yPOVIDONE-IOD OIN 10% 49158011108 THAMES PHARMACEUTICALS, INC. yPOVIDONE-IOD SOL 10% 49158011538 THAMES PHARMACEUTICALS, INC. yTHERAPEUTIC OIL BATH 49158011736 THAMES PHARMACEUTICALS, INC. yLIDOCAINE OIN 5% 49158013019 THAMES PHARMACEUTICALS, INC. ySKIN MOISTUR LOT 49158013236 THAMES PHARMACEUTICALS, INC. yBENZOYL PER GEL 5% 49158013709 THAMES PHARMACEUTICALS, INC. yBENZOYL PER GEL 10% 49158013809 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.025% 49158013920 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.025% 49158013921 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.025% 49158013922 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 49158014008 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 49158014016 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 49158014020 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 49158014021 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.1% 49158014022 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON CRE 0.5% 49158014120 THAMES PHARMACEUTICALS, INC. yBENZOYL PER LOT 5% 49158015731 THAMES PHARMACEUTICALS, INC. yBENZOYL PER LOT 10% 49158015831 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON OIN 0.1% 49158016008 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON OIN 0.1% 49158016020 THAMES PHARMACEUTICALS, INC. yTRIAMCINOLON OIN 0.1% 49158016021 THAMES PHARMACEUTICALS, INC. yGENTAMICIN CRE 0.1% 49158016220 THAMES PHARMACEUTICALS, INC. yGENTAMICIN CRE 0.1% 49158016268 THAMES PHARMACEUTICALS, INC. yBETAMETH VAL CRE 0.1% 49158018427 THAMES PHARMACEUTICALS, INC. yGENTAMICIN OIN 0.1% 49158019168 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 2.5% 49158020007 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 2.5% 49158020008 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 2.5% 49158020016 THAMES PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FLUOCINONIDE CRE 0.05% 49158021224 THAMES PHARMACEUTICALS, INC. yNU SOAP LOT 49158023536 THAMES PHARMACEUTICALS, INC. yBETAMETH DIP LOT 0.05% 49158024532 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 49158033808 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 49158033812 THAMES PHARMACEUTICALS, INC. yHYDROCORT CRE 1% 49158033816 THAMES PHARMACEUTICALS, INC. yHYDROCORT OIN 1% 49158033908 THAMES PHARMACEUTICALS, INC. yMETAMUCIL POW 30.9% 37000001308 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 30.9% 37000001309 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 30.9% 37000001310 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 525/15ML 37000001901 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 525/15ML 37000001902 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 525/15ML 37000001903 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 28% ORNG 37000002304 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 28.3%ORG 37000002305 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 28.3%ORG 37000002306 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 28.3%ORG 37000002307 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 58.6%ORG 37000002401 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 58.6%ORG 37000002402 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 58.6 ORG 37000002404 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 58.6%ORG 37000002406 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL POW 58.6% OR 37000002407 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL WAF 1.7GM 37000002901 THE PROCTER & GAMBLE DISTRIBUTING CO. yMETAMUCIL WAF 1.7GM 37000003001 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 262/15ML 37000003201 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 262/15ML 37000003202 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 262/15ML 37000003203 THE PROCTER & GAMBLE DISTRIBUTING CO. yPEPTO-BISMOL SUS 262/15ML 37000003204 THE PROCTER & GAMBLE DISTRIBUTING CO. yPRILOSEC OTC TAB 20MG 37000045502 THE PROCTER & GAMBLE DISTRIBUTING CO. yPRILOSEC OTC TAB 20MG 37000045503 THE PROCTER & GAMBLE DISTRIBUTING CO. yPRILOSEC OTC TAB 20MG 37000045504 THE PROCTER & GAMBLE DISTRIBUTING CO. yPRILOSEC OTC TAB 20MG 37000045505 THE PROCTER & GAMBLE DISTRIBUTING CO. yDAYQUIL LIQ 37000051106 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS 44D ELX COUGH 37000051404 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS 44D ELX COUGH 37000051408 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS 44E SYP 37000051504 THE PROCTER & GAMBLE DISTRIBUTING CO. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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VICKS 44E SYP 37000051508 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS 44M LIQ 37000051604 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS 44M LIQ 37000051608 THE PROCTER & GAMBLE DISTRIBUTING CO. yNYQUIL LIQ CHERRY 37000051706 THE PROCTER & GAMBLE DISTRIBUTING CO. yNYQUIL LIQ CHERRY 37000051707 THE PROCTER & GAMBLE DISTRIBUTING CO. yNYQUIL LIQ ORIGINAL 37000051806 THE PROCTER & GAMBLE DISTRIBUTING CO. yNYQUIL LIQ ORIGINAL 37000051807 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS FORM SYP 44E PED 37000052004 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS FORM SYP 44M PED 37000052104 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS LIQ VAPSTEAM 37000052204 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS LIQ VAPSTEAM 37000052208 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICK VAPORUB CRE 37000052902 THE PROCTER & GAMBLE DISTRIBUTING CO. yDAYQUIL TAB SINUS 37000053002 THE PROCTER & GAMBLE DISTRIBUTING CO. yDAYQUIL TAB SINUS 37000053007 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS 44 CGH CAP COLD&FLU 37000053502 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS VAPOR INH 37000053607 THE PROCTER & GAMBLE DISTRIBUTING CO. yDAYQUIL CAP LIQUICAP 37000053705 THE PROCTER & GAMBLE DISTRIBUTING CO. yDAYQUIL CAP LIQUICAP 37000053707 THE PROCTER & GAMBLE DISTRIBUTING CO. yNYQUIL CAP LIQUICAP 37000053902 THE PROCTER & GAMBLE DISTRIBUTING CO. yNYQUIL CAP LIQUICAP 37000053904 THE PROCTER & GAMBLE DISTRIBUTING CO. ySINEX REGULR SPR 0.5% 37000054005 THE PROCTER & GAMBLE DISTRIBUTING CO. ySINEX UF MST SPR 0.5% REG 37000054105 THE PROCTER & GAMBLE DISTRIBUTING CO. ySINEX L-A SPR 0.05% 37000054205 THE PROCTER & GAMBLE DISTRIBUTING CO. ySINEX UF MST SPR 0.05%12H 37000054305 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS OIN VAPORUB 37000054401 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS OIN VAPORUB 37000054403 THE PROCTER & GAMBLE DISTRIBUTING CO. yVICKS OIN VAPORUB 37000054406 THE PROCTER & GAMBLE DISTRIBUTING CO. yRE-AZO TAB 97 MG 10956055132 THE REESE CHEMICAL COMPANY ySLEEP-ETTES TAB D 50MG 10956060124 THE REESE CHEMICAL COMPANY ySLEEP-ETTES TAB D 50MG 10956060148 THE REESE CHEMICAL COMPANY yALER-DRYL TAB 50MG 10956060724 THE REESE CHEMICAL COMPANY yALER-DRYL TAB 50MG 10956060748 THE REESE CHEMICAL COMPANY yDENTAPAINE GEL 10956060811 THE REESE CHEMICAL COMPANY yAURAPHENE-B SOL 6.5% OT 10956061653 THE REESE CHEMICAL COMPANY yREESES PIN- SUS WORM MED 10956061801 THE REESE CHEMICAL COMPANY yPAIN-EZE/RHU TAB 650MG 10956062525 THE REESE CHEMICAL COMPANY y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PAIN-EZE/RHU TAB 650MG 10956062550 THE REESE CHEMICAL COMPANY yRECOFEN "D" LIQ 100-5/5 10956063404 THE REESE CHEMICAL COMPANY yRECOFEN "D" LIQ 100-5/5 10956063408 THE REESE CHEMICAL COMPANY yPODACTIN POW 1% 10956064245 THE REESE CHEMICAL COMPANY yDOCU SOFT CAP 100MG 10956064360 THE REESE CHEMICAL COMPANY yANTI-NAUSEA/ SOL REKEMAT 10956064504 THE REESE CHEMICAL COMPANY yPINWORM TAB MEDICINE 10956065824 THE REESE CHEMICAL COMPANY yRECORT PLUS CRE 1% 10956067301 THE REESE CHEMICAL COMPANY yDOUBLE-TUSS LIQ DM 10956067404 THE REESE CHEMICAL COMPANY yIBUPROFEN TAB 200MG 10956067809 THE REESE CHEMICAL COMPANY yIBUPROFEN TAB 200MG 10956067824 THE REESE CHEMICAL COMPANY yIBUPROFEN TAB 200MG 10956067850 THE REESE CHEMICAL COMPANY yPHARMACISTS CRE CREME 10956068002 THE REESE CHEMICAL COMPANY yRECTACAINE SUP 10956069212 THE REESE CHEMICAL COMPANY yRECTACAINE OIN 10956070701 THE REESE CHEMICAL COMPANY yPODACTIN CRE 2% 10956070801 THE REESE CHEMICAL COMPANY yTRI-BIOZENE OIN 10956070915 THE REESE CHEMICAL COMPANY yLICIDE SHA 10956071104 THE REESE CHEMICAL COMPANY yBI-ZETS LOZ 10956071310 THE REESE CHEMICAL COMPANY yGYNAZOLE-1 CRE 2% 64011000108 THER-RX CORPORATION yMICRO-K CAP 10MEQ CR 64011000904 THER-RX CORPORATION yMICRO-K CAP 10MEQ CR 64011000908 THER-RX CORPORATION yMICRO-K CAP 10MEQ CR 64011000911 THER-RX CORPORATION yMICRO-K CAP 8MEQ CR 64011001004 THER-RX CORPORATION yMICRO-K CAP 8MEQ CR 64011001008 THER-RX CORPORATION yMICRO-K CAP 8MEQ CR 64011001011 THER-RX CORPORATION yPRECARE TAB CONCEIVE 64011001411 THER-RX CORPORATION yPRECARE TAB CONCEIVE 64011001419 THER-RX CORPORATION yPREMESIS RX TAB 64011001919 THER-RX CORPORATION yPRECARE CHW 64011002419 THER-RX CORPORATION yPRECARE TAB PRENATAL 64011011819 THER-RX CORPORATION ySTRONGSTART TAB 64011012811 THER-RX CORPORATION ySTRONGSTART TAB 64011012822 THER-RX CORPORATION yCHROMAGEN CAP 64011012911 THER-RX CORPORATION yCHROMAGEN FA CAP 64011013011 THER-RX CORPORATION yCHROMAGEN CAP FORTE 64011013111 THER-RX CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NIFEREX CAP 64011013411 THER-RX CORPORATION yNIFEREX-150 CAP 64011013511 THER-RX CORPORATION yNIFEREX-150 CAP FORTE 64011013611 THER-RX CORPORATION ySTRONGSTART CHW 64011013711 THER-RX CORPORATION ySTRONGSTART CHW 64011013722 THER-RX CORPORATION yPRIMACARE CAP ONE 64011014219 THER-RX CORPORATION yPRIMACARE MIS COMBO PK 64011014628 THER-RX CORPORATION yNIFEREX ELX 100/5ML 64011016005 THER-RX CORPORATION yNIFEREX GOLD TAB 64011016226 THER-RX CORPORATION yNIFEREX-150 CAP 64011016326 THER-RX CORPORATION yNIFEREX-150 CAP FORTE 64011016426 THER-RX CORPORATION yREPLIVA 21/7 TAB 64011016534 THER-RX CORPORATION yENCORA MIS 64011016636 THER-RX CORPORATION yPRECARE TAB PREMIER 64011019519 THER-RX CORPORATION yCHROMAGEN TAB FORTE 64011019726 THER-RX CORPORATION yCHROMAGEN TAB 64011019826 THER-RX CORPORATION yCHROMAGEN FA TAB 64011019926 THER-RX CORPORATION yPRIMACARE CAP ONE 64011020019 THER-RX CORPORATION yPRIMACARE MIS COMBO PK 64011020428 THER-RX CORPORATION yRIBASPHERE CAP 200MG 66435010118 THREE RIVERS PHARMACEUTICALS, LLC yRIBASPHERE TAB 200MG 66435010216 THREE RIVERS PHARMACEUTICALS, LLC yRIBASPHERE TAB 400MG 66435010356 THREE RIVERS PHARMACEUTICALS, LLC yRIBASPHERE TAB 600MG 66435010456 THREE RIVERS PHARMACEUTICALS, LLC yASPIRIN TAB 650MG EC 49483000201 TIME-CAP LABS, INC. yASPIRIN TAB 650MG EC 49483000210 TIME-CAP LABS, INC. yBISACODYL TAB 5MG EC 49483000301 TIME-CAP LABS, INC. yBISACODYL TAB 5MG EC 49483000310 TIME-CAP LABS, INC. yASPIRIN TAB 325MG 49483001101 TIME-CAP LABS, INC. yASPIRIN TAB 325MG 49483001110 TIME-CAP LABS, INC. yNIACIN CAP 125MG SR 49483001301 TIME-CAP LABS, INC. yNIACIN CAP 125MG SR 49483001310 TIME-CAP LABS, INC. yNIACIN CAP 250MG SR 49483001401 TIME-CAP LABS, INC. yNIACIN CAP 250MG SR 49483001410 TIME-CAP LABS, INC. yNIACIN CAP 400MG SR 49483001501 TIME-CAP LABS, INC. yNIACIN CAP 400MG SR 49483001510 TIME-CAP LABS, INC. yPSEUDOEPHEDR TAB 30MG 49483001601 TIME-CAP LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PSEUDOEPHEDR TAB 30MG 49483001610 TIME-CAP LABS, INC. yPSEUDOEPHEDR TAB 30MG 49483001624 TIME-CAP LABS, INC. yPSEUDOEPHEDR TAB 30MG 49483001648 TIME-CAP LABS, INC. yPSEUDOEPHEDR TAB 30MG 49483001696 TIME-CAP LABS, INC. yNIACIN CAP 500MG SR 49483001801 TIME-CAP LABS, INC. yNIACIN CAP 500MG SR 49483001810 TIME-CAP LABS, INC. yPARA-TIME CAP 150MG ER 49483001901 TIME-CAP LABS, INC. yPARA-TIME CAP 150MG ER 49483001910 TIME-CAP LABS, INC. yPARA-TIME CAP 150MG ER 49483001950 TIME-CAP LABS, INC. yTHYROID TAB 30MG 49483002101 TIME-CAP LABS, INC. yTHYROID TAB 30MG 49483002110 TIME-CAP LABS, INC. yTHYROID TAB 60MG 49483002201 TIME-CAP LABS, INC. yTHYROID TAB 60MG 49483002210 TIME-CAP LABS, INC. yTHYROID TAB 120MG 49483002301 TIME-CAP LABS, INC. yTHYROID TAB 120MG 49483002310 TIME-CAP LABS, INC. yASPIRIN TAB 325MG EC 49483003201 TIME-CAP LABS, INC. yASPIRIN TAB 325MG EC 49483003210 TIME-CAP LABS, INC. yTHYROID TAB 195MG 49483003801 TIME-CAP LABS, INC. yTHYROID TAB 195MG 49483003810 TIME-CAP LABS, INC. yCHLORPHENIR CAP 8MG ER 49483004101 TIME-CAP LABS, INC. yCHLORPHENIR CAP 8MG ER 49483004110 TIME-CAP LABS, INC. yCHLORPHENIR CAP 12MG ER 49483004301 TIME-CAP LABS, INC. yCHLORPHENIR CAP 12MG ER 49483004310 TIME-CAP LABS, INC. yASPIRIN TAB 325MG EC 49483005201 TIME-CAP LABS, INC. yASPIRIN TAB 325MG EC 49483005210 TIME-CAP LABS, INC. yASPIRIN TAB 81MG EC 49483005410 TIME-CAP LABS, INC. yASPIRIN TAB 81MG EC 49483005412 TIME-CAP LABS, INC. yCORRECT TAB 5MG EC 49483005701 TIME-CAP LABS, INC. yCORRECT TAB 5MG EC 49483005710 TIME-CAP LABS, INC. yDIPHENHYDRAM TAB 25MG 49483006101 TIME-CAP LABS, INC. yDIPHENHYDRAM TAB 25MG 49483006110 TIME-CAP LABS, INC. ySENNA-TIME TAB 8.6MG 49483008001 TIME-CAP LABS, INC. ySENNA-TIME TAB 8.6MG 49483008010 TIME-CAP LABS, INC. ySENNA-TIME S TAB 8.6-50MG 49483008101 TIME-CAP LABS, INC. ySENNA-TIME S TAB 8.6-50MG 49483008110 TIME-CAP LABS, INC. yASPIRIN TAB 81MG EC 49483010701 TIME-CAP LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ASPIRIN TAB 81MG EC 49483010710 TIME-CAP LABS, INC. yNITRO-TIME CAP 2.5MG CR 49483022106 TIME-CAP LABS, INC. yNITRO-TIME CAP 2.5MG CR 49483022110 TIME-CAP LABS, INC. yNITROGLYCER CAP 6.5MG CR 49483022206 TIME-CAP LABS, INC. yNITROGLYCER CAP 6.5MG CR 49483022210 TIME-CAP LABS, INC. yNITRO-TIME CAP 9MG CR 49483022306 TIME-CAP LABS, INC. yNITRO-TIME CAP 9MG CR 49483022310 TIME-CAP LABS, INC. yASPIRIN EC TAB 975MG 49483022401 TIME-CAP LABS, INC. ySENIOR TOPIX OIN VESTIX 58211035204 TOPIX PHARMACEUTICALS, INC. yRESURFIX OIN 58211035301 TOPIX PHARMACEUTICALS, INC. yRESURFIX OIN 58211035303 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX CRE EURIX 58211035404 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX OIN AQUIX 58211035504 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX OIN AQUIX 58211035515 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX OIN DIA RASH 58211035604 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX OIN DIA RASH 58211035616 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX OIN GUARDIX 58211035740 TOPIX PHARMACEUTICALS, INC. ySENIOR TOPIX OIN GUARDIX 58211035741 TOPIX PHARMACEUTICALS, INC. yRESURFIX CRE 58211035802 TOPIX PHARMACEUTICALS, INC. yGAS RELIEF DRO 55654000901 TRI-MED LABORATORIES, INC. yMULTI-VIT/FL DRO 0.25MG 55654001001 TRI-MED LABORATORIES, INC. yMULTI-VIT/FL DRO 0.5MG/ML 55654001101 TRI-MED LABORATORIES, INC. yTRI-VIT/FLUO DRO 0.25MG 55654001201 TRI-MED LABORATORIES, INC. yTRI-VIT/FLUO DRO 0.5MG 55654001301 TRI-MED LABORATORIES, INC. ySOD FLUORIDE DRO 0.125MG 55654001402 TRI-MED LABORATORIES, INC. yMULTI-VIT DRO 55654002001 TRI-MED LABORATORIES, INC. yMULTI-VIT DRO /FE 55654002101 TRI-MED LABORATORIES, INC. yCARBODEX DM DRO 55654002801 TRI-MED LABORATORIES, INC. yCARBODEX DM SYP 55654002905 TRI-MED LABORATORIES, INC. yCENOGEN ULTR CAP 52747014060 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE-F TAB 52747030630 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE-F TAB 52747030670 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE TAB 324MG 52747030730 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE TAB 324MG 52747030770 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE-F ELX 52747040490 U.S. PHARMACEUTICAL CORPORATION yNOREL DM SOL 52747041090 U.S. PHARMACEUTICAL CORPORATION y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NOREL SR TAB 52747042070 U.S. PHARMACEUTICAL CORPORATION yNOREL EX TAB 40-800MG 52747044070 U.S. PHARMACEUTICAL CORPORATION yMEDIGESIC CAP 52747060060 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE PLU CAP 52747080030 U.S. PHARMACEUTICAL CORPORATION yHEMOCYTE PLU CAP 52747080060 U.S. PHARMACEUTICAL CORPORATION yTANDEM CAP 52747090090 U.S. PHARMACEUTICAL CORPORATION yTANDEM F CAP 52747090160 U.S. PHARMACEUTICAL CORPORATION yTANDEM PLUS CAP 52747090260 U.S. PHARMACEUTICAL CORPORATION yTANDEM OB CAP 52747090360 U.S. PHARMACEUTICAL CORPORATION yLORCET PLUS TAB 7.5-650 00785112201 UAD LABORATORIES INC yLORCET PLUS TAB 7.5-650 00785112250 UAD LABORATORIES INC yLORCET TAB 10/650 00785635001 UAD LABORATORIES INC yLORCET TAB 10/650 00785635050 UAD LABORATORIES INC yLORCET TAB 10/650 00785635063 UAD LABORATORIES INC yKEPPRA SOL 100MG/ML 50474000148 UCB PHARMA, INC. yKEPPRA INJ 500/5ML 50474000263 UCB PHARMA, INC. yTHEO-24 CAP 100MG CR 50474010001 UCB PHARMA, INC. yTHEO-24 CAP 200MG CR 50474020001 UCB PHARMA, INC. yTHEO-24 CAP 200MG CR 50474020050 UCB PHARMA, INC. yVICON-C CAP 50474027322 UCB PHARMA, INC. yVICON-C CAP 50474027324 UCB PHARMA, INC. yTHEO-24 CAP 300MG CR 50474030001 UCB PHARMA, INC. yTHEO-24 CAP 300MG CR 50474030050 UCB PHARMA, INC. yVICON FORTE CAP 50474031622 UCB PHARMA, INC. yVICON FORTE CAP 50474031624 UCB PHARMA, INC. yVICON FORTE CAP 50474031627 UCB PHARMA, INC. yTRINSICON CAP 50474036422 UCB PHARMA, INC. yTRINSICON CAP 50474036423 UCB PHARMA, INC. yTRINSICON CAP 50474036424 UCB PHARMA, INC. yTRINSICON CAP 50474036427 UCB PHARMA, INC. yTRINSICON CAP 50474036428 UCB PHARMA, INC. yTHEO-24 CAP 400MG ER 50474040001 UCB PHARMA, INC. yTHEO-24 CAP 400MG ER 50474040060 UCB PHARMA, INC. yCORTICAINE CRE 0.5% 50474040501 UCB PHARMA, INC. yKEPPRA TAB 250MG 50474059140 UCB PHARMA, INC. yKEPPRA TAB 500MG 50474059240 UCB PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KEPPRA TAB 750MG 50474059340 UCB PHARMA, INC. yKEPPRA TAB 250MG 50474059440 UCB PHARMA, INC. yKEPPRA TAB 500MG 50474059540 UCB PHARMA, INC. yKEPPRA TAB 750MG 50474059640 UCB PHARMA, INC. yKEPPRA TAB 1000MG 50474059766 UCB PHARMA, INC. yLORTAB 5 TAB 50474090201 UCB PHARMA, INC. yLORTAB 5 TAB 50474090250 UCB PHARMA, INC. yLORTAB 5 TAB 50474090260 UCB PHARMA, INC. yLORTAB 7.5 TAB 50474090701 UCB PHARMA, INC. yLORTAB 7.5 TAB 50474090750 UCB PHARMA, INC. yLORTAB 7.5 TAB 50474090760 UCB PHARMA, INC. yLORTAB ELX 50474090916 UCB PHARMA, INC. yLORTAB 10 TAB 50474091001 UCB PHARMA, INC. yLORTAB 10 TAB 50474091050 UCB PHARMA, INC. yLORTAB 10 TAB 50474091060 UCB PHARMA, INC. yLORTAB 2.5 TAB 50474092501 UCB PHARMA, INC. yBUPHENYL POW 62592018864 UCYCLYD PHARMA, INC. yBUPHENYL TAB 500MG 62592049603 UCYCLYD PHARMA, INC. yACETAMIN TAB 325MG 51079000201 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000202 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000217 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000219 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000220 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000222 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000240 UDL LABORATORIES, INC. yACETAMIN TAB 325MG 51079000260 UDL LABORATORIES, INC. yOMEPRAZOLE CAP 20MG 51079000701 UDL LABORATORIES, INC. yOMEPRAZOLE CAP 20MG 51079000720 UDL LABORATORIES, INC. yNEOMYCIN TAB 500MG 51079001501 UDL LABORATORIES, INC. yNEOMYCIN TAB 500MG 51079001520 UDL LABORATORIES, INC. yCEFUROXIME TAB 250MG 51079001601 UDL LABORATORIES, INC. yCEFUROXIME TAB 250MG 51079001620 UDL LABORATORIES, INC. yCEFUROXIME TAB 500MG 51079001701 UDL LABORATORIES, INC. yCEFUROXIME TAB 500MG 51079001720 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 51079001901 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 51079001917 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DOCUSATE SOD CAP 100MG 51079001919 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 51079001920 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 51079001940 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 100MG 51079001960 UDL LABORATORIES, INC. yPREDNISONE TAB 20MG 51079002217 UDL LABORATORIES, INC. yPREDNISONE TAB 20MG 51079002219 UDL LABORATORIES, INC. yPREDNISONE TAB 20MG 51079002220 UDL LABORATORIES, INC. yMETOLAZONE TAB 2.5MG 51079002301 UDL LABORATORIES, INC. yMETOLAZONE TAB 2.5MG 51079002320 UDL LABORATORIES, INC. yMETOLAZONE TAB 5MG 51079002401 UDL LABORATORIES, INC. yMETOLAZONE TAB 5MG 51079002420 UDL LABORATORIES, INC. yTORSEMIDE TAB 10MG 51079002501 UDL LABORATORIES, INC. yTORSEMIDE TAB 10MG 51079002520 UDL LABORATORIES, INC. yTORSEMIDE TAB 20MG 51079002601 UDL LABORATORIES, INC. yTORSEMIDE TAB 20MG 51079002620 UDL LABORATORIES, INC. yQUINIDINE GL TAB 324MG CR 51079002701 UDL LABORATORIES, INC. yQUINIDINE GL TAB 324MG CR 51079002720 UDL LABORATORIES, INC. yPREDNISONE TAB 5MG 51079003217 UDL LABORATORIES, INC. yPREDNISONE TAB 5MG 51079003219 UDL LABORATORIES, INC. yPREDNISONE TAB 10MG 51079003317 UDL LABORATORIES, INC. yPREDNISONE TAB 10MG 51079003319 UDL LABORATORIES, INC. yPREDNISONE TAB 10MG 51079003320 UDL LABORATORIES, INC. yFOLIC ACID TAB 1MG 51079004101 UDL LABORATORIES, INC. yFOLIC ACID TAB 1MG 51079004117 UDL LABORATORIES, INC. yFOLIC ACID TAB 1MG 51079004119 UDL LABORATORIES, INC. yFOLIC ACID TAB 1MG 51079004120 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 250MG 51079004801 UDL LABORATORIES, INC. yDOCUSATE SOD CAP 250MG 51079004820 UDL LABORATORIES, INC. yCARISOPRODOL TAB 350MG 51079005501 UDL LABORATORIES, INC. yCARISOPRODOL TAB 350MG 51079005520 UDL LABORATORIES, INC. yCHLORTHALID TAB 25MG 51079005801 UDL LABORATORIES, INC. yCHLORTHALID TAB 25MG 51079005820 UDL LABORATORIES, INC. yCHLORTHALID TAB 50MG 51079005901 UDL LABORATORIES, INC. yCHLORTHALID TAB 50MG 51079005920 UDL LABORATORIES, INC. yCHLOROTHIAZ TAB 250MG 51079006001 UDL LABORATORIES, INC. yCHLOROTHIAZ TAB 250MG 51079006020 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

673 of 774

CHLOROTHIAZ TAB 500MG 51079006101 UDL LABORATORIES, INC. yCHLOROTHIAZ TAB 500MG 51079006120 UDL LABORATORIES, INC. yDIPHENHYDRAM CAP 50MG 51079006601 UDL LABORATORIES, INC. yDIPHENHYDRAM CAP 50MG 51079006617 UDL LABORATORIES, INC. yDIPHENHYDRAM CAP 50MG 51079006619 UDL LABORATORIES, INC. yDIPHENHYDRAM CAP 50MG 51079006620 UDL LABORATORIES, INC. yDIPHEN/ATROP TAB 2.5MG 51079006701 UDL LABORATORIES, INC. yDIPHEN/ATROP TAB 2.5MG 51079006717 UDL LABORATORIES, INC. yDIPHEN/ATROP TAB 2.5MG 51079006719 UDL LABORATORIES, INC. yDIPHEN/ATROP TAB 2.5MG 51079006720 UDL LABORATORIES, INC. yDIPYRIDAMOLE TAB 25MG 51079006801 UDL LABORATORIES, INC. yDIPYRIDAMOLE TAB 25MG 51079006820 UDL LABORATORIES, INC. yDIPYRIDAMOLE TAB 50MG 51079006901 UDL LABORATORIES, INC. yDIPYRIDAMOLE TAB 50MG 51079006920 UDL LABORATORIES, INC. yDIPYRIDAMOLE TAB 75MG 51079007001 UDL LABORATORIES, INC. yDIPYRIDAMOLE TAB 75MG 51079007020 UDL LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 51079007101 UDL LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 51079007117 UDL LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 51079007119 UDL LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 51079007120 UDL LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 51079007140 UDL LABORATORIES, INC. yDOCUSATE CAL CAP 240MG 51079007150 UDL LABORATORIES, INC. yFUROSEMIDE TAB 20MG 51079007201 UDL LABORATORIES, INC. yFUROSEMIDE TAB 20MG 51079007217 UDL LABORATORIES, INC. yFUROSEMIDE TAB 20MG 51079007219 UDL LABORATORIES, INC. yFUROSEMIDE TAB 20MG 51079007220 UDL LABORATORIES, INC. yFUROSEMIDE TAB 20MG 51079007257 UDL LABORATORIES, INC. yFUROSEMIDE TAB 40MG 51079007301 UDL LABORATORIES, INC. yFUROSEMIDE TAB 40MG 51079007317 UDL LABORATORIES, INC. yFUROSEMIDE TAB 40MG 51079007319 UDL LABORATORIES, INC. yFUROSEMIDE TAB 40MG 51079007320 UDL LABORATORIES, INC. yFUROSEMIDE TAB 40MG 51079007357 UDL LABORATORIES, INC. yISONIAZID TAB 100MG 51079008201 UDL LABORATORIES, INC. yISONIAZID TAB 100MG 51079008220 UDL LABORATORIES, INC. yISONIAZID TAB 300MG 51079008301 UDL LABORATORIES, INC. yISONIAZID TAB 300MG 51079008320 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

674 of 774

MIRTAZAPINE TAB 15MG 51079008601 UDL LABORATORIES, INC. yMIRTAZAPINE TAB 15MG 51079008620 UDL LABORATORIES, INC. yMIRTAZAPINE TAB 30MG 51079008701 UDL LABORATORIES, INC. yMIRTAZAPINE TAB 30MG 51079008720 UDL LABORATORIES, INC. yMIRTAZAPINE TAB 45MG 51079008801 UDL LABORATORIES, INC. yMIRTAZAPINE TAB 45MG 51079008820 UDL LABORATORIES, INC. yMECLIZINE TAB 12.5MG 51079008901 UDL LABORATORIES, INC. yMECLIZINE TAB 12.5MG 51079008920 UDL LABORATORIES, INC. yMECLIZINE TAB 25MG 51079009001 UDL LABORATORIES, INC. yMECLIZINE TAB 25MG 51079009017 UDL LABORATORIES, INC. yMECLIZINE TAB 25MG 51079009019 UDL LABORATORIES, INC. yMECLIZINE TAB 25MG 51079009020 UDL LABORATORIES, INC. yPHENOBARB TAB 30MG 51079009501 UDL LABORATORIES, INC. yPHENOBARB TAB 30MG 51079009520 UDL LABORATORIES, INC. ySPIRONOLACT TAB 25MG 51079010301 UDL LABORATORIES, INC. ySPIRONOLACT TAB 25MG 51079010317 UDL LABORATORIES, INC. ySPIRONOLACT TAB 25MG 51079010319 UDL LABORATORIES, INC. ySPIRONOLACT TAB 25MG 51079010320 UDL LABORATORIES, INC. ySPIRONO/HCTZ TAB 25/25 51079010401 UDL LABORATORIES, INC. ySPIRONO/HCTZ TAB 25/25 51079010420 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-60MG 51079010601 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-60MG 51079010620 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-60MG 51079010621 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 25MG 51079010701 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 25MG 51079010717 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 25MG 51079010719 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 25MG 51079010720 UDL LABORATORIES, INC. yDICYCLOMINE CAP 10MG 51079011801 UDL LABORATORIES, INC. yDICYCLOMINE CAP 10MG 51079011820 UDL LABORATORIES, INC. yDICYCLOMINE TAB 20MG 51079011901 UDL LABORATORIES, INC. yDICYCLOMINE TAB 20MG 51079011920 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 250MG 51079012201 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 250MG 51079012217 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 250MG 51079012219 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 250MG 51079012220 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 500MG 51079012601 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

675 of 774

METRONIDAZOL TAB 500MG 51079012617 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 500MG 51079012619 UDL LABORATORIES, INC. yMETRONIDAZOL TAB 500MG 51079012620 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 50MG 51079013001 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 50MG 51079013020 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 10MG 51079013101 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 10MG 51079013120 UDL LABORATORIES, INC. yLORATADINE TAB 10MG 51079013201 UDL LABORATORIES, INC. yLORATADINE TAB 10MG 51079013220 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 50MG 51079013301 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 50MG 51079013320 UDL LABORATORIES, INC. ySELEGILINE CAP 5MG 51079013720 UDL LABORATORIES, INC. yCHLORDIAZEP CAP 25MG 51079014101 UDL LABORATORIES, INC. yCHLORDIAZEP CAP 25MG 51079014120 UDL LABORATORIES, INC. yPERGOLIDE TAB 0.25MG 51079014320 UDL LABORATORIES, INC. yPERGOLIDE TAB 1MG 51079014420 UDL LABORATORIES, INC. yBENAZEPRIL TAB 10MG 51079014501 UDL LABORATORIES, INC. yBENAZEPRIL TAB 10MG 51079014520 UDL LABORATORIES, INC. yBENAZEPRIL TAB 20MG 51079014601 UDL LABORATORIES, INC. yBENAZEPRIL TAB 20MG 51079014620 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 75MG 51079014701 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 75MG 51079014720 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-30MG 51079016101 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-30MG 51079016120 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-30MG 51079016121 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-30MG 51079016196 UDL LABORATORIES, INC. yAPAP/CODEINE TAB 300-30MG 51079016199 UDL LABORATORIES, INC. yCHLORPHENIR TAB 4MG 51079016301 UDL LABORATORIES, INC. yCHLORPHENIR TAB 4MG 51079016320 UDL LABORATORIES, INC. yINDOMETHACIN CAP 25MG 51079019001 UDL LABORATORIES, INC. yINDOMETHACIN CAP 25MG 51079019017 UDL LABORATORIES, INC. yINDOMETHACIN CAP 25MG 51079019019 UDL LABORATORIES, INC. yINDOMETHACIN CAP 25MG 51079019020 UDL LABORATORIES, INC. yINDOMETHACIN CAP 50MG 51079019101 UDL LABORATORIES, INC. yINDOMETHACIN CAP 50MG 51079019120 UDL LABORATORIES, INC. yMETHYLDOPA TAB 250MG 51079020001 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

676 of 774

METHYLDOPA TAB 250MG 51079020020 UDL LABORATORIES, INC. yMETHYLDOPA TAB 500MG 51079020101 UDL LABORATORIES, INC. yMETHYLDOPA TAB 500MG 51079020120 UDL LABORATORIES, INC. yCHLORPROPAM TAB 100MG 51079020201 UDL LABORATORIES, INC. yCHLORPROPAM TAB 100MG 51079020220 UDL LABORATORIES, INC. yCHLORPROPAM TAB 250MG 51079020301 UDL LABORATORIES, INC. yCHLORPROPAM TAB 250MG 51079020320 UDL LABORATORIES, INC. yALLOPURINOL TAB 100MG 51079020501 UDL LABORATORIES, INC. yALLOPURINOL TAB 100MG 51079020517 UDL LABORATORIES, INC. yALLOPURINOL TAB 100MG 51079020519 UDL LABORATORIES, INC. yALLOPURINOL TAB 100MG 51079020520 UDL LABORATORIES, INC. yALLOPURINOL TAB 300MG 51079020601 UDL LABORATORIES, INC. yALLOPURINOL TAB 300MG 51079020617 UDL LABORATORIES, INC. yALLOPURINOL TAB 300MG 51079020619 UDL LABORATORIES, INC. yALLOPURINOL TAB 300MG 51079020620 UDL LABORATORIES, INC. yCIPROFLOXACN TAB 250MG 51079021801 UDL LABORATORIES, INC. yCIPROFLOXACN TAB 250MG 51079021820 UDL LABORATORIES, INC. yBENZTROPINE TAB 0.5MG 51079022001 UDL LABORATORIES, INC. yBENZTROPINE TAB 0.5MG 51079022020 UDL LABORATORIES, INC. yBENZTROPINE TAB 1MG 51079022101 UDL LABORATORIES, INC. yBENZTROPINE TAB 1MG 51079022117 UDL LABORATORIES, INC. yBENZTROPINE TAB 1MG 51079022119 UDL LABORATORIES, INC. yBENZTROPINE TAB 1MG 51079022120 UDL LABORATORIES, INC. yBENZTROPINE TAB 2MG 51079022201 UDL LABORATORIES, INC. yBENZTROPINE TAB 2MG 51079022220 UDL LABORATORIES, INC. yCIPROFLOXACN TAB 500MG 51079023301 UDL LABORATORIES, INC. yCIPROFLOXACN TAB 500MG 51079023320 UDL LABORATORIES, INC. yMETOPROLOL TAB 25MG 51079025501 UDL LABORATORIES, INC. yMETOPROLOL TAB 25MG 51079025517 UDL LABORATORIES, INC. yMETOPROLOL TAB 25MG 51079025519 UDL LABORATORIES, INC. yMETOPROLOL TAB 25MG 51079025520 UDL LABORATORIES, INC. yFLUCONAZOLE TAB 100MG 51079025903 UDL LABORATORIES, INC. yFLUCONAZOLE TAB 200MG 51079026003 UDL LABORATORIES, INC. yAMOX/K CLAV TAB 500MG 51079026501 UDL LABORATORIES, INC. yAMOX/K CLAV TAB 500MG 51079026520 UDL LABORATORIES, INC. yAMOX/K CLAV TAB 875MG 51079026701 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

677 of 774

AMOX/K CLAV TAB 875MG 51079026720 UDL LABORATORIES, INC. yLITHIUM CARB CAP 300MG 51079026901 UDL LABORATORIES, INC. yLITHIUM CARB CAP 300MG 51079026920 UDL LABORATORIES, INC. yPROPRANOLOL TAB 10MG 51079027701 UDL LABORATORIES, INC. yPROPRANOLOL TAB 10MG 51079027717 UDL LABORATORIES, INC. yPROPRANOLOL TAB 10MG 51079027719 UDL LABORATORIES, INC. yPROPRANOLOL TAB 10MG 51079027720 UDL LABORATORIES, INC. yPROPRANOLOL TAB 20MG 51079027801 UDL LABORATORIES, INC. yPROPRANOLOL TAB 20MG 51079027820 UDL LABORATORIES, INC. yPROPRANOLOL TAB 40MG 51079027901 UDL LABORATORIES, INC. yPROPRANOLOL TAB 40MG 51079027920 UDL LABORATORIES, INC. yPROPRANOLOL TAB 80MG 51079028001 UDL LABORATORIES, INC. yPROPRANOLOL TAB 80MG 51079028020 UDL LABORATORIES, INC. yIBUPROFEN TAB 400MG 51079028101 UDL LABORATORIES, INC. yIBUPROFEN TAB 400MG 51079028117 UDL LABORATORIES, INC. yIBUPROFEN TAB 400MG 51079028119 UDL LABORATORIES, INC. yIBUPROFEN TAB 400MG 51079028120 UDL LABORATORIES, INC. yIBUPROFEN TAB 600MG 51079028201 UDL LABORATORIES, INC. yIBUPROFEN TAB 600MG 51079028217 UDL LABORATORIES, INC. yIBUPROFEN TAB 600MG 51079028219 UDL LABORATORIES, INC. yIBUPROFEN TAB 600MG 51079028220 UDL LABORATORIES, INC. yIBUPROFEN TAB 600MG 51079028294 UDL LABORATORIES, INC. yIBUPROFEN TAB 600MG 51079028298 UDL LABORATORIES, INC. yMETOCLOPRAM TAB 10MG 51079028301 UDL LABORATORIES, INC. yMETOCLOPRAM TAB 10MG 51079028317 UDL LABORATORIES, INC. yMETOCLOPRAM TAB 10MG 51079028319 UDL LABORATORIES, INC. yMETOCLOPRAM TAB 10MG 51079028320 UDL LABORATORIES, INC. yDIAZEPAM TAB 2MG 51079028401 UDL LABORATORIES, INC. yDIAZEPAM TAB 2MG 51079028420 UDL LABORATORIES, INC. yDIAZEPAM TAB 2MG 51079028421 UDL LABORATORIES, INC. yDIAZEPAM TAB 5MG 51079028501 UDL LABORATORIES, INC. yDIAZEPAM TAB 5MG 51079028520 UDL LABORATORIES, INC. yDIAZEPAM TAB 5MG 51079028521 UDL LABORATORIES, INC. yDIAZEPAM TAB 10MG 51079028601 UDL LABORATORIES, INC. yDIAZEPAM TAB 10MG 51079028620 UDL LABORATORIES, INC. yDIAZEPAM TAB 10MG 51079028621 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

678 of 774

VALPROIC ACD CAP 250MG 51079029801 UDL LABORATORIES, INC. yVALPROIC ACD CAP 250MG 51079029820 UDL LABORATORIES, INC. yVALPROIC ACD CAP 250MG 51079029856 UDL LABORATORIES, INC. yCLONIDINE TAB 0.1MG 51079029901 UDL LABORATORIES, INC. yCLONIDINE TAB 0.1MG 51079029917 UDL LABORATORIES, INC. yCLONIDINE TAB 0.1MG 51079029919 UDL LABORATORIES, INC. yCLONIDINE TAB 0.1MG 51079029920 UDL LABORATORIES, INC. yCLONIDINE TAB 0.1MG 51079029962 UDL LABORATORIES, INC. yCLONIDINE TAB 0.1MG 51079029963 UDL LABORATORIES, INC. yCLONIDINE TAB 0.2MG 51079030001 UDL LABORATORIES, INC. yCLONIDINE TAB 0.2MG 51079030017 UDL LABORATORIES, INC. yCLONIDINE TAB 0.2MG 51079030019 UDL LABORATORIES, INC. yCLONIDINE TAB 0.2MG 51079030020 UDL LABORATORIES, INC. yCLONIDINE TAB 0.2MG 51079030062 UDL LABORATORIES, INC. yCLONIDINE TAB 0.2MG 51079030063 UDL LABORATORIES, INC. yCLONIDINE TAB 0.3MG 51079030101 UDL LABORATORIES, INC. yCLONIDINE TAB 0.3MG 51079030120 UDL LABORATORIES, INC. yCLONIDINE TAB 0.3MG 51079030162 UDL LABORATORIES, INC. yCLONIDINE TAB 0.3MG 51079030163 UDL LABORATORIES, INC. yFLURAZEPAM CAP 15MG 51079030201 UDL LABORATORIES, INC. yFLURAZEPAM CAP 15MG 51079030220 UDL LABORATORIES, INC. yFLURAZEPAM CAP 15MG 51079030221 UDL LABORATORIES, INC. yFLURAZEPAM CAP 30MG 51079030301 UDL LABORATORIES, INC. yFLURAZEPAM CAP 30MG 51079030320 UDL LABORATORIES, INC. yFLURAZEPAM CAP 30MG 51079030321 UDL LABORATORIES, INC. yVITAMIN E CAP 400UNIT 51079031620 UDL LABORATORIES, INC. yPROPO-N/APAP TAB 100-650 51079032201 UDL LABORATORIES, INC. yPROPO-N/APAP TAB 100-650 51079032220 UDL LABORATORIES, INC. yPROPO-N/APAP TAB 100-650 51079032221 UDL LABORATORIES, INC. yPROPO-N/APAP TAB 100-650 51079032256 UDL LABORATORIES, INC. yPROPO-N/APAP TAB 100-650 51079032299 UDL LABORATORIES, INC. yCLARITHROMYC TAB 500MG 51079036201 UDL LABORATORIES, INC. yCLARITHROMYC TAB 500MG 51079036220 UDL LABORATORIES, INC. yCHLORDIAZEP CAP 5MG 51079037401 UDL LABORATORIES, INC. yCHLORDIAZEP CAP 5MG 51079037420 UDL LABORATORIES, INC. yCHLORDIAZEP CAP 10MG 51079037501 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

679 of 774

CHLORDIAZEP CAP 10MG 51079037520 UDL LABORATORIES, INC. yCARBAMAZEPIN TAB 200MG 51079038501 UDL LABORATORIES, INC. yCARBAMAZEPIN TAB 200MG 51079038517 UDL LABORATORIES, INC. yCARBAMAZEPIN TAB 200MG 51079038519 UDL LABORATORIES, INC. yCARBAMAZEPIN TAB 200MG 51079038520 UDL LABORATORIES, INC. yLORAZEPAM TAB 1MG 51079038601 UDL LABORATORIES, INC. yLORAZEPAM TAB 1MG 51079038617 UDL LABORATORIES, INC. yLORAZEPAM TAB 1MG 51079038619 UDL LABORATORIES, INC. yLORAZEPAM TAB 1MG 51079038620 UDL LABORATORIES, INC. yLORAZEPAM TAB 1MG 51079038621 UDL LABORATORIES, INC. yLORAZEPAM TAB 1MG 51079038656 UDL LABORATORIES, INC. yLORAZEPAM TAB 2MG 51079038701 UDL LABORATORIES, INC. yLORAZEPAM TAB 2MG 51079038720 UDL LABORATORIES, INC. yLORAZEPAM TAB 2MG 51079038721 UDL LABORATORIES, INC. yACETAMIN TAB 500MG 51079039601 UDL LABORATORIES, INC. yACETAMIN TAB 500MG 51079039617 UDL LABORATORIES, INC. yACETAMIN TAB 500MG 51079039619 UDL LABORATORIES, INC. yACETAMIN TAB 500MG 51079039620 UDL LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 51079041701 UDL LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 51079041717 UDL LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 51079041719 UDL LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 51079041720 UDL LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 51079041721 UDL LABORATORIES, INC. yLORAZEPAM TAB 0.5MG 51079041756 UDL LABORATORIES, INC. yTEMAZEPAM CAP 15MG 51079041801 UDL LABORATORIES, INC. yTEMAZEPAM CAP 15MG 51079041820 UDL LABORATORIES, INC. yTEMAZEPAM CAP 15MG 51079041821 UDL LABORATORIES, INC. yTEMAZEPAM CAP 30MG 51079041901 UDL LABORATORIES, INC. yTEMAZEPAM CAP 30MG 51079041920 UDL LABORATORIES, INC. yTEMAZEPAM CAP 30MG 51079041921 UDL LABORATORIES, INC. yHYDROCO/APAP TAB 5-500MG 51079042096 UDL LABORATORIES, INC. yHYDROCO/APAP TAB 5-500MG 51079042099 UDL LABORATORIES, INC. yCILOSTAZOL TAB 100MG 51079042401 UDL LABORATORIES, INC. yCILOSTAZOL TAB 100MG 51079042420 UDL LABORATORIES, INC. yGLIMEPIRIDE TAB 2MG 51079042501 UDL LABORATORIES, INC. yGLIMEPIRIDE TAB 2MG 51079042520 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

680 of 774

GLIMEPIRIDE TAB 4MG 51079042601 UDL LABORATORIES, INC. yGLIMEPIRIDE TAB 4MG 51079042620 UDL LABORATORIES, INC. yTRAZODONE TAB 50MG 51079042701 UDL LABORATORIES, INC. yTRAZODONE TAB 50MG 51079042717 UDL LABORATORIES, INC. yTRAZODONE TAB 50MG 51079042719 UDL LABORATORIES, INC. yTRAZODONE TAB 50MG 51079042720 UDL LABORATORIES, INC. yTRAZODONE TAB 100MG 51079042801 UDL LABORATORIES, INC. yTRAZODONE TAB 100MG 51079042817 UDL LABORATORIES, INC. yTRAZODONE TAB 100MG 51079042819 UDL LABORATORIES, INC. yTRAZODONE TAB 100MG 51079042820 UDL LABORATORIES, INC. yTRIAMT/HCTZ TAB 75-50MG 51079043301 UDL LABORATORIES, INC. yTRIAMT/HCTZ TAB 75-50MG 51079043320 UDL LABORATORIES, INC. yMEGESTROL AC TAB 20MG 51079043401 UDL LABORATORIES, INC. yMEGESTROL AC TAB 20MG 51079043420 UDL LABORATORIES, INC. yMEGESTROL AC TAB 40MG 51079043501 UDL LABORATORIES, INC. yMEGESTROL AC TAB 40MG 51079043517 UDL LABORATORIES, INC. yMEGESTROL AC TAB 40MG 51079043519 UDL LABORATORIES, INC. yMEGESTROL AC TAB 40MG 51079043520 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 10MG 51079043601 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 10MG 51079043620 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 25MG 51079043701 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 25MG 51079043720 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 50MG 51079043801 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 50MG 51079043820 UDL LABORATORIES, INC. yMIDODRINE TAB 5MG 51079045301 UDL LABORATORIES, INC. yMIDODRINE TAB 5MG 51079045320 UDL LABORATORIES, INC. ySIMVASTATIN TAB 10MG 51079045401 UDL LABORATORIES, INC. ySIMVASTATIN TAB 10MG 51079045420 UDL LABORATORIES, INC. ySIMVASTATIN TAB 20MG 51079045501 UDL LABORATORIES, INC. ySIMVASTATIN TAB 20MG 51079045520 UDL LABORATORIES, INC. ySIMVASTATIN TAB 40MG 51079045601 UDL LABORATORIES, INC. ySIMVASTATIN TAB 40MG 51079045620 UDL LABORATORIES, INC. yMELOXICAM TAB 7.5MG 51079045701 UDL LABORATORIES, INC. yMELOXICAM TAB 7.5MG 51079045720 UDL LABORATORIES, INC. yPRAVASTATIN TAB 20MG 51079045801 UDL LABORATORIES, INC. yPRAVASTATIN TAB 20MG 51079045820 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

681 of 774

MELOXICAM TAB 15MG 51079045901 UDL LABORATORIES, INC. yMELOXICAM TAB 15MG 51079045920 UDL LABORATORIES, INC. yAMANTADINE CAP 100MG 51079048101 UDL LABORATORIES, INC. yAMANTADINE CAP 100MG 51079048120 UDL LABORATORIES, INC. yFLUPHENAZINE TAB 1MG 51079048501 UDL LABORATORIES, INC. yFLUPHENAZINE TAB 1MG 51079048520 UDL LABORATORIES, INC. yFLUPHENAZINE TAB 5MG 51079048701 UDL LABORATORIES, INC. yFLUPHENAZINE TAB 5MG 51079048720 UDL LABORATORIES, INC. yFLUPHENAZINE TAB 10MG 51079048801 UDL LABORATORIES, INC. yFLUPHENAZINE TAB 10MG 51079048820 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 100MG 51079051601 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 100MG 51079051620 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 200MG 51079051701 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 200MG 51079051720 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 10MG 51079051801 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 10MG 51079051820 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 25MG 51079051901 UDL LABORATORIES, INC. yCHLORPROMAZ TAB 25MG 51079051920 UDL LABORATORIES, INC. yFUROSEMIDE TAB 80MG 51079052701 UDL LABORATORIES, INC. yFUROSEMIDE TAB 80MG 51079052717 UDL LABORATORIES, INC. yFUROSEMIDE TAB 80MG 51079052719 UDL LABORATORIES, INC. yFUROSEMIDE TAB 80MG 51079052720 UDL LABORATORIES, INC. yFEXOFENADINE TAB 60MG 51079052901 UDL LABORATORIES, INC. yFEXOFENADINE TAB 60MG 51079052920 UDL LABORATORIES, INC. yPROCHLORPER TAB 5MG 51079054101 UDL LABORATORIES, INC. yPROCHLORPER TAB 5MG 51079054117 UDL LABORATORIES, INC. yPROCHLORPER TAB 5MG 51079054119 UDL LABORATORIES, INC. yPROCHLORPER TAB 5MG 51079054120 UDL LABORATORIES, INC. yPROCHLORPER TAB 10MG 51079054201 UDL LABORATORIES, INC. yPROCHLORPER TAB 10MG 51079054217 UDL LABORATORIES, INC. yPROCHLORPER TAB 10MG 51079054219 UDL LABORATORIES, INC. yPROCHLORPER TAB 10MG 51079054220 UDL LABORATORIES, INC. yTOLBUTAMIDE TAB 500MG 51079056001 UDL LABORATORIES, INC. yTOLBUTAMIDE TAB 500MG 51079056020 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 100MG 51079056301 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 100MG 51079056320 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

682 of 774

AMITRIPTYLIN TAB 150MG 51079056401 UDL LABORATORIES, INC. yAMITRIPTYLIN TAB 150MG 51079056420 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 10MG 51079056501 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 10MG 51079056520 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 25MG 51079056601 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 25MG 51079056620 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 50MG 51079056701 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 50MG 51079056720 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 1MG 51079057201 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 1MG 51079057220 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 2MG 51079057301 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 2MG 51079057320 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 5MG 51079057401 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 5MG 51079057420 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 10MG 51079057501 UDL LABORATORIES, INC. yTRIFLUOPERAZ TAB 10MG 51079057520 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 100MG 51079058001 UDL LABORATORIES, INC. yTHIORIDAZINE TAB 100MG 51079058020 UDL LABORATORIES, INC. yLEUCOVOR CA TAB 5MG 51079058101 UDL LABORATORIES, INC. yLEUCOVOR CA TAB 5MG 51079058106 UDL LABORATORIES, INC. yLEUCOVOR CA TAB 25MG 51079058201 UDL LABORATORIES, INC. yLEUCOVOR CA TAB 25MG 51079058205 UDL LABORATORIES, INC. yNITROFUR MAC CAP 50MG 51079058401 UDL LABORATORIES, INC. yNITROFUR MAC CAP 50MG 51079058420 UDL LABORATORIES, INC. yNITROFUR MAC CAP 100MG 51079058501 UDL LABORATORIES, INC. yNITROFUR MAC CAP 100MG 51079058520 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 1MG 51079058601 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 1MG 51079058620 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 2MG 51079058701 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 2MG 51079058720 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 5MG 51079058801 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 5MG 51079058820 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 10MG 51079058901 UDL LABORATORIES, INC. yTHIOTHIXENE CAP 10MG 51079058920 UDL LABORATORIES, INC. yIBUPROFEN TAB 800MG 51079059601 UDL LABORATORIES, INC. yIBUPROFEN TAB 800MG 51079059617 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

683 of 774

IBUPROFEN TAB 800MG 51079059619 UDL LABORATORIES, INC. yIBUPROFEN TAB 800MG 51079059620 UDL LABORATORIES, INC. yIBUPROFEN TAB 800MG 51079059624 UDL LABORATORIES, INC. yCLINDAMYCIN CAP 150MG 51079059801 UDL LABORATORIES, INC. yCLINDAMYCIN CAP 150MG 51079059817 UDL LABORATORIES, INC. yCLINDAMYCIN CAP 150MG 51079059819 UDL LABORATORIES, INC. yCLINDAMYCIN CAP 150MG 51079059820 UDL LABORATORIES, INC. yAMOXICILLIN CAP 250MG 51079060001 UDL LABORATORIES, INC. yAMOXICILLIN CAP 250MG 51079060020 UDL LABORATORIES, INC. yAMOXICILLIN CAP 500MG 51079060101 UDL LABORATORIES, INC. yAMOXICILLIN CAP 500MG 51079060120 UDL LABORATORIES, INC. yCEPHALEXIN CAP 250MG 51079060401 UDL LABORATORIES, INC. yCEPHALEXIN CAP 250MG 51079060420 UDL LABORATORIES, INC. yCEPHALEXIN CAP 500MG 51079060501 UDL LABORATORIES, INC. yCEPHALEXIN CAP 500MG 51079060520 UDL LABORATORIES, INC. yGRANULEX AER 51079062181 UDL LABORATORIES, INC. ySULFAMYLON CRE 85MG/GM 51079062383 UDL LABORATORIES, INC. yMETFORMIN TAB 500MG ER 51079062601 UDL LABORATORIES, INC. yMETFORMIN TAB 500MG ER 51079062620 UDL LABORATORIES, INC. yMETFORMIN TAB 750MG ER 51079062701 UDL LABORATORIES, INC. yMETFORMIN TAB 750MG ER 51079062720 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 51079062801 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 51079062817 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 51079062819 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 51079062820 UDL LABORATORIES, INC. yMETOCLOPRAM TAB 5MG 51079062901 UDL LABORATORIES, INC. yMETOCLOPRAM TAB 5MG 51079062920 UDL LABORATORIES, INC. yPRAZOSIN HCL CAP 1MG 51079063001 UDL LABORATORIES, INC. yPRAZOSIN HCL CAP 1MG 51079063020 UDL LABORATORIES, INC. yPRAZOSIN HCL CAP 2MG 51079063101 UDL LABORATORIES, INC. yPRAZOSIN HCL CAP 2MG 51079063120 UDL LABORATORIES, INC. yPRAZOSIN HCL CAP 5MG 51079063201 UDL LABORATORIES, INC. yPRAZOSIN HCL CAP 5MG 51079063220 UDL LABORATORIES, INC. yCYCLOBENZAPR TAB 10MG 51079064401 UDL LABORATORIES, INC. yCYCLOBENZAPR TAB 10MG 51079064417 UDL LABORATORIES, INC. yCYCLOBENZAPR TAB 10MG 51079064419 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

684 of 774

CYCLOBENZAPR TAB 10MG 51079064420 UDL LABORATORIES, INC. yCYCLOBENZAPR TAB 10MG 51079064493 UDL LABORATORIES, INC. yCYCLOBENZAPR TAB 10MG 51079064497 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 75MG 51079064501 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 75MG 51079064520 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 100MG 51079065101 UDL LABORATORIES, INC. yDOXEPIN HCL CAP 100MG 51079065120 UDL LABORATORIES, INC. yALBUTEROL TAB 2MG 51079065701 UDL LABORATORIES, INC. yALBUTEROL TAB 2MG 51079065720 UDL LABORATORIES, INC. yALBUTEROL TAB 4MG 51079065801 UDL LABORATORIES, INC. yALBUTEROL TAB 4MG 51079065820 UDL LABORATORIES, INC. ySULINDAC TAB 150MG 51079066601 UDL LABORATORIES, INC. ySULINDAC TAB 150MG 51079066620 UDL LABORATORIES, INC. ySULINDAC TAB 200MG 51079066701 UDL LABORATORIES, INC. ySULINDAC TAB 200MG 51079066720 UDL LABORATORIES, INC. yBACLOFEN TAB 10MG 51079066801 UDL LABORATORIES, INC. yBACLOFEN TAB 10MG 51079066820 UDL LABORATORIES, INC. yBACLOFEN TAB 20MG 51079066901 UDL LABORATORIES, INC. yBACLOFEN TAB 20MG 51079066920 UDL LABORATORIES, INC. yMETHOTREXATE TAB 2.5MG 51079067001 UDL LABORATORIES, INC. yMETHOTREXATE TAB 2.5MG 51079067005 UDL LABORATORIES, INC. yVERAPAMIL TAB 80MG 51079068201 UDL LABORATORIES, INC. yVERAPAMIL TAB 80MG 51079068217 UDL LABORATORIES, INC. yVERAPAMIL TAB 80MG 51079068219 UDL LABORATORIES, INC. yVERAPAMIL TAB 80MG 51079068220 UDL LABORATORIES, INC. yVERAPAMIL TAB 120MG 51079068301 UDL LABORATORIES, INC. yVERAPAMIL TAB 120MG 51079068320 UDL LABORATORIES, INC. yATENOLOL TAB 50MG 51079068401 UDL LABORATORIES, INC. yATENOLOL TAB 50MG 51079068417 UDL LABORATORIES, INC. yATENOLOL TAB 50MG 51079068419 UDL LABORATORIES, INC. yATENOLOL TAB 50MG 51079068420 UDL LABORATORIES, INC. yATENOLOL TAB 100MG 51079068501 UDL LABORATORIES, INC. yATENOLOL TAB 100MG 51079068520 UDL LABORATORIES, INC. yLOPERAMIDE CAP 2MG 51079069001 UDL LABORATORIES, INC. yLOPERAMIDE CAP 2MG 51079069017 UDL LABORATORIES, INC. yLOPERAMIDE CAP 2MG 51079069019 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

685 of 774

LOPERAMIDE CAP 2MG 51079069020 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 5MG ER 51079072201 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 5MG ER 51079072220 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 10MG ER 51079072301 UDL LABORATORIES, INC. yOXYBUTYNIN TAB 10MG ER 51079072320 UDL LABORATORIES, INC. yIBUPROFEN TAB 200MG 51079073101 UDL LABORATORIES, INC. yIBUPROFEN TAB 200MG 51079073120 UDL LABORATORIES, INC. yHALOPERIDOL TAB 0.5MG 51079073301 UDL LABORATORIES, INC. yHALOPERIDOL TAB 0.5MG 51079073320 UDL LABORATORIES, INC. yHALOPERIDOL TAB 1MG 51079073401 UDL LABORATORIES, INC. yHALOPERIDOL TAB 1MG 51079073420 UDL LABORATORIES, INC. yHALOPERIDOL TAB 2MG 51079073501 UDL LABORATORIES, INC. yHALOPERIDOL TAB 2MG 51079073520 UDL LABORATORIES, INC. yHALOPERIDOL TAB 5MG 51079073601 UDL LABORATORIES, INC. yHALOPERIDOL TAB 5MG 51079073620 UDL LABORATORIES, INC. yPROPOXY/APAP TAB 65-650MG 51079074101 UDL LABORATORIES, INC. yPROPOXY/APAP TAB 65-650MG 51079074120 UDL LABORATORIES, INC. yPIROXICAM CAP 10MG 51079074201 UDL LABORATORIES, INC. yPIROXICAM CAP 10MG 51079074220 UDL LABORATORIES, INC. yPIROXICAM CAP 20MG 51079074301 UDL LABORATORIES, INC. yPIROXICAM CAP 20MG 51079074320 UDL LABORATORIES, INC. yDILTIAZEM TAB 30MG 51079074501 UDL LABORATORIES, INC. yDILTIAZEM TAB 30MG 51079074517 UDL LABORATORIES, INC. yDILTIAZEM TAB 30MG 51079074519 UDL LABORATORIES, INC. yDILTIAZEM TAB 30MG 51079074520 UDL LABORATORIES, INC. yDILTIAZEM TAB 60MG 51079074601 UDL LABORATORIES, INC. yDILTIAZEM TAB 60MG 51079074617 UDL LABORATORIES, INC. yDILTIAZEM TAB 60MG 51079074619 UDL LABORATORIES, INC. yDILTIAZEM TAB 60MG 51079074620 UDL LABORATORIES, INC. yDILTIAZEM TAB 90MG 51079074701 UDL LABORATORIES, INC. yDILTIAZEM TAB 90MG 51079074720 UDL LABORATORIES, INC. yCARB/LEVO TAB 10-100MG 51079075501 UDL LABORATORIES, INC. yCARB/LEVO TAB 10-100MG 51079075520 UDL LABORATORIES, INC. yCARB/LEVO TAB 25-100MG 51079075601 UDL LABORATORIES, INC. yCARB/LEVO TAB 25-100MG 51079075617 UDL LABORATORIES, INC. yCARB/LEVO TAB 25-100MG 51079075619 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARB/LEVO TAB 25-100MG 51079075620 UDL LABORATORIES, INC. yCARB/LEVO TAB 25-100MG 51079075657 UDL LABORATORIES, INC. yATENOLOL TAB 25MG 51079075901 UDL LABORATORIES, INC. yATENOLOL TAB 25MG 51079075917 UDL LABORATORIES, INC. yATENOLOL TAB 25MG 51079075919 UDL LABORATORIES, INC. yATENOLOL TAB 25MG 51079075920 UDL LABORATORIES, INC. yZONISAMIDE CAP 100MG 51079076801 UDL LABORATORIES, INC. yZONISAMIDE CAP 100MG 51079076820 UDL LABORATORIES, INC. yPAROXETINE TAB 20MG 51079077401 UDL LABORATORIES, INC. yPAROXETINE TAB 20MG 51079077420 UDL LABORATORIES, INC. yPAROXETINE TAB 40MG 51079077501 UDL LABORATORIES, INC. yPAROXETINE TAB 40MG 51079077520 UDL LABORATORIES, INC. yHYDROCHLOROT CAP 12.5MG 51079077601 UDL LABORATORIES, INC. yHYDROCHLOROT CAP 12.5MG 51079077620 UDL LABORATORIES, INC. yCARB/LEVO TAB 25-250MG 51079078301 UDL LABORATORIES, INC. yCARB/LEVO TAB 25-250MG 51079078320 UDL LABORATORIES, INC. yGABAPENTIN CAP 300MG 51079078601 UDL LABORATORIES, INC. yGABAPENTIN CAP 300MG 51079078617 UDL LABORATORIES, INC. yGABAPENTIN CAP 300MG 51079078619 UDL LABORATORIES, INC. yGABAPENTIN CAP 300MG 51079078620 UDL LABORATORIES, INC. yGEMFIBROZIL TAB 600MG 51079078701 UDL LABORATORIES, INC. yGEMFIBROZIL TAB 600MG 51079078717 UDL LABORATORIES, INC. yGEMFIBROZIL TAB 600MG 51079078719 UDL LABORATORIES, INC. yGEMFIBROZIL TAB 600MG 51079078720 UDL LABORATORIES, INC. yALPRAZOLAM TAB 0.25MG 51079078801 UDL LABORATORIES, INC. yALPRAZOLAM TAB 0.25MG 51079078820 UDL LABORATORIES, INC. yALPRAZOLAM TAB 0.25MG 51079078821 UDL LABORATORIES, INC. yALPRAZOLAM TAB 0.5MG 51079078901 UDL LABORATORIES, INC. yALPRAZOLAM TAB 0.5MG 51079078920 UDL LABORATORIES, INC. yALPRAZOLAM TAB 0.5MG 51079078921 UDL LABORATORIES, INC. yALPRAZOLAM TAB 1MG 51079079001 UDL LABORATORIES, INC. yALPRAZOLAM TAB 1MG 51079079020 UDL LABORATORIES, INC. yALPRAZOLAM TAB 1MG 51079079021 UDL LABORATORIES, INC. yNAPROXEN TAB 250MG 51079079301 UDL LABORATORIES, INC. yNAPROXEN TAB 250MG 51079079317 UDL LABORATORIES, INC. yNAPROXEN TAB 250MG 51079079319 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NAPROXEN TAB 250MG 51079079320 UDL LABORATORIES, INC. yNAPROXEN TAB 375MG 51079079401 UDL LABORATORIES, INC. yNAPROXEN TAB 375MG 51079079420 UDL LABORATORIES, INC. yNAPROXEN TAB 500MG 51079079501 UDL LABORATORIES, INC. yNAPROXEN TAB 500MG 51079079519 UDL LABORATORIES, INC. yNAPROXEN TAB 500MG 51079079520 UDL LABORATORIES, INC. yMETOPROLOL TAB 50MG 51079080101 UDL LABORATORIES, INC. yMETOPROLOL TAB 50MG 51079080117 UDL LABORATORIES, INC. yMETOPROLOL TAB 50MG 51079080119 UDL LABORATORIES, INC. yMETOPROLOL TAB 50MG 51079080120 UDL LABORATORIES, INC. yMETOPROLOL TAB 50MG 51079080157 UDL LABORATORIES, INC. yMETOPROLOL TAB 100MG 51079080201 UDL LABORATORIES, INC. yMETOPROLOL TAB 100MG 51079080217 UDL LABORATORIES, INC. yMETOPROLOL TAB 100MG 51079080219 UDL LABORATORIES, INC. yMETOPROLOL TAB 100MG 51079080220 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 10MG 51079080301 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 10MG 51079080320 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 25MG 51079080401 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 25MG 51079080417 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 25MG 51079080419 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 25MG 51079080420 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 50MG 51079080501 UDL LABORATORIES, INC. yNORTRIPTYLIN CAP 50MG 51079080520 UDL LABORATORIES, INC. yCIMETIDINE TAB 300MG 51079080701 UDL LABORATORIES, INC. yCIMETIDINE TAB 300MG 51079080720 UDL LABORATORIES, INC. yCIMETIDINE TAB 400MG 51079080801 UDL LABORATORIES, INC. yCIMETIDINE TAB 400MG 51079080820 UDL LABORATORIES, INC. yCIMETIDINE TAB 400MG 51079080824 UDL LABORATORIES, INC. yGLIPIZIDE TAB 5MG 51079081001 UDL LABORATORIES, INC. yGLIPIZIDE TAB 5MG 51079081017 UDL LABORATORIES, INC. yGLIPIZIDE TAB 5MG 51079081019 UDL LABORATORIES, INC. yGLIPIZIDE TAB 5MG 51079081020 UDL LABORATORIES, INC. yGLIPIZIDE TAB 10MG 51079081101 UDL LABORATORIES, INC. yGLIPIZIDE TAB 10MG 51079081117 UDL LABORATORIES, INC. yGLIPIZIDE TAB 10MG 51079081119 UDL LABORATORIES, INC. yGLIPIZIDE TAB 10MG 51079081120 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

688 of 774

NADOLOL TAB 20MG 51079081201 UDL LABORATORIES, INC. yNADOLOL TAB 20MG 51079081220 UDL LABORATORIES, INC. yNADOLOL TAB 40MG 51079081301 UDL LABORATORIES, INC. yNADOLOL TAB 40MG 51079081320 UDL LABORATORIES, INC. yNADOLOL TAB 80MG 51079081401 UDL LABORATORIES, INC. yNADOLOL TAB 80MG 51079081420 UDL LABORATORIES, INC. yFLURBIPROFEN TAB 100MG 51079081501 UDL LABORATORIES, INC. yFLURBIPROFEN TAB 100MG 51079081520 UDL LABORATORIES, INC. yCAPTOPRIL TAB 12.5MG 51079086301 UDL LABORATORIES, INC. yCAPTOPRIL TAB 12.5MG 51079086320 UDL LABORATORIES, INC. yCAPTOPRIL TAB 25MG 51079086401 UDL LABORATORIES, INC. yCAPTOPRIL TAB 25MG 51079086420 UDL LABORATORIES, INC. yINDAPAMIDE TAB 2.5MG 51079086801 UDL LABORATORIES, INC. yINDAPAMIDE TAB 2.5MG 51079086820 UDL LABORATORIES, INC. yVERAPAMIL TAB 240MG ER 51079086901 UDL LABORATORIES, INC. yVERAPAMIL TAB 240MG ER 51079086917 UDL LABORATORIES, INC. yVERAPAMIL TAB 240MG ER 51079086919 UDL LABORATORIES, INC. yVERAPAMIL TAB 240MG ER 51079086920 UDL LABORATORIES, INC. yCARBAMAZEPIN CHW 100MG 51079087001 UDL LABORATORIES, INC. yCARBAMAZEPIN CHW 100MG 51079087017 UDL LABORATORIES, INC. yCARBAMAZEPIN CHW 100MG 51079087019 UDL LABORATORIES, INC. yCARBAMAZEPIN CHW 100MG 51079087020 UDL LABORATORIES, INC. ySUCRALFATE TAB 1GM 51079087101 UDL LABORATORIES, INC. ySUCRALFATE TAB 1GM 51079087117 UDL LABORATORIES, INC. ySUCRALFATE TAB 1GM 51079087119 UDL LABORATORIES, INC. ySUCRALFATE TAB 1GM 51079087120 UDL LABORATORIES, INC. yGLYBURIDE TAB 2.5MG 51079087201 UDL LABORATORIES, INC. yGLYBURIDE TAB 2.5MG 51079087217 UDL LABORATORIES, INC. yGLYBURIDE TAB 2.5MG 51079087219 UDL LABORATORIES, INC. yGLYBURIDE TAB 2.5MG 51079087220 UDL LABORATORIES, INC. yGLYBURIDE TAB 5MG 51079087301 UDL LABORATORIES, INC. yGLYBURIDE TAB 5MG 51079087317 UDL LABORATORIES, INC. yGLYBURIDE TAB 5MG 51079087319 UDL LABORATORIES, INC. yGLYBURIDE TAB 5MG 51079087320 UDL LABORATORIES, INC. yACYCLOVIR CAP 200MG 51079087601 UDL LABORATORIES, INC. yACYCLOVIR CAP 200MG 51079087620 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

689 of 774

ACYCLOVIR TAB 400MG 51079087701 UDL LABORATORIES, INC. yACYCLOVIR TAB 400MG 51079087720 UDL LABORATORIES, INC. yACYCLOVIR TAB 800MG 51079087801 UDL LABORATORIES, INC. yACYCLOVIR TAB 800MG 51079087820 UDL LABORATORIES, INC. yCLONAZEPAM TAB 0.5MG 51079088101 UDL LABORATORIES, INC. yCLONAZEPAM TAB 0.5MG 51079088120 UDL LABORATORIES, INC. yCLONAZEPAM TAB 0.5MG 51079088121 UDL LABORATORIES, INC. yCLONAZEPAM TAB 0.5MG 51079088156 UDL LABORATORIES, INC. yCLONAZEPAM TAB 1MG 51079088201 UDL LABORATORIES, INC. yCLONAZEPAM TAB 1MG 51079088220 UDL LABORATORIES, INC. yCLONAZEPAM TAB 1MG 51079088221 UDL LABORATORIES, INC. yCLONAZEPAM TAB 1MG 51079088256 UDL LABORATORIES, INC. yCLONAZEPAM TAB 2MG 51079088301 UDL LABORATORIES, INC. yCLONAZEPAM TAB 2MG 51079088320 UDL LABORATORIES, INC. yCLONAZEPAM TAB 2MG 51079088321 UDL LABORATORIES, INC. yELDEPRYL CAP 5MG 51079088701 UDL LABORATORIES, INC. yELDEPRYL CAP 5MG 51079088703 UDL LABORATORIES, INC. yPENTOXIFYLLI TAB 400MG ER 51079088901 UDL LABORATORIES, INC. yPENTOXIFYLLI TAB 400MG ER 51079088917 UDL LABORATORIES, INC. yPENTOXIFYLLI TAB 400MG ER 51079088919 UDL LABORATORIES, INC. yPENTOXIFYLLI TAB 400MG ER 51079088920 UDL LABORATORIES, INC. yRIFAMPIN CAP 300MG 51079089001 UDL LABORATORIES, INC. yRIFAMPIN CAP 300MG 51079089017 UDL LABORATORIES, INC. yRIFAMPIN CAP 300MG 51079089019 UDL LABORATORIES, INC. yRIFAMPIN CAP 300MG 51079089020 UDL LABORATORIES, INC. yBUMETANIDE TAB 0.5MG 51079089101 UDL LABORATORIES, INC. yBUMETANIDE TAB 0.5MG 51079089120 UDL LABORATORIES, INC. yBUMETANIDE TAB 1MG 51079089201 UDL LABORATORIES, INC. yBUMETANIDE TAB 1MG 51079089217 UDL LABORATORIES, INC. yBUMETANIDE TAB 1MG 51079089219 UDL LABORATORIES, INC. yBUMETANIDE TAB 1MG 51079089220 UDL LABORATORIES, INC. yBUMETANIDE TAB 2MG 51079089301 UDL LABORATORIES, INC. yBUMETANIDE TAB 2MG 51079089320 UDL LABORATORIES, INC. yVERAPAMIL TAB 120MG ER 51079089401 UDL LABORATORIES, INC. yVERAPAMIL TAB 120MG ER 51079089420 UDL LABORATORIES, INC. yVERAPAMIL TAB 180MG ER 51079089901 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

690 of 774

VERAPAMIL TAB 180MG ER 51079089920 UDL LABORATORIES, INC. yLOXAPINE CAP 10MG 51079090101 UDL LABORATORIES, INC. yLOXAPINE CAP 10MG 51079090120 UDL LABORATORIES, INC. yLOXAPINE CAP 25MG 51079090201 UDL LABORATORIES, INC. yLOXAPINE CAP 25MG 51079090220 UDL LABORATORIES, INC. yLOXAPINE CAP 50MG 51079090301 UDL LABORATORIES, INC. yLOXAPINE CAP 50MG 51079090320 UDL LABORATORIES, INC. yPHENYTOIN EX CAP 100MG 51079090501 UDL LABORATORIES, INC. yPHENYTOIN EX CAP 100MG 51079090517 UDL LABORATORIES, INC. yPHENYTOIN EX CAP 100MG 51079090519 UDL LABORATORIES, INC. yPHENYTOIN EX CAP 100MG 51079090520 UDL LABORATORIES, INC. yPHENYTOIN EX CAP 100MG 51079090556 UDL LABORATORIES, INC. yPHENYTOIN EX CAP 100MG 51079090557 UDL LABORATORIES, INC. yAMIODARONE TAB 200MG 51079090601 UDL LABORATORIES, INC. yAMIODARONE TAB 200MG 51079090620 UDL LABORATORIES, INC. yVERAPAMIL CAP 120MG ER 51079091701 UDL LABORATORIES, INC. yVERAPAMIL CAP 120MG ER 51079091720 UDL LABORATORIES, INC. yVERAPAMIL CAP 180MG ER 51079091801 UDL LABORATORIES, INC. yVERAPAMIL CAP 180MG ER 51079091820 UDL LABORATORIES, INC. yVERAPAMIL CAP 240MG ER 51079091901 UDL LABORATORIES, INC. yVERAPAMIL CAP 240MG ER 51079091908 UDL LABORATORIES, INC. yCLOZAPINE TAB 25MG 51079092101 UDL LABORATORIES, INC. yCLOZAPINE TAB 25MG 51079092120 UDL LABORATORIES, INC. yCLOZAPINE TAB 100MG 51079092201 UDL LABORATORIES, INC. yCLOZAPINE TAB 100MG 51079092220 UDL LABORATORIES, INC. yCARB/LEVO ER TAB 50-200MG 51079092301 UDL LABORATORIES, INC. yCARB/LEVO ER TAB 50-200MG 51079092317 UDL LABORATORIES, INC. yCARB/LEVO ER TAB 50-200MG 51079092319 UDL LABORATORIES, INC. yCARB/LEVO ER TAB 50-200MG 51079092320 UDL LABORATORIES, INC. yDILTIAZEM CAP 60MG ER 51079092401 UDL LABORATORIES, INC. yDILTIAZEM CAP 60MG ER 51079092420 UDL LABORATORIES, INC. yDILTIAZEM CAP 90MG ER 51079092501 UDL LABORATORIES, INC. yDILTIAZEM CAP 90MG ER 51079092520 UDL LABORATORIES, INC. yDILTIAZEM CAP 120MG ER 51079092601 UDL LABORATORIES, INC. yDILTIAZEM CAP 120MG ER 51079092620 UDL LABORATORIES, INC. yLABETALOL TAB 100MG 51079092801 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

691 of 774

LABETALOL TAB 100MG 51079092820 UDL LABORATORIES, INC. yLABETALOL TAB 200MG 51079092920 UDL LABORATORIES, INC. yTRIAM/HCTZ CAP 37.5-25 51079093501 UDL LABORATORIES, INC. yTRIAM/HCTZ CAP 37.5-25 51079093520 UDL LABORATORIES, INC. yTERAZOSIN CAP 1MG 51079093601 UDL LABORATORIES, INC. yTERAZOSIN CAP 1MG 51079093620 UDL LABORATORIES, INC. yTERAZOSIN CAP 2MG 51079093701 UDL LABORATORIES, INC. yTERAZOSIN CAP 2MG 51079093720 UDL LABORATORIES, INC. yTERAZOSIN CAP 5MG 51079093801 UDL LABORATORIES, INC. yTERAZOSIN CAP 5MG 51079093820 UDL LABORATORIES, INC. yTERAZOSIN CAP 10MG 51079093901 UDL LABORATORIES, INC. yTERAZOSIN CAP 10MG 51079093920 UDL LABORATORIES, INC. yNIFEDIPINE TAB 30MG ER 51079094001 UDL LABORATORIES, INC. yNIFEDIPINE TAB 30MG ER 51079094020 UDL LABORATORIES, INC. yBUPROPION TAB 75MG 51079094301 UDL LABORATORIES, INC. yBUPROPION TAB 75MG 51079094320 UDL LABORATORIES, INC. yBUPROPION TAB 100MG 51079094401 UDL LABORATORIES, INC. yBUPROPION TAB 100MG 51079094420 UDL LABORATORIES, INC. yDIGITEK TAB 0.125MG 51079094501 UDL LABORATORIES, INC. yDIGITEK TAB 0.125MG 51079094520 UDL LABORATORIES, INC. yDIGITEK TAB 0.125MG 51079094557 UDL LABORATORIES, INC. yDIGITEK TAB 0.25MG 51079094601 UDL LABORATORIES, INC. yDIGITEK TAB 0.25MG 51079094620 UDL LABORATORIES, INC. yDILTIAZEM CAP 120MG ER 51079094701 UDL LABORATORIES, INC. yDILTIAZEM CAP 120MG ER 51079094708 UDL LABORATORIES, INC. yDILTIAZEM CAP 180MG ER 51079094801 UDL LABORATORIES, INC. yDILTIAZEM CAP 180MG ER 51079094808 UDL LABORATORIES, INC. yDILTIAZEM CAP 240MG ER 51079094901 UDL LABORATORIES, INC. yDILTIAZEM CAP 240MG ER 51079094908 UDL LABORATORIES, INC. yENALAPRIL TAB 2.5MG 51079095001 UDL LABORATORIES, INC. yENALAPRIL TAB 2.5MG 51079095020 UDL LABORATORIES, INC. yENALAPRIL TAB 5MG 51079095101 UDL LABORATORIES, INC. yENALAPRIL TAB 5MG 51079095120 UDL LABORATORIES, INC. yENALAPRIL TAB 10MG 51079095201 UDL LABORATORIES, INC. yENALAPRIL TAB 10MG 51079095220 UDL LABORATORIES, INC. yENALAPRIL TAB 20MG 51079095301 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ENALAPRIL TAB 20MG 51079095320 UDL LABORATORIES, INC. yBISOPRL/HCTZ TAB 2.5/6.25 51079095401 UDL LABORATORIES, INC. yBISOPRL/HCTZ TAB 2.5/6.25 51079095420 UDL LABORATORIES, INC. yBISOPRL/HCTZ TAB 5/6.25MG 51079095501 UDL LABORATORIES, INC. yBISOPRL/HCTZ TAB 5/6.25MG 51079095520 UDL LABORATORIES, INC. yBISOPRL/HCTZ TAB 10/6.25 51079095601 UDL LABORATORIES, INC. yBISOPRL/HCTZ TAB 10/6.25 51079095620 UDL LABORATORIES, INC. yDOXAZOSIN TAB 1MG 51079095701 UDL LABORATORIES, INC. yDOXAZOSIN TAB 1MG 51079095720 UDL LABORATORIES, INC. yDOXAZOSIN TAB 2MG 51079095801 UDL LABORATORIES, INC. yDOXAZOSIN TAB 2MG 51079095820 UDL LABORATORIES, INC. yDOXAZOSIN TAB 4MG 51079095901 UDL LABORATORIES, INC. yDOXAZOSIN TAB 4MG 51079095920 UDL LABORATORIES, INC. yBUSPIRONE TAB 15MG 51079096020 UDL LABORATORIES, INC. yPACLITAXEL INJ 51079096201 UDL LABORATORIES, INC. yPACLITAXEL INJ 51079096301 UDL LABORATORIES, INC. yETOPOSIDE CAP 50MG 51079096501 UDL LABORATORIES, INC. yETOPOSIDE CAP 50MG 51079096505 UDL LABORATORIES, INC. yFAMOTIDINE TAB 20MG 51079096601 UDL LABORATORIES, INC. yFAMOTIDINE TAB 20MG 51079096617 UDL LABORATORIES, INC. yFAMOTIDINE TAB 20MG 51079096619 UDL LABORATORIES, INC. yFAMOTIDINE TAB 20MG 51079096620 UDL LABORATORIES, INC. yDIPHENHYDRAM TAB 25MG 51079096701 UDL LABORATORIES, INC. yDIPHENHYDRAM TAB 25MG 51079096717 UDL LABORATORIES, INC. yDIPHENHYDRAM TAB 25MG 51079096719 UDL LABORATORIES, INC. yDIPHENHYDRAM TAB 25MG 51079096720 UDL LABORATORIES, INC. yNIFEDIPINE TAB 60MG ER 51079096801 UDL LABORATORIES, INC. yNIFEDIPINE TAB 60MG ER 51079096820 UDL LABORATORIES, INC. yNIFEDIPINE TAB 90MG ER 51079096901 UDL LABORATORIES, INC. yNIFEDIPINE TAB 90MG ER 51079096920 UDL LABORATORIES, INC. yURSODIOL CAP 300MG 51079097001 UDL LABORATORIES, INC. yURSODIOL CAP 300MG 51079097020 UDL LABORATORIES, INC. yFLUOXETINE CAP 20MG 51079097101 UDL LABORATORIES, INC. yFLUOXETINE CAP 20MG 51079097117 UDL LABORATORIES, INC. yFLUOXETINE CAP 20MG 51079097119 UDL LABORATORIES, INC. yFLUOXETINE CAP 20MG 51079097120 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METFORMIN TAB 500MG 51079097201 UDL LABORATORIES, INC. yMETFORMIN TAB 500MG 51079097217 UDL LABORATORIES, INC. yMETFORMIN TAB 500MG 51079097219 UDL LABORATORIES, INC. yMETFORMIN TAB 500MG 51079097220 UDL LABORATORIES, INC. yMETFORMIN TAB 500MG 51079097257 UDL LABORATORIES, INC. yMETFORMIN TAB 850MG 51079097301 UDL LABORATORIES, INC. yMETFORMIN TAB 850MG 51079097320 UDL LABORATORIES, INC. yLOVASTATIN TAB 10MG 51079097401 UDL LABORATORIES, INC. yLOVASTATIN TAB 10MG 51079097420 UDL LABORATORIES, INC. yLOVASTATIN TAB 20MG 51079097501 UDL LABORATORIES, INC. yLOVASTATIN TAB 20MG 51079097520 UDL LABORATORIES, INC. yLOVASTATIN TAB 20MG 51079097556 UDL LABORATORIES, INC. yLOVASTATIN TAB 40MG 51079097601 UDL LABORATORIES, INC. yLOVASTATIN TAB 40MG 51079097620 UDL LABORATORIES, INC. yLOVASTATIN TAB 40MG 51079097656 UDL LABORATORIES, INC. yCARB/LEVO ER TAB 25/100 51079097801 UDL LABORATORIES, INC. yCARB/LEVO ER TAB 25/100 51079097820 UDL LABORATORIES, INC. ySPIRONOLACT TAB 50MG 51079097901 UDL LABORATORIES, INC. ySPIRONOLACT TAB 50MG 51079097920 UDL LABORATORIES, INC. ySPIRONOLACT TAB 100MG 51079098001 UDL LABORATORIES, INC. ySPIRONOLACT TAB 100MG 51079098020 UDL LABORATORIES, INC. yLISINOPRIL TAB 5MG 51079098101 UDL LABORATORIES, INC. yLISINOPRIL TAB 5MG 51079098120 UDL LABORATORIES, INC. yLISINOPRIL TAB 5MG 51079098157 UDL LABORATORIES, INC. yLISINOPRIL TAB 10MG 51079098201 UDL LABORATORIES, INC. yLISINOPRIL TAB 10MG 51079098217 UDL LABORATORIES, INC. yLISINOPRIL TAB 10MG 51079098219 UDL LABORATORIES, INC. yLISINOPRIL TAB 10MG 51079098220 UDL LABORATORIES, INC. yLISINOPRIL TAB 10MG 51079098257 UDL LABORATORIES, INC. yLISINOPRIL TAB 20MG 51079098301 UDL LABORATORIES, INC. yLISINOPRIL TAB 20MG 51079098317 UDL LABORATORIES, INC. yLISINOPRIL TAB 20MG 51079098319 UDL LABORATORIES, INC. yLISINOPRIL TAB 20MG 51079098320 UDL LABORATORIES, INC. yLISINOPRIL TAB 20MG 51079098357 UDL LABORATORIES, INC. yLISINOPRIL TAB 40MG 51079098401 UDL LABORATORIES, INC. yLISINOPRIL TAB 40MG 51079098420 UDL LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

694 of 774

BUSPIRONE TAB 5MG 51079098501 UDL LABORATORIES, INC. yBUSPIRONE TAB 5MG 51079098520 UDL LABORATORIES, INC. yBUSPIRONE TAB 10MG 51079098601 UDL LABORATORIES, INC. yBUSPIRONE TAB 10MG 51079098620 UDL LABORATORIES, INC. yNABUMETONE TAB 500MG 51079098901 UDL LABORATORIES, INC. yNABUMETONE TAB 500MG 51079098920 UDL LABORATORIES, INC. yNIZATIDINE CAP 150MG 51079099001 UDL LABORATORIES, INC. yNIZATIDINE CAP 150MG 51079099020 UDL LABORATORIES, INC. yTRAMADOL HCL TAB 50MG 51079099101 UDL LABORATORIES, INC. yTRAMADOL HCL TAB 50MG 51079099120 UDL LABORATORIES, INC. yTRAMADOL HCL TAB 50MG 51079099157 UDL LABORATORIES, INC. yFLUVOXAMINE TAB 50MG 51079099201 UDL LABORATORIES, INC. yFLUVOXAMINE TAB 50MG 51079099220 UDL LABORATORIES, INC. yFLUVOXAMINE TAB 100MG 51079099301 UDL LABORATORIES, INC. yFLUVOXAMINE TAB 100MG 51079099320 UDL LABORATORIES, INC. yBUSPIRONE TAB 30MG 51079099401 UDL LABORATORIES, INC. yBUSPIRONE TAB 30MG 51079099420 UDL LABORATORIES, INC. yMETFORMIN TAB 1000MG 51079099501 UDL LABORATORIES, INC. yMETFORMIN TAB 1000MG 51079099520 UDL LABORATORIES, INC. yPROPAFENONE TAB 150MG 51079099601 UDL LABORATORIES, INC. yPROPAFENONE TAB 150MG 51079099620 UDL LABORATORIES, INC. yFLUOXETINE CAP 10MG 51079099701 UDL LABORATORIES, INC. yFLUOXETINE CAP 10MG 51079099720 UDL LABORATORIES, INC. yTIZANIDINE TAB 4MG 51079099801 UDL LABORATORIES, INC. yTIZANIDINE TAB 4MG 51079099820 UDL LABORATORIES, INC. yMARINOL CAP 2.5MG 00051002121 UNIMED PHARMACEUTICALS, INC yMARINOL CAP 5MG 00051002211 UNIMED PHARMACEUTICALS, INC yMARINOL CAP 5MG 00051002221 UNIMED PHARMACEUTICALS, INC yMARINOL CAP 10MG 00051002321 UNIMED PHARMACEUTICALS, INC yESTROGEL GEL 00051102858 UNIMED PHARMACEUTICALS, INC yANDROGEL GEL 1%(25MG) 00051842530 UNIMED PHARMACEUTICALS, INC yANDROGEL GEL 1%(50MG) 00051845030 UNIMED PHARMACEUTICALS, INC yANDROGEL GEL PUMP 1% 00051848888 UNIMED PHARMACEUTICALS, INC yANADROL-50 TAB 50MG 00051863333 UNIMED PHARMACEUTICALS, INC yAMINOPHYLLIN TAB 100MG 00677000301 UNITED RESEARCH LABORATORIES yAMINOPHYLLIN TAB 200MG 00677000701 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

695 of 774

CORTISONE AC TAB 25MG 00677004601 UNITED RESEARCH LABORATORIES yHYDROCORT TAB 20MG 00677007601 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 5MG 00677011701 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 5MG 00677011710 UNITED RESEARCH LABORATORIES yQUINIDINE SU TAB 200MG 00677012201 UNITED RESEARCH LABORATORIES yQUINIDINE SU TAB 200MG 00677012210 UNITED RESEARCH LABORATORIES ySODIUM BICAR TAB 650MG 00677013110 UNITED RESEARCH LABORATORIES yUNI-DAILY TAB 00677016301 UNITED RESEARCH LABORATORIES yUNI-DAILY TAB /IRON 00677016401 UNITED RESEARCH LABORATORIES yPAPAVERINE CAP 150MG CR 00677017101 UNITED RESEARCH LABORATORIES yVITAMIN C TAB 500MG 00677019001 UNITED RESEARCH LABORATORIES yDOCUSATE SOD CAP 100MG 00677019101 UNITED RESEARCH LABORATORIES yDOCUSATE SOD CAP 100MG 00677019110 UNITED RESEARCH LABORATORIES yDOCUSATE SOD CAP 250MG 00677019201 UNITED RESEARCH LABORATORIES yVITAMIN E CAP 400UNIT 00677021001 UNITED RESEARCH LABORATORIES yVITAMIN E CAP 1000UNIT 00677038101 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 10MG 00677042101 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 10MG 00677042106 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 10MG 00677042107 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 25MG 00677042201 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 25MG 00677042206 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 25MG 00677042207 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 50MG 00677042301 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 50MG 00677042306 UNITED RESEARCH LABORATORIES yIMIPRAM HCL TAB 50MG 00677042307 UNITED RESEARCH LABORATORIES yNIACIN CAP 125MG SR 00677042401 UNITED RESEARCH LABORATORIES yNIACIN SR CAP 250MG CR 00677042501 UNITED RESEARCH LABORATORIES yNIACIN SR CAP 250MG CR 00677042505 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 20MG 00677042701 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 20MG 00677042705 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 20MG 00677042710 UNITED RESEARCH LABORATORIES yMETHOCARBAM TAB 500MG 00677043001 UNITED RESEARCH LABORATORIES yMETHOCARBAM TAB 750MG 00677043101 UNITED RESEARCH LABORATORIES yMETHOCARBAM TAB 750MG 00677043105 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 10MG 00677047501 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 10MG 00677047510 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMITRIPTYLIN TAB 25MG 00677047601 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 50MG 00677047701 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 50MG 00677047710 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 75MG 00677047801 UNITED RESEARCH LABORATORIES ySULFASALAZIN TAB 500MG 00677048301 UNITED RESEARCH LABORATORIES ySULFASALAZIN TAB 500MG 00677048305 UNITED RESEARCH LABORATORIES yNITROGLYCER CAP 2.5MG CR 00677048501 UNITED RESEARCH LABORATORIES yNITROGLYCER CAP 6.5MG CR 00677048601 UNITED RESEARCH LABORATORIES yUNI-LAN SUS 00677048732 UNITED RESEARCH LABORATORIES yPOT CHLORIDE LIQ 10% SF 00677054033 UNITED RESEARCH LABORATORIES yDOXYCYCL HYC CAP 100MG 00677056202 UNITED RESEARCH LABORATORIES yDOXYCYCL HYC CAP 100MG 00677056205 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 100MG 00677056801 UNITED RESEARCH LABORATORIES yPHENAZOPYRID TAB 100MG 00677057501 UNITED RESEARCH LABORATORIES yBISACODYL TAB 5MG EC 00677057801 UNITED RESEARCH LABORATORIES yBISACODYL TAB 5MG EC 00677057810 UNITED RESEARCH LABORATORIES yCARISOPRODOL TAB 350MG 00677058901 UNITED RESEARCH LABORATORIES yCARISOPRODOL TAB 350MG 00677058905 UNITED RESEARCH LABORATORIES yCARISOPRODOL TAB 350MG 00677058906 UNITED RESEARCH LABORATORIES yCARISOPRODOL TAB 350MG 00677058907 UNITED RESEARCH LABORATORIES yCARISOPRODOL TAB 350MG 00677058910 UNITED RESEARCH LABORATORIES yDOXYCYCL HYC CAP 50MG 00677059802 UNITED RESEARCH LABORATORIES yHYDROXYZ HCL TAB 25MG 00677060501 UNITED RESEARCH LABORATORIES yHYDROXYZ HCL TAB 25MG 00677060505 UNITED RESEARCH LABORATORIES yHYDROXYZ HCL TAB 25MG 00677060510 UNITED RESEARCH LABORATORIES yHYDROXYZ HCL TAB 50MG 00677060601 UNITED RESEARCH LABORATORIES yHYDROXYZ HCL TAB 50MG 00677060605 UNITED RESEARCH LABORATORIES yHYDROXYZ HCL TAB 50MG 00677060610 UNITED RESEARCH LABORATORIES yNYSTATIN TAB 500000 00677061301 UNITED RESEARCH LABORATORIES yZINC SULFATE CAP 220MG 00677062201 UNITED RESEARCH LABORATORIES ySPIRONO/HCTZ TAB 25/25 00677062401 UNITED RESEARCH LABORATORIES ySPIRONO/HCTZ TAB 25/25 00677062405 UNITED RESEARCH LABORATORIES ySPIRONO/HCTZ TAB 25/25 00677062407 UNITED RESEARCH LABORATORIES ySPIRONO/HCTZ TAB 25/25 00677062410 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 25MG 00677062501 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 25MG 00677062505 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SPIRONOLACT TAB 25MG 00677062506 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 25MG 00677062507 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 25MG 00677062510 UNITED RESEARCH LABORATORIES yAMITRIPTYLIN TAB 150MG 00677064501 UNITED RESEARCH LABORATORIES yQUINIDINE GL TAB 324MG CR 00677067501 UNITED RESEARCH LABORATORIES yQUINIDINE GL TAB 324MG CR 00677067503 UNITED RESEARCH LABORATORIES yQUINIDINE GL TAB 324MG CR 00677067505 UNITED RESEARCH LABORATORIES yACETAMIN CAP 500MG 00677067801 UNITED RESEARCH LABORATORIES yACETAMIN CAP 500MG 00677067810 UNITED RESEARCH LABORATORIES yISOSORB DIN TAB 20MG 00677068910 UNITED RESEARCH LABORATORIES yMETRONIDAZOL TAB 250MG 00677069001 UNITED RESEARCH LABORATORIES yMETRONIDAZOL TAB 250MG 00677069003 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 10MG 00677069801 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 10MG 00677069805 UNITED RESEARCH LABORATORIES yPREDNISONE TAB 10MG 00677069810 UNITED RESEARCH LABORATORIES yLANOLIN OIN 00677073044 UNITED RESEARCH LABORATORIES yASPIRIN TAB 325MG EC 00677077101 UNITED RESEARCH LABORATORIES yASPIRIN TAB 325MG EC 00677077110 UNITED RESEARCH LABORATORIES yASPIRIN TAB 650MG EC 00677077201 UNITED RESEARCH LABORATORIES yBISACODYL SUP 10MG 00677078001 UNITED RESEARCH LABORATORIES yBISACODYL SUP 10MG 00677078012 UNITED RESEARCH LABORATORIES yERGOLOID MES TAB 1MG ORAL 00677078201 UNITED RESEARCH LABORATORIES yERGOLOID MES TAB 1MG ORAL 00677078205 UNITED RESEARCH LABORATORIES ySMZ-TMP TAB 400-80MG 00677078301 UNITED RESEARCH LABORATORIES ySMZ-TMP TAB 400-80MG 00677078305 UNITED RESEARCH LABORATORIES ySMZ-TMP TAB 400-80MG 00677078360 UNITED RESEARCH LABORATORIES ySMZ/TMP DS TAB 800-160 00677078401 UNITED RESEARCH LABORATORIES ySMZ/TMP DS TAB 800-160 00677078405 UNITED RESEARCH LABORATORIES yDOXYCYCL HYC TAB 100MG 00677079902 UNITED RESEARCH LABORATORIES yDOXYCYCL HYC TAB 100MG 00677079905 UNITED RESEARCH LABORATORIES yPHENAZOPYRID TAB 200MG 00677080401 UNITED RESEARCH LABORATORIES yMETRONIDAZOL TAB 500MG 00677081601 UNITED RESEARCH LABORATORIES yTHEOPHYLLINE TAB 300MG CR 00677081701 UNITED RESEARCH LABORATORIES yTHEOPHYLLINE TAB 300MG CR 00677081705 UNITED RESEARCH LABORATORIES yMILK OF MAGN SUS 00677081832 UNITED RESEARCH LABORATORIES yPOT EFFERVES TAB 25MEQ EF 00677081907 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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THIORIDAZINE TAB 10MG 00677082301 UNITED RESEARCH LABORATORIES yTHIORIDAZINE TAB 25MG 00677082401 UNITED RESEARCH LABORATORIES yTHIORIDAZINE TAB 50MG 00677082501 UNITED RESEARCH LABORATORIES yFORTABS TAB 00677082701 UNITED RESEARCH LABORATORIES yTHIORIDAZINE TAB 100MG 00677083201 UNITED RESEARCH LABORATORIES yTHIORIDAZINE TAB 100MG 00677083206 UNITED RESEARCH LABORATORIES yTHEOPHYLLINE TAB 200MG ER 00677084601 UNITED RESEARCH LABORATORIES yUNI-PERR TAB 00677086490 UNITED RESEARCH LABORATORIES yALLOPURINOL TAB 300MG 00677087101 UNITED RESEARCH LABORATORIES yALLOPURINOL TAB 300MG 00677087105 UNITED RESEARCH LABORATORIES yALLOPURINOL TAB 300MG 00677087110 UNITED RESEARCH LABORATORIES yOCUTRICIN SOL OP 00677090621 UNITED RESEARCH LABORATORIES ySOD SULFACET SOL 10% OP 00677091730 UNITED RESEARCH LABORATORIES yUNI-EASE CAP 100MG 00677092406 UNITED RESEARCH LABORATORIES yDOCUSATE CAL CAP 240MG 00677094101 UNITED RESEARCH LABORATORIES yDOCUSATE CAL CAP 240MG 00677094105 UNITED RESEARCH LABORATORIES yARTIFICIAL SOL TEARS OP 00677098530 UNITED RESEARCH LABORATORIES yAPAP/CODEINE SOL 120-12/5 00677099633 UNITED RESEARCH LABORATORIES ySALSALATE TAB 500MG 00677102401 UNITED RESEARCH LABORATORIES ySALSALATE TAB 750MG 00677102501 UNITED RESEARCH LABORATORIES ySALSALATE TAB 750MG 00677102505 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 400MG 00677103101 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 400MG 00677103105 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 600MG 00677103201 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 600MG 00677103205 UNITED RESEARCH LABORATORIES yPOT CHLORIDE POW 20MEQ 00677103507 UNITED RESEARCH LABORATORIES yLORAZEPAM TAB 0.5MG 00677105601 UNITED RESEARCH LABORATORIES yLORAZEPAM TAB 0.5MG 00677105605 UNITED RESEARCH LABORATORIES yLORAZEPAM TAB 1MG 00677105701 UNITED RESEARCH LABORATORIES yLORAZEPAM TAB 2MG 00677105801 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 200MG 00677109001 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 200MG 00677109002 UNITED RESEARCH LABORATORIES yNIACIN CAP 400MG SR 00677112601 UNITED RESEARCH LABORATORIES yTRAZODONE TAB 50MG 00677113301 UNITED RESEARCH LABORATORIES yTRAZODONE TAB 50MG 00677113305 UNITED RESEARCH LABORATORIES yTRAZODONE TAB 100MG 00677113401 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRAZODONE TAB 100MG 00677113405 UNITED RESEARCH LABORATORIES ySULINDAC TAB 150MG 00677117305 UNITED RESEARCH LABORATORIES ySULINDAC TAB 150MG 00677117306 UNITED RESEARCH LABORATORIES ySULINDAC TAB 200MG 00677117401 UNITED RESEARCH LABORATORIES ySULINDAC TAB 200MG 00677117405 UNITED RESEARCH LABORATORIES ySULINDAC TAB 200MG 00677117406 UNITED RESEARCH LABORATORIES yHYDROCO/APAP TAB 5-500MG 00677118405 UNITED RESEARCH LABORATORIES yQUINIDINE SU TAB 300MG 00677120901 UNITED RESEARCH LABORATORIES yCHLORD/CLIDI CAP 5-2.5MG 00677124701 UNITED RESEARCH LABORATORIES yACETAZOLAMID TAB 125MG 00677124801 UNITED RESEARCH LABORATORIES yTRAZODONE TAB 150MG 00677130201 UNITED RESEARCH LABORATORIES yTRAZODONE TAB 150MG 00677130205 UNITED RESEARCH LABORATORIES yTRAZODONE TAB 150MG 00677130207 UNITED RESEARCH LABORATORIES yMETOCLOPRAM TAB 5MG 00677132301 UNITED RESEARCH LABORATORIES yMETOCLOPRAM TAB 5MG 00677132305 UNITED RESEARCH LABORATORIES yASPIRIN TAB 975MG EC 00677134701 UNITED RESEARCH LABORATORIES yALBUTEROL TAB 2MG 00677135901 UNITED RESEARCH LABORATORIES yALBUTEROL TAB 2MG 00677135905 UNITED RESEARCH LABORATORIES yALBUTEROL TAB 4MG 00677136001 UNITED RESEARCH LABORATORIES yALBUTEROL TAB 4MG 00677136005 UNITED RESEARCH LABORATORIES yTOLMETIN SOD TAB 200MG 00677142501 UNITED RESEARCH LABORATORIES yBENZONATATE CAP 100MG 00677147201 UNITED RESEARCH LABORATORIES yGG/PSE CR TAB 600-120 00677147601 UNITED RESEARCH LABORATORIES yGG/PSE CR TAB 600-120 00677147605 UNITED RESEARCH LABORATORIES yATENOLOL TAB 100MG 00677147901 UNITED RESEARCH LABORATORIES yATENOLOL TAB 100MG 00677147910 UNITED RESEARCH LABORATORIES yATENOL/CHLOR TAB 50-25MG 00677148001 UNITED RESEARCH LABORATORIES yATENOL/CHLOR TAB 100-25MG 00677148101 UNITED RESEARCH LABORATORIES yMETOPROLOL TAB 50MG 00677148201 UNITED RESEARCH LABORATORIES yMETOPROLOL TAB 50MG 00677148210 UNITED RESEARCH LABORATORIES yMETOPROLOL TAB 100MG 00677148301 UNITED RESEARCH LABORATORIES yMETOPROLOL TAB 100MG 00677148310 UNITED RESEARCH LABORATORIES yGG/PSE CR TAB 600-60MG 00677148701 UNITED RESEARCH LABORATORIES yIRON COMPLEX CAP 150MG 00677159701 UNITED RESEARCH LABORATORIES yB-COMPLEX TAB PLUS C 00677160401 UNITED RESEARCH LABORATORIES yAZO-GESIC TAB 95MG 00677164630 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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QUININE SULF CAP 5GR 00677164701 UNITED RESEARCH LABORATORIES yQUININE SULF CAP 5GR 00677164705 UNITED RESEARCH LABORATORIES yQUININE SULF CAP 5GR 00677164707 UNITED RESEARCH LABORATORIES yQUININE SULF CAP 5GR 00677164710 UNITED RESEARCH LABORATORIES yGLUCOS/CHOND CAP 500-400 00677165206 UNITED RESEARCH LABORATORIES yGLUCOS/CHOND CAP 500-400 00677165267 UNITED RESEARCH LABORATORIES yTHYROID TAB 32.5MG 00677165710 UNITED RESEARCH LABORATORIES yTHYROID TAB 65MG 00677165810 UNITED RESEARCH LABORATORIES yTHYROID TAB 130MG 00677165910 UNITED RESEARCH LABORATORIES yGUAIFENESIN TAB 200MG 00677166101 UNITED RESEARCH LABORATORIES yHYOSCYAMINE SUB 0.125MG 00677166501 UNITED RESEARCH LABORATORIES yANTIBIOT EAR SOL 1% OTIC 00677167621 UNITED RESEARCH LABORATORIES yANTIBIOT EAR SUS 1% OTIC 00677167721 UNITED RESEARCH LABORATORIES ySOD FLUORIDE CHW 1MG 00677167810 UNITED RESEARCH LABORATORIES yMETHENAM MAN TAB 0.5GM 00677168101 UNITED RESEARCH LABORATORIES yMETHENAM MAN TAB 1GM 00677168201 UNITED RESEARCH LABORATORIES yCOLCHICINE TAB 0.6MG 00677168301 UNITED RESEARCH LABORATORIES yCOLCHICINE TAB 0.6MG 00677168310 UNITED RESEARCH LABORATORIES yHAPONAL TAB 00677168510 UNITED RESEARCH LABORATORIES yDIMENHYDRIN TAB 50MG 00677168601 UNITED RESEARCH LABORATORIES yCHLORPHENIR TAB 4MG 00677168701 UNITED RESEARCH LABORATORIES yCHLORPHENIR TAB 4MG 00677168710 UNITED RESEARCH LABORATORIES yPRENATAL NF TAB PLUS 00677168901 UNITED RESEARCH LABORATORIES yPHENOBARB TAB 64.8MG 00677169810 UNITED RESEARCH LABORATORIES yKETOCONAZOLE TAB 200MG 00677170001 UNITED RESEARCH LABORATORIES yKETOCONAZOLE TAB 200MG 00677170007 UNITED RESEARCH LABORATORIES yLABETALOL TAB 100MG 00677170101 UNITED RESEARCH LABORATORIES yLABETALOL TAB 100MG 00677170105 UNITED RESEARCH LABORATORIES yLABETALOL TAB 200MG 00677170201 UNITED RESEARCH LABORATORIES yLABETALOL TAB 200MG 00677170205 UNITED RESEARCH LABORATORIES yLABETALOL TAB 300MG 00677170301 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 50MG 00677170701 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 50MG 00677170705 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 50MG 00677170706 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 50MG 00677170707 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 100MG 00677170801 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SPIRONOLACT TAB 100MG 00677170805 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 100MG 00677170806 UNITED RESEARCH LABORATORIES ySPIRONOLACT TAB 100MG 00677170807 UNITED RESEARCH LABORATORIES ySOTALOL HCL TAB 80MG 00677170901 UNITED RESEARCH LABORATORIES ySOTALOL HCL TAB 120MG 00677171001 UNITED RESEARCH LABORATORIES ySOTALOL HCL TAB 160MG 00677171101 UNITED RESEARCH LABORATORIES yUNI-CENNA TAB 8.6MG 00677171901 UNITED RESEARCH LABORATORIES yPHENOBARB TAB 15MG 00677173110 UNITED RESEARCH LABORATORIES yPHENOBARB TAB 30MG 00677173210 UNITED RESEARCH LABORATORIES yISOMETH/APAP CAP DICHLOR 00677173901 UNITED RESEARCH LABORATORIES yCPM/PSE CAP 8-120 SR 00677174701 UNITED RESEARCH LABORATORIES yBUT/APAP/CAF TAB 00677174801 UNITED RESEARCH LABORATORIES yUNI-THERA M TAB ADVANCED 00677175001 UNITED RESEARCH LABORATORIES yTRIHEXYPHEN TAB 2MG 00677175101 UNITED RESEARCH LABORATORIES yTRIHEXYPHEN TAB 5MG 00677175201 UNITED RESEARCH LABORATORIES yFELODIPINE TAB 2.5MG ER 00677176801 UNITED RESEARCH LABORATORIES yFELODIPINE TAB 5MG ER 00677176901 UNITED RESEARCH LABORATORIES yFELODIPINE TAB 10MG ER 00677177001 UNITED RESEARCH LABORATORIES yGUAIFENESIN SYP 100/5ML 00677177333 UNITED RESEARCH LABORATORIES yBEL-TABS TAB 00677177501 UNITED RESEARCH LABORATORIES yDYPHYLLIN/GG TAB 200-200 00677178001 UNITED RESEARCH LABORATORIES yACETAMIN TAB 325MG 00677178101 UNITED RESEARCH LABORATORIES yACETAMIN TAB 325MG 00677178110 UNITED RESEARCH LABORATORIES yACETAMIN TAB 500MG 00677178201 UNITED RESEARCH LABORATORIES yACETAMIN TAB 500MG 00677178210 UNITED RESEARCH LABORATORIES yACETAMIN TAB 500MG 00677178401 UNITED RESEARCH LABORATORIES yACETAMIN TAB 500MG 00677178410 UNITED RESEARCH LABORATORIES yPSEUDOEPH/GG TAB 45-800MG 00677178701 UNITED RESEARCH LABORATORIES yPSEUDOEPHEDR TAB /GG/DM 00677178801 UNITED RESEARCH LABORATORIES yGUAIF/PHENYL TAB 600-40MG 00677179001 UNITED RESEARCH LABORATORIES yHYDRO/PE/CTM SYP 00677179833 UNITED RESEARCH LABORATORIES yDM HB/PE/CPM SYP STRAWBER 00677180333 UNITED RESEARCH LABORATORIES yPROPAFENONE TAB 150MG 00677181501 UNITED RESEARCH LABORATORIES yPROPAFENONE TAB 150MG 00677181503 UNITED RESEARCH LABORATORIES yPROPAFENONE TAB 300MG 00677181701 UNITED RESEARCH LABORATORIES yPSE/HYDROCOD LIQ /CARBINX 00677182233 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CAR-B-PEN TAB CHLOR-TA 00677182501 UNITED RESEARCH LABORATORIES yPED TAN/CHLO SUS 00677182633 UNITED RESEARCH LABORATORIES yPED TAN/CHLO SUS 00677182641 UNITED RESEARCH LABORATORIES yPROMETHAZINE SYP DM 00677182733 UNITED RESEARCH LABORATORIES yGG/DM LA TAB 00677182901 UNITED RESEARCH LABORATORIES yMETHYLPRED PAK 4MG 00677183113 UNITED RESEARCH LABORATORIES yPSE/CPM/METH TAB SR 00677183801 UNITED RESEARCH LABORATORIES yACETAMIN LIQ 160/5ML 00677183933 UNITED RESEARCH LABORATORIES yPE/GG LA TAB 20-600MG 00677184201 UNITED RESEARCH LABORATORIES yPOT GUAIACO/ SYP HYDROCOD 00677184333 UNITED RESEARCH LABORATORIES yPE/HCOD/CPM SYP 00677184433 UNITED RESEARCH LABORATORIES yHCOD/PE/CPM LIQ 00677184533 UNITED RESEARCH LABORATORIES yPSE/CPM TAB 12HR 00677184901 UNITED RESEARCH LABORATORIES yGG/PSE SR TAB 12HR 00677185101 UNITED RESEARCH LABORATORIES yDM/PE/CPM LIQ 00677185233 UNITED RESEARCH LABORATORIES yASPIRIN TAB 325MG 00677185301 UNITED RESEARCH LABORATORIES yASPIRIN CHW 81MG 00677185408 UNITED RESEARCH LABORATORIES yASPIRIN TAB 81MG EC 00677185510 UNITED RESEARCH LABORATORIES yASPIRIN TAB 81MG EC 00677185567 UNITED RESEARCH LABORATORIES yDIPHENHYDRAM CAP 25MG 00677185601 UNITED RESEARCH LABORATORIES yDIPHENHYDRAM CAP 25MG 00677185610 UNITED RESEARCH LABORATORIES yDIPHENHYDRAM CAP 50MG 00677185701 UNITED RESEARCH LABORATORIES yDIPHENHYDRAM CAP 50MG 00677185710 UNITED RESEARCH LABORATORIES yDIPHENHYDRAM TAB 25MG 00677185801 UNITED RESEARCH LABORATORIES yPSE/DM/GG SYP 40-15-10 00677186033 UNITED RESEARCH LABORATORIES yPSE-DM-GG TAB 00677186101 UNITED RESEARCH LABORATORIES yDM/POT GUAIA LIQ 15-300MG 00677186433 UNITED RESEARCH LABORATORIES yCOLDEX-A SR TAB 4-40-20 00677187301 UNITED RESEARCH LABORATORIES yCOLDTUSS-DR SYP 6-2-15 00677187433 UNITED RESEARCH LABORATORIES yDM/PSE/GG TAB 00677187501 UNITED RESEARCH LABORATORIES yGUAIFE/PSEUD TAB 00677187601 UNITED RESEARCH LABORATORIES yUNI-FAC ZX TAB 00677188306 UNITED RESEARCH LABORATORIES yGG/PHENYLEP TAB 40-1200 00677188501 UNITED RESEARCH LABORATORIES ySENNA-DOCUSA TAB 8.6-50MG 00677188901 UNITED RESEARCH LABORATORIES ySENNA-DOCUSA TAB 8.6-50MG 00677188906 UNITED RESEARCH LABORATORIES ySENNA-DOCUSA TAB 8.6-50MG 00677188910 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PSEUDO/GG LA TAB 12HR 00677189001 UNITED RESEARCH LABORATORIES yGG-PSED SR TAB 12HR 00677189101 UNITED RESEARCH LABORATORIES ySOTALOL AF TAB 80MG 00677189301 UNITED RESEARCH LABORATORIES ySOTALOL AF TAB 80MG 00677189306 UNITED RESEARCH LABORATORIES ySOTALOL AF TAB 120MG 00677189401 UNITED RESEARCH LABORATORIES ySOTALOL AF TAB 120MG 00677189406 UNITED RESEARCH LABORATORIES ySOTALOL AF TAB 160MG 00677189501 UNITED RESEARCH LABORATORIES ySOTALOL AF TAB 160MG 00677189506 UNITED RESEARCH LABORATORIES yHCOD/PE/GG SYP 2-10-100 00677189833 UNITED RESEARCH LABORATORIES yHCOD/PE/GG SYP 2-10-100 00677189841 UNITED RESEARCH LABORATORIES yPSE/GG SR TAB 50-1200 00677189901 UNITED RESEARCH LABORATORIES yPSE/GG SR TAB 50-1200 00677189907 UNITED RESEARCH LABORATORIES yCARB/PE/GG SYP 00677190033 UNITED RESEARCH LABORATORIES yCARB/PE/GG SYP 00677190041 UNITED RESEARCH LABORATORIES yUNI-COF EXP SYP 00677190333 UNITED RESEARCH LABORATORIES yUNI-COF SYP 00677190433 UNITED RESEARCH LABORATORIES yUNI-TEX ER CAP 120/10 00677191701 UNITED RESEARCH LABORATORIES yUNI-TEX ER CAP 120/10 00677191707 UNITED RESEARCH LABORATORIES yCYCLOBENZAPR TAB 10MG 00677191801 UNITED RESEARCH LABORATORIES yCYCLOBENZAPR TAB 10MG 00677191805 UNITED RESEARCH LABORATORIES yCYCLOBENZAPR TAB 10MG 00677191810 UNITED RESEARCH LABORATORIES yKAPECTOLIN SUS 262/15ML 00677192133 UNITED RESEARCH LABORATORIES yCLONIDINE TAB 0.1MG 00677192201 UNITED RESEARCH LABORATORIES yCLONIDINE TAB 0.1MG 00677192210 UNITED RESEARCH LABORATORIES yCLONIDINE TAB 0.2MG 00677192301 UNITED RESEARCH LABORATORIES yCLONIDINE TAB 0.2MG 00677192310 UNITED RESEARCH LABORATORIES yCLONIDINE TAB 0.3MG 00677192401 UNITED RESEARCH LABORATORIES yGUAIFENESIN TAB 400MG 00677192901 UNITED RESEARCH LABORATORIES yGUAIFENESIN TAB 400MG 00677192902 UNITED RESEARCH LABORATORIES yUNI-KAR CAP PLUS C 00677193001 UNITED RESEARCH LABORATORIES yGLYCOPYRROL TAB 1MG 00677193101 UNITED RESEARCH LABORATORIES yGLYCOPYRROL TAB 2MG 00677193201 UNITED RESEARCH LABORATORIES yMEFENAM ACID CAP 250MG 00677193401 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 100MG 00677193501 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 100MG 00677193505 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 100MG 00677193510 UNITED RESEARCH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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GABAPENTIN CAP 300MG 00677193601 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 300MG 00677193605 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 300MG 00677193610 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 400MG 00677193701 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 400MG 00677193705 UNITED RESEARCH LABORATORIES yGABAPENTIN CAP 400MG 00677193710 UNITED RESEARCH LABORATORIES yPHENOBARB TAB 60MG 00677193810 UNITED RESEARCH LABORATORIES yPHENOBARB TAB 100MG 00677193910 UNITED RESEARCH LABORATORIES yFOLIC ACID TAB 1MG 00677194001 UNITED RESEARCH LABORATORIES yFOLIC ACID TAB 1MG 00677194010 UNITED RESEARCH LABORATORIES yMETHIMAZOLE TAB 5MG 00677194501 UNITED RESEARCH LABORATORIES yMETHIMAZOLE TAB 10MG 00677194601 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 200MG 00677194701 UNITED RESEARCH LABORATORIES yIBUPROFEN TAB 200MG 00677194702 UNITED RESEARCH LABORATORIES yUNI ALL 12 SUS 00677194841 UNITED RESEARCH LABORATORIES yISOMETH/APAP CAP DICHLOR 00677194901 UNITED RESEARCH LABORATORIES yUNI-TANN SUS 25MG/5ML 00677195641 UNITED RESEARCH LABORATORIES yUNI-TANN CHW 25MG 00677195706 UNITED RESEARCH LABORATORIES yUNI-TANN CS CHW 10-25-30 00677195806 UNITED RESEARCH LABORATORIES yUNI-TANN CS SUS 00677195941 UNITED RESEARCH LABORATORIES yUNI-TANN D SUS 00677196041 UNITED RESEARCH LABORATORIES yUNI-TANN D CHW 25-10MG 00677196106 UNITED RESEARCH LABORATORIES yCOLCHICINE TAB 0.6MG 00677196201 UNITED RESEARCH LABORATORIES yCOLCHICINE TAB 0.6MG 00677196210 UNITED RESEARCH LABORATORIES yPRAMOXINE AER 1% 00677196579 UNITED RESEARCH LABORATORIES yREMODULIN INJ 1MG/ML 66302010101 UNITED THERAPEUTICS CORPORATION yREMODULIN INJ 2.5MG/ML 66302010201 UNITED THERAPEUTICS CORPORATION yREMODULIN INJ 5MG/ML 66302010501 UNITED THERAPEUTICS CORPORATION yREMODULIN INJ 10MG/ML 66302011001 UNITED THERAPEUTICS CORPORATION ySSKI SOL 1GM/ML 00245000308 UPSHER-SMITH LABORATORIES, INC. ySSKI SOL 1GM/ML 00245000331 UPSHER-SMITH LABORATORIES, INC. yFORTICAL SPR 200/ACT 00245000835 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 80MG 00245001201 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 80MG 00245001211 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 120MG 00245001301 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 120MG 00245001311 UPSHER-SMITH LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SORINE TAB 160MG 00245001401 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 160MG 00245001411 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 240MG 00245001501 UPSHER-SMITH LABORATORIES, INC. ySORINE TAB 240MG 00245001511 UPSHER-SMITH LABORATORIES, INC. yFOLGARD RX TAB 2.2 00245001611 UPSHER-SMITH LABORATORIES, INC. ySORBITOL SOL 70% 00245002016 UPSHER-SMITH LABORATORIES, INC. yAMLACTIN XL LOT 00245002216 UPSHER-SMITH LABORATORIES, INC. yAMLACTIN LOT 12% 00245002322 UPSHER-SMITH LABORATORIES, INC. yAMLACTIN LOT 12% 00245002340 UPSHER-SMITH LABORATORIES, INC. yAMLACTIN CRE 12% 00245002414 UPSHER-SMITH LABORATORIES, INC. yAMLACTIN AP CRE 1-12% 00245002514 UPSHER-SMITH LABORATORIES, INC. yPENTOXIL TAB 400MG CR 00245002701 UPSHER-SMITH LABORATORIES, INC. yPENTOXIL TAB 400MG CR 00245002711 UPSHER-SMITH LABORATORIES, INC. yPENTOXIL TAB 400MG CR 00245002715 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON POW 20MEQ 00245003501 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON POW 20MEQ 00245003530 UPSHER-SMITH LABORATORIES, INC. yPREVALITE POW 4GM 00245003623 UPSHER-SMITH LABORATORIES, INC. yPREVALITE POW 4GM PK 00245003642 UPSHER-SMITH LABORATORIES, INC. yPREVALITE POW 4GM PK 00245003660 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON-25 POW 25MEQ 00245003701 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON-25 POW 25MEQ 00245003730 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON/EF TAB 25MEQ FR 00245003901 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON/EF TAB 25MEQ FR 00245003930 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 8 TAB 8MEQ ER 00245004000 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 8 TAB 8MEQ ER 00245004001 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 8 TAB 8MEQ ER 00245004011 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 8 TAB 8MEQ ER 00245004015 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 8 TAB 8MEQ ER 00245004055 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 10 TAB 10MEQ ER 00245004100 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 10 TAB 10MEQ ER 00245004101 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 10 TAB 10MEQ ER 00245004111 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 10 TAB 10MEQ ER 00245004115 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON 10 TAB 10MEQ ER 00245004155 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 8MEQ ER 00245004200 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 8MEQ ER 00245004255 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 10MEQ ER 00245004300 UPSHER-SMITH LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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POT CHLORIDE TAB 10MEQ ER 00245004355 UPSHER-SMITH LABORATORIES, INC. yFERATAB TAB 300MG 00245005301 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M10 TAB 10MEQ ER 00245005701 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M10 TAB 10MEQ ER 00245005710 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M10 TAB 10MEQ ER 00245005711 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M20 TAB 20MEQ ER 00245005801 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M20 TAB 20MEQ ER 00245005810 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M20 TAB 20MEQ ER 00245005811 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M20 TAB 20MEQ ER 00245005815 UPSHER-SMITH LABORATORIES, INC. ySLO-NIACIN TAB 250MG CR 00245006211 UPSHER-SMITH LABORATORIES, INC. ySLO-NIACIN TAB 500MG CR 00245006311 UPSHER-SMITH LABORATORIES, INC. ySLO-NIACIN TAB 750MG CR 00245006411 UPSHER-SMITH LABORATORIES, INC. yNIACOR TAB 500MG 00245006711 UPSHER-SMITH LABORATORIES, INC. yPOT CITRATE TAB 540MG 00245007011 UPSHER-SMITH LABORATORIES, INC. yPOT CITRATE TAB 1080MG 00245007111 UPSHER-SMITH LABORATORIES, INC. yZINC SULFATE CAP 220MG 00245008011 UPSHER-SMITH LABORATORIES, INC. yBISACODYL SUP 10MG 00245010405 UPSHER-SMITH LABORATORIES, INC. yBISACODYL SUP 10MG 00245010412 UPSHER-SMITH LABORATORIES, INC. yBISACODYL SUP 10MG 00245010450 UPSHER-SMITH LABORATORIES, INC. yHEMORRHOIDAL SUP -HC 25MG 00245011112 UPSHER-SMITH LABORATORIES, INC. yHEMRIL-30 SUP 30MG 00245011212 UPSHER-SMITH LABORATORIES, INC. yHEMRIL-30 SUP 30MG 00245011224 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 100MG 00245014401 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 100MG 00245014430 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 400MG 00245014501 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 400MG 00245014530 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 200MG 00245014701 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 200MG 00245014715 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 200MG 00245014760 UPSHER-SMITH LABORATORIES, INC. yPACERONE TAB 200MG 00245014790 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M15 TAB 00245015001 UPSHER-SMITH LABORATORIES, INC. yKLOR-CON M15 TAB 00245015011 UPSHER-SMITH LABORATORIES, INC. yFOLGARD OS TAB 00245015560 UPSHER-SMITH LABORATORIES, INC. yRMS SUP 5MG 00245016012 UPSHER-SMITH LABORATORIES, INC. yRMS SUP 10MG 00245016112 UPSHER-SMITH LABORATORIES, INC. yRMS SUP 20MG 00245016212 UPSHER-SMITH LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RMS SUP 30MG 00245016312 UPSHER-SMITH LABORATORIES, INC. yCLENIA EMU FOAMING 00245016806 UPSHER-SMITH LABORATORIES, INC. yCLENIA EMU FOAMING 00245016812 UPSHER-SMITH LABORATORIES, INC. yCLENIA CRE 10-5% 00245016901 UPSHER-SMITH LABORATORIES, INC. yFA-B6-B12 TAB 00245018311 UPSHER-SMITH LABORATORIES, INC. yMIDODRINE TAB 2.5MG 00245021111 UPSHER-SMITH LABORATORIES, INC. yMIDODRINE TAB 5MG 00245021201 UPSHER-SMITH LABORATORIES, INC. yMIDODRINE TAB 5MG 00245021211 UPSHER-SMITH LABORATORIES, INC. yMIDODRINE TAB 10MG 00245021311 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 8MEQ ER 00245024210 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 8MEQ ER 00245024211 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 10MEQ ER 00245024310 UPSHER-SMITH LABORATORIES, INC. yPOT CHLORIDE TAB 10MEQ ER 00245024311 UPSHER-SMITH LABORATORIES, INC. yVANDAZOLE GEL 0.75% 00245086070 UPSHER-SMITH LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 00832003800 UPSHER-SMITH LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 00832003810 UPSHER-SMITH LABORATORIES, INC. yOXYBUTYNIN TAB 5MG 00832003850 UPSHER-SMITH LABORATORIES, INC. yANDROXY TAB 10MG 00832008600 UPSHER-SMITH LABORATORIES, INC. yAMANTADINE TAB 100MG 00832011100 UPSHER-SMITH LABORATORIES, INC. yAMANTADINE TAB 100MG 00832011150 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 10MG 00832030000 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 10MG 00832030010 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 25MG 00832030100 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 25MG 00832030110 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 50MG 00832030200 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 50MG 00832030210 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 100MG 00832030300 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 100MG 00832030310 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 200MG 00832030400 UPSHER-SMITH LABORATORIES, INC. yCHLORPROMAZ TAB 200MG 00832030410 UPSHER-SMITH LABORATORIES, INC. yNYAMYC POW 100000 00832046515 UPSHER-SMITH LABORATORIES, INC. yNYAMYC POW 100000 00832046530 UPSHER-SMITH LABORATORIES, INC. yNYAMYC POW 100000 00832046560 UPSHER-SMITH LABORATORIES, INC. yBETHANECHOL TAB 5MG 00832051000 UPSHER-SMITH LABORATORIES, INC. yBETHANECHOL TAB 25MG 00832051200 UPSHER-SMITH LABORATORIES, INC. yBETHANECHOL TAB 25MG 00832051201 UPSHER-SMITH LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BETHANECHOL TAB 25MG 00832051250 UPSHER-SMITH LABORATORIES, INC. yBETHANECHOL TAB 50MG 00832051300 UPSHER-SMITH LABORATORIES, INC. yBETHANECHOL TAB 50MG 00832051301 UPSHER-SMITH LABORATORIES, INC. yVALPROIC ACD CAP 250MG 00832100800 UPSHER-SMITH LABORATORIES, INC. yAMANTADINE CAP 100MG 00832101500 UPSHER-SMITH LABORATORIES, INC. yAMANTADINE CAP 100MG 00832101550 UPSHER-SMITH LABORATORIES, INC. yBACLOFEN TAB 10MG 00832102400 UPSHER-SMITH LABORATORIES, INC. yBACLOFEN TAB 10MG 00832102410 UPSHER-SMITH LABORATORIES, INC. yBACLOFEN TAB 10MG 00832102450 UPSHER-SMITH LABORATORIES, INC. yBACLOFEN TAB 20MG 00832102500 UPSHER-SMITH LABORATORIES, INC. yBACLOFEN TAB 20MG 00832102550 UPSHER-SMITH LABORATORIES, INC. yBENZTROPINE TAB 0.5MG 00832108000 UPSHER-SMITH LABORATORIES, INC. yBENZTROPINE TAB 1MG 00832108100 UPSHER-SMITH LABORATORIES, INC. yBENZTROPINE TAB 1MG 00832108110 UPSHER-SMITH LABORATORIES, INC. yBENZTROPINE TAB 2MG 00832108200 UPSHER-SMITH LABORATORIES, INC. yBENZTROPINE TAB 2MG 00832108210 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 1MG 00832121100 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 1MG 00832121101 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 1MG 00832121110 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 2MG 00832121200 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 2MG 00832121201 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 2MG 00832121210 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 2.5MG 00832121300 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 2.5MG 00832121301 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 2.5MG 00832121310 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 3MG 00832121400 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 3MG 00832121401 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 3MG 00832121410 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 4MG 00832121500 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 4MG 00832121501 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 4MG 00832121510 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 5MG 00832121600 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 5MG 00832121601 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 5MG 00832121610 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 6MG 00832121700 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 6MG 00832121701 UPSHER-SMITH LABORATORIES, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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JANTOVEN TAB 6MG 00832121710 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 7.5MG 00832121800 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 7.5MG 00832121801 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 7.5MG 00832121850 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 10MG 00832121900 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 10MG 00832121901 UPSHER-SMITH LABORATORIES, INC. yJANTOVEN TAB 10MG 00832121950 UPSHER-SMITH LABORATORIES, INC. yMETOLAZONE TAB 2.5MG 65580064371 UPSTATE PHARMA, LLC yMETOLAZONE TAB 5MG 65580064471 UPSTATE PHARMA, LLC yMETOLAZONE TAB 10MG 65580064571 UPSTATE PHARMA, LLC yCAPITAL/COD SUS 120-12/5 00187000301 VALEANT PHARMACEUTICALS INTERNATIONAL yVIRAZOLE INH 6GM 00187000714 VALEANT PHARMACEUTICALS INTERNATIONAL yCESAMET CAP 1MG 00187024701 VALEANT PHARMACEUTICALS INTERNATIONAL ySOLAQUIN CRE 2% 00187037231 VALEANT PHARMACEUTICALS INTERNATIONAL yBENOQUIN CRE 20% 00187038034 VALEANT PHARMACEUTICALS INTERNATIONAL yELDOQUIN CRE 2% 00187038231 VALEANT PHARMACEUTICALS INTERNATIONAL yELDOQUIN CRE 2% 00187038235 VALEANT PHARMACEUTICALS INTERNATIONAL yELDOQUIN CRE 4% FORTE 00187039431 VALEANT PHARMACEUTICALS INTERNATIONAL yELDOPAQUE CRE 4% FORTE 00187039531 VALEANT PHARMACEUTICALS INTERNATIONAL ySOLAQUIN FOR CRE 4% 00187039631 VALEANT PHARMACEUTICALS INTERNATIONAL yOXSORALEN LOT 1% 00187040231 VALEANT PHARMACEUTICALS INTERNATIONAL yVITADYE LOT 5% 00187041302 VALEANT PHARMACEUTICALS INTERNATIONAL yVITADYE LOT 5% 00187041335 VALEANT PHARMACEUTICALS INTERNATIONAL yGLYQUIN CRE 4% W/SUN 00187042046 VALEANT PHARMACEUTICALS INTERNATIONAL yGLYQUIN XM CRE 00187042146 VALEANT PHARMACEUTICALS INTERNATIONAL yZELAPAR TAB 1.25MG 00187045302 VALEANT PHARMACEUTICALS INTERNATIONAL yBONTRIL PDM TAB 35MG 00187049701 VALEANT PHARMACEUTICALS INTERNATIONAL yBONTRIL PDM TAB 35MG 00187049702 VALEANT PHARMACEUTICALS INTERNATIONAL yBONTRIL SR CAP 105MG 00187049801 VALEANT PHARMACEUTICALS INTERNATIONAL yBONTRIL SR CAP 105MG 00187049802 VALEANT PHARMACEUTICALS INTERNATIONAL yELDOPAQUE CRE 2% 00187051831 VALEANT PHARMACEUTICALS INTERNATIONAL yELDOPAQUE CRE 2% 00187051835 VALEANT PHARMACEUTICALS INTERNATIONAL ySOLAQUIN FOR GEL 4% 00187052331 VALEANT PHARMACEUTICALS INTERNATIONAL yFOTOTAR CRE 2% 00187052603 VALEANT PHARMACEUTICALS INTERNATIONAL yFOTOTAR CRE 2% 00187052605 VALEANT PHARMACEUTICALS INTERNATIONAL yRV PAQUE CRE 00187053934 VALEANT PHARMACEUTICALS INTERNATIONAL y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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RV PAQUE CRE 00187053935 VALEANT PHARMACEUTICALS INTERNATIONAL yOXSORALEN-UL CAP 10MG 00187065042 VALEANT PHARMACEUTICALS INTERNATIONAL y8-MOP CAP 10MG 00187065142 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT ACDL MIS 5-7.5-10 00187065820 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT ACDL MIS 10-15-20 00187065920 VALEANT PHARMACEUTICALS INTERNATIONAL yINSTA-GLUCOS GEL 40% 00187074631 VALEANT PHARMACEUTICALS INTERNATIONAL yINSTA-GLUCOS GEL 40% 00187074633 VALEANT PHARMACEUTICALS INTERNATIONAL yPERMAX TAB 0.05MG 00187083901 VALEANT PHARMACEUTICALS INTERNATIONAL yPERMAX TAB 0.25MG 00187084002 VALEANT PHARMACEUTICALS INTERNATIONAL yPERMAX TAB 1MG 00187084102 VALEANT PHARMACEUTICALS INTERNATIONAL yPHRENILIN/ CAP CAFF/COD 00187084301 VALEANT PHARMACEUTICALS INTERNATIONAL yPHRENILIN CAP FORTE 00187084401 VALEANT PHARMACEUTICALS INTERNATIONAL yTESTRED CAP 10MG 00187090101 VALEANT PHARMACEUTICALS INTERNATIONAL yANDROID CAP 10MG 00187090201 VALEANT PHARMACEUTICALS INTERNATIONAL yMESTINON TAB 60MG 00187301030 VALEANT PHARMACEUTICALS INTERNATIONAL yMESTINON TAB 60MG 00187301040 VALEANT PHARMACEUTICALS INTERNATIONAL yMESTINON INJ 5MG/ML 00187301110 VALEANT PHARMACEUTICALS INTERNATIONAL yMESTINON SYP 60MG/5ML 00187301220 VALEANT PHARMACEUTICALS INTERNATIONAL yMESTINON TAB TIMESPAN 00187301330 VALEANT PHARMACEUTICALS INTERNATIONAL yPROSTIGMIN TAB 15MG 00187310010 VALEANT PHARMACEUTICALS INTERNATIONAL yPROSTIGMIN INJ 0.5MG/ML 00187310130 VALEANT PHARMACEUTICALS INTERNATIONAL yPROSTIGMIN INJ 0.25/ML 00187310240 VALEANT PHARMACEUTICALS INTERNATIONAL yPROSTIGMIN INJ 1MG/ML 00187310350 VALEANT PHARMACEUTICALS INTERNATIONAL yPROSTIGMIN INJ 0.5MG/ML 00187310460 VALEANT PHARMACEUTICALS INTERNATIONAL yTENSILON INJ 10MG/ML 00187320010 VALEANT PHARMACEUTICALS INTERNATIONAL yTENSILON INJ 10MG/ML 00187320020 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX SOL 2% 00187320202 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX SOL 2% 00187320210 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX SOL 5% 00187320302 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX SOL 5% 00187320310 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX CRE 5% 00187320426 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX CRE 5% 00187320447 VALEANT PHARMACEUTICALS INTERNATIONAL yLEVO-DROMORA TAB 2MG 00187325110 VALEANT PHARMACEUTICALS INTERNATIONAL yANCOBON CAP 250MG 00187355410 VALEANT PHARMACEUTICALS INTERNATIONAL yANCOBON CAP 500MG 00187355510 VALEANT PHARMACEUTICALS INTERNATIONAL yEFUDEX KIT OCCLUSIO 00187360060 VALEANT PHARMACEUTICALS INTERNATIONAL y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIBRIUM CAP 5MG 00187375010 VALEANT PHARMACEUTICALS INTERNATIONAL yLIBRIUM CAP 10MG 00187375110 VALEANT PHARMACEUTICALS INTERNATIONAL yLIBRIUM INJ 100MG 00187375574 VALEANT PHARMACEUTICALS INTERNATIONAL yLIBRIUM CAP 25MG 00187375810 VALEANT PHARMACEUTICALS INTERNATIONAL yLIMBITROL TAB 5-12.5MG 00187380510 VALEANT PHARMACEUTICALS INTERNATIONAL yLIMBITROL DS TAB 10-25MG 00187380610 VALEANT PHARMACEUTICALS INTERNATIONAL yFLUOROURACIL INJ 50MG/ML 00187395364 VALEANT PHARMACEUTICALS INTERNATIONAL yDALMANE CAP 15MG 00187405110 VALEANT PHARMACEUTICALS INTERNATIONAL yDALMANE CAP 30MG 00187405210 VALEANT PHARMACEUTICALS INTERNATIONAL yLIBRAX CAP 5-2.5MG 00187410010 VALEANT PHARMACEUTICALS INTERNATIONAL yD.H.E. 45 INJ 1MG/ML 66490004101 VALEANT PHARMACEUTICALS INTERNATIONAL yMIGRANAL SPR 4MG/ML 66490024598 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT PED MIS 2.5M GEL 66490065020 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT PED MIS 5MG GEL 66490065120 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT UNIV MIS 10MG GEL 66490065220 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT MIS 15MG GEL 66490065420 VALEANT PHARMACEUTICALS INTERNATIONAL yDIASTAT ADUL MIS 20MG GEL 66490065520 VALEANT PHARMACEUTICALS INTERNATIONAL yMYSOLINE TAB 50MG 66490069010 VALEANT PHARMACEUTICALS INTERNATIONAL yMYSOLINE TAB 50MG 66490069050 VALEANT PHARMACEUTICALS INTERNATIONAL yMYSOLINE TAB 250MG 66490069110 VALEANT PHARMACEUTICALS INTERNATIONAL yMYSOLINE TAB 250MG 66490069111 VALEANT PHARMACEUTICALS INTERNATIONAL yMYSOLINE TAB 250MG 66490069181 VALEANT PHARMACEUTICALS INTERNATIONAL yPERMAX TAB 0.05MG 65234002430 VALEANT PHARMACEUTICALS, INTERNATIONAL yPERMAX TAB 0.25MG 65234002510 VALEANT PHARMACEUTICALS, INTERNATIONAL yPERMAX TAB 1MG 65234002610 VALEANT PHARMACEUTICALS, INTERNATIONAL yCAPITAL/COD SUS 120-12/5 65234004616 VALEANT PHARMACEUTICALS, INTERNATIONAL yBONTRIL SR CAP 105MG 65234004710 VALEANT PHARMACEUTICALS, INTERNATIONAL yBONTRIL SR CAP 105MG 65234004790 VALEANT PHARMACEUTICALS, INTERNATIONAL yBONTRIL PDM TAB 35MG 65234004810 VALEANT PHARMACEUTICALS, INTERNATIONAL yBONTRIL PDM TAB 35MG 65234004890 VALEANT PHARMACEUTICALS, INTERNATIONAL yPHRENILIN TAB 50-325MG 65234005010 VALEANT PHARMACEUTICALS, INTERNATIONAL yPHRENILIN TAB 50-325MG 65234005050 VALEANT PHARMACEUTICALS, INTERNATIONAL yNOLAHIST TAB 25MG 65234005210 VALEANT PHARMACEUTICALS, INTERNATIONAL yNOLAHIST TAB 25MG 65234005224 VALEANT PHARMACEUTICALS, INTERNATIONAL yPHRENILIN CAP FORTE 65234005610 VALEANT PHARMACEUTICALS, INTERNATIONAL yPHRENILIN CAP FORTE 65234005650 VALEANT PHARMACEUTICALS, INTERNATIONAL y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PHRENILIN/ CAP CAFF/COD 65234006110 VALEANT PHARMACEUTICALS, INTERNATIONAL yMOTOFEN TAB 65234007405 VALEANT PHARMACEUTICALS, INTERNATIONAL yMOTOFEN TAB 65234007410 VALEANT PHARMACEUTICALS, INTERNATIONAL ySMZ/TMP DS TAB 800-160 00615017063 VANGARD LABS, INC. yHYDROXYZ PAM CAP 25MG 00615033163 VANGARD LABS, INC. yHYDROXYZ PAM CAP 50MG 00615033263 VANGARD LABS, INC. yLOPERAMIDE CAP 2MG 00615036263 VANGARD LABS, INC. yDIPHENHYDRAM CAP 25MG 00615036863 VANGARD LABS, INC. yDOCUSATE CAL CAP 240MG 00615037863 VANGARD LABS, INC. yFUROSEMIDE TAB 40MG 00615044663 VANGARD LABS, INC. yHYDRALAZINE TAB 10MG 00615051639 VANGARD LABS, INC. yASPIRIN TAB 325MG 00615052263 VANGARD LABS, INC. yHYDRALAZINE TAB 25MG 00615053139 VANGARD LABS, INC. yPREDNISONE TAB 5MG 00615053663 VANGARD LABS, INC. yASPIRIN TAB 325MG EC 00615056439 VANGARD LABS, INC. yASPIRIN TAB 325MG EC 00615056463 VANGARD LABS, INC. yTRIAMT/HCTZ TAB 75-50MG 00615056739 VANGARD LABS, INC. yDOCUSATE SOD CAP 100MG 00615058563 VANGARD LABS, INC. yACETAMIN TAB 325MG 00615059163 VANGARD LABS, INC. yBISACODYL TAB 5MG EC 00615059863 VANGARD LABS, INC. yFOLIC ACID TAB 1MG 00615066463 VANGARD LABS, INC. yTRIHEXYPHEN TAB 2MG 00615067563 VANGARD LABS, INC. yAMITRIPTYLIN TAB 10MG 00615082839 VANGARD LABS, INC. yAMITRIPTYLIN TAB 10MG 00615082863 VANGARD LABS, INC. yAMITRIPTYLIN TAB 25MG 00615082939 VANGARD LABS, INC. yAMITRIPTYLIN TAB 25MG 00615082963 VANGARD LABS, INC. yNORTRIPTYLIN CAP 10MG 00615130663 VANGARD LABS, INC. yNORTRIPTYLIN CAP 25MG 00615130763 VANGARD LABS, INC. yNITROFUR MAC CAP 50MG 00615130863 VANGARD LABS, INC. yPOT CHLORIDE CAP 10MEQ CR 00615131863 VANGARD LABS, INC. yVALPROIC ACD CAP 250MG 00615132563 VANGARD LABS, INC. yTRIAM/HCTZ CAP 37.5-25 00615133363 VANGARD LABS, INC. yTERAZOSIN CAP 2MG 00615133863 VANGARD LABS, INC. yDILTIAZEM CAP 180MG XR 00615134163 VANGARD LABS, INC. yDILTIAZEM CAP 240MG XR 00615134263 VANGARD LABS, INC. yPHENYTOIN EX CAP 100MG 00615134363 VANGARD LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

713 of 774

HYDROXYZ HCL TAB 25MG 00615152663 VANGARD LABS, INC. ySPIRONOLACT TAB 25MG 00615153505 VANGARD LABS, INC. ySPIRONOLACT TAB 25MG 00615153563 VANGARD LABS, INC. yMECLIZINE TAB 12.5MG 00615155363 VANGARD LABS, INC. yMECLIZINE TAB 25MG 00615155463 VANGARD LABS, INC. yGLYBURIDE TAB 5MG 00615155663 VANGARD LABS, INC. yISOSORB DIN TAB 10MG 00615156039 VANGARD LABS, INC. yISOSORB DIN TAB 10MG 00615156063 VANGARD LABS, INC. yHYDROCHLOROT TAB 25MG 00615156163 VANGARD LABS, INC. yISOSORB DIN TAB 5MG 00615156463 VANGARD LABS, INC. yFUROSEMIDE TAB 20MG 00615156905 VANGARD LABS, INC. yFUROSEMIDE TAB 20MG 00615156963 VANGARD LABS, INC. yFUROSEMIDE TAB 80MG 00615157163 VANGARD LABS, INC. yISOSORB DIN TAB 20MG 00615157563 VANGARD LABS, INC. yALLOPURINOL TAB 100MG 00615159239 VANGARD LABS, INC. yALLOPURINOL TAB 100MG 00615159263 VANGARD LABS, INC. yALLOPURINOL TAB 300MG 00615159305 VANGARD LABS, INC. yALLOPURINOL TAB 300MG 00615159339 VANGARD LABS, INC. yALLOPURINOL TAB 300MG 00615159363 VANGARD LABS, INC. yIBUPROFEN TAB 400MG 00615252563 VANGARD LABS, INC. yIBUPROFEN TAB 600MG 00615252663 VANGARD LABS, INC. yIBUPROFEN TAB 800MG 00615252863 VANGARD LABS, INC. yMETOCLOPRAM TAB 10MG 00615253639 VANGARD LABS, INC. yMETOCLOPRAM TAB 10MG 00615253663 VANGARD LABS, INC. yACETAMIN TAB 500MG 00615254263 VANGARD LABS, INC. yBENZTROPINE TAB 0.5MG 00615254763 VANGARD LABS, INC. yBENZTROPINE TAB 1MG 00615254863 VANGARD LABS, INC. yBENZTROPINE TAB 2MG 00615254963 VANGARD LABS, INC. yBETHANECHOL TAB 25MG 00615255839 VANGARD LABS, INC. yPROPRANOLOL TAB 10MG 00615256139 VANGARD LABS, INC. yPROPRANOLOL TAB 10MG 00615256163 VANGARD LABS, INC. yPROPRANOLOL TAB 20MG 00615256239 VANGARD LABS, INC. yPROPRANOLOL TAB 40MG 00615256339 VANGARD LABS, INC. yPROPRANOLOL TAB 40MG 00615256363 VANGARD LABS, INC. yCLONIDINE TAB 0.1MG 00615257239 VANGARD LABS, INC. yCLONIDINE TAB 0.1MG 00615257263 VANGARD LABS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CLONIDINE TAB 0.2MG 00615257339 VANGARD LABS, INC. yCLONIDINE TAB 0.2MG 00615257363 VANGARD LABS, INC. yCLONIDINE TAB 0.3MG 00615257439 VANGARD LABS, INC. yTRAZODONE TAB 50MG 00615257863 VANGARD LABS, INC. yTRAZODONE TAB 100MG 00615257963 VANGARD LABS, INC. yHALOPERIDOL TAB 0.5MG 00615259463 VANGARD LABS, INC. yHALOPERIDOL TAB 1MG 00615259539 VANGARD LABS, INC. yHALOPERIDOL TAB 1MG 00615259563 VANGARD LABS, INC. yHALOPERIDOL TAB 2MG 00615259639 VANGARD LABS, INC. yHALOPERIDOL TAB 2MG 00615259663 VANGARD LABS, INC. yHALOPERIDOL TAB 5MG 00615259739 VANGARD LABS, INC. yHALOPERIDOL TAB 5MG 00615259763 VANGARD LABS, INC. yCARBAMAZEPIN TAB 200MG 00615350563 VANGARD LABS, INC. yASPIRIN CHW 75MG 00615350863 VANGARD LABS, INC. yOXYBUTYNIN TAB 5MG 00615351263 VANGARD LABS, INC. yCYCLOBENZAPR TAB 10MG 00615352063 VANGARD LABS, INC. yATENOLOL TAB 50MG 00615353263 VANGARD LABS, INC. yCARB/LEVO TAB 10-100MG 00615353763 VANGARD LABS, INC. yBACLOFEN TAB 10MG 00615354163 VANGARD LABS, INC. yBACLOFEN TAB 20MG 00615354263 VANGARD LABS, INC. yATENOLOL TAB 25MG 00615354463 VANGARD LABS, INC. yMETOCLOPRAM TAB 5MG 00615354663 VANGARD LABS, INC. yDILTIAZEM TAB 30MG 00615354863 VANGARD LABS, INC. yDILTIAZEM TAB 60MG 00615354963 VANGARD LABS, INC. yMETOPROLOL TAB 50MG 00615355263 VANGARD LABS, INC. yGEMFIBROZIL TAB 600MG 00615355963 VANGARD LABS, INC. yCARB/LEVO TAB 25-100MG 00615356163 VANGARD LABS, INC. yNAPROXEN TAB 500MG 00615356363 VANGARD LABS, INC. yMEGESTROL AC TAB 40MG 00615357063 VANGARD LABS, INC. yPREDNISONE TAB 10MG 00615359363 VANGARD LABS, INC. yGLIPIZIDE TAB 5MG 00615359563 VANGARD LABS, INC. yGLIPIZIDE TAB 10MG 00615359663 VANGARD LABS, INC. yCARB/LEVO TAB 25-250MG 00615450463 VANGARD LABS, INC. yACETAMIN TAB 500MG 00615451063 VANGARD LABS, INC. yRANITIDINE TAB 150MG 00615451363 VANGARD LABS, INC. yCARBAMAZEPIN CHW 100MG 00615451563 VANGARD LABS, INC. y

Page 715: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SUCRALFATE TAB 1GM 00615451763 VANGARD LABS, INC. yCAPTOPRIL TAB 12.5MG 00615451963 VANGARD LABS, INC. yCAPTOPRIL TAB 25MG 00615452063 VANGARD LABS, INC. yCAPTOPRIL TAB 50MG 00615452163 VANGARD LABS, INC. yPENTOXIFYLLI TAB 400MG ER 00615452363 VANGARD LABS, INC. yBUMETANIDE TAB 1MG 00615453663 VANGARD LABS, INC. yPOT CHLORIDE TAB 10MEQ ER 00615454263 VANGARD LABS, INC. yISOSORB MONO TAB 60MG ER 00615454463 VANGARD LABS, INC. yISOSORB MONO TAB 30MG ER 00615454663 VANGARD LABS, INC. yACETAMIN TAB 325MG 00615455462 VANGARD LABS, INC. yDIGITEK TAB 0.125MG 00615456663 VANGARD LABS, INC. yDIGITEK TAB 0.25MG 00615456763 VANGARD LABS, INC. yCARB/LEVO ER TAB 50-200MG 00615456863 VANGARD LABS, INC. yBUSPIRONE TAB 10MG 00615457563 VANGARD LABS, INC. yMETFORMIN TAB 500MG 00615458063 VANGARD LABS, INC. yFAMOTIDINE TAB 20MG 00615458263 VANGARD LABS, INC. yENALAPRIL TAB 5MG 00615459063 VANGARD LABS, INC. yENALAPRIL TAB 10MG 00615459163 VANGARD LABS, INC. yBUSPIRONE TAB 5MG 00615459563 VANGARD LABS, INC. yBUSPIRONE TAB 15MG 00615459663 VANGARD LABS, INC. yFLUOXETINE TAB 20MG 00615550263 VANGARD LABS, INC. yLEV/PSE/GG CAP 90-400MG 67537003501 VARSITY LABORATORIES yCARB/PHENYL SUS 12 67537018016 VARSITY LABORATORIES yBROMPHEN/PSE CAP 9-90MG 67537027101 VARSITY LABORATORIES yBROMPHENIRAM CHW 12MG 67537027360 VARSITY LABORATORIES yBROMPHENIRAM SUS PHENYL 67537027416 VARSITY LABORATORIES yBPM/HYDROCOD LIQ /PSE 67537094016 VARSITY LABORATORIES yUREX TAB 1GM 65199120101 VATRING PHARMACEUTICALS, INC. yHC PRAMOXINE CRE 67887010030 VERACITY PHARMACEUTICALS, INC. yHC PRAMOXINE CRE 2.5% 67887010130 VERACITY PHARMACEUTICALS, INC. yETHAMBUTOL TAB 100MG 61748001101 VERSAPHARM INCORPORATED yPYRAZINAMIDE TAB 500MG 61748001201 VERSAPHARM INCORPORATED yPYRAZINAMIDE TAB 500MG 61748001205 VERSAPHARM INCORPORATED yPYRAZINAMIDE TAB 500MG 61748001206 VERSAPHARM INCORPORATED yPYRAZINAMIDE TAB 500MG 61748001209 VERSAPHARM INCORPORATED yPYRAZINAMIDE TAB 500MG 61748001211 VERSAPHARM INCORPORATED y

Page 716: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ISONIAZID TAB 300MG 61748001301 VERSAPHARM INCORPORATED yISONIAZID TAB 300MG 61748001310 VERSAPHARM INCORPORATED yISONIAZID TAB 300MG 61748001330 VERSAPHARM INCORPORATED yETHAMBUTOL TAB 400MG 61748001401 VERSAPHARM INCORPORATED yETHAMBUTOL TAB 400MG 61748001406 VERSAPHARM INCORPORATED yETHAMBUTOL TAB 400MG 61748001409 VERSAPHARM INCORPORATED yETHAMBUTOL TAB 400MG 61748001410 VERSAPHARM INCORPORATED yETHAMBUTOL TAB 400MG 61748001411 VERSAPHARM INCORPORATED yRIFAMPIN CAP 150MG 61748001511 VERSAPHARM INCORPORATED yRIFAMPIN CAP 150MG 61748001530 VERSAPHARM INCORPORATED yISONIAZID TAB 100MG 61748001601 VERSAPHARM INCORPORATED yISONARIF CAP 61748001760 VERSAPHARM INCORPORATED yRIFAMPIN CAP 300MG 61748001801 VERSAPHARM INCORPORATED yRIFAMPIN CAP 300MG 61748001811 VERSAPHARM INCORPORATED yRIFAMPIN CAP 300MG 61748001830 VERSAPHARM INCORPORATED yRIFAMPIN CAP 300MG 61748001860 VERSAPHARM INCORPORATED yETHOSUXIMIDE SOL 250/5ML 61748002416 VERSAPHARM INCORPORATED yAMINOCAPR AC SYP 25% 61748004408 VERSAPHARM INCORPORATED yAMINOCAPR AC SYP 25% 61748004416 VERSAPHARM INCORPORATED yAMINOCAPR AC TAB 500MG 61748004501 VERSAPHARM INCORPORATED yAMINOCAPR AC TAB 500MG 61748004511 VERSAPHARM INCORPORATED yTRIHEXYPHEN ELX 0.4MG/ML 61748005416 VERSAPHARM INCORPORATED yPYRIDOXINE TAB 25MG 61748009201 VERSAPHARM INCORPORATED yPYRIDOXINE TAB 25MG 61748009210 VERSAPHARM INCORPORATED yPYRIDOXINE TAB 25MG 61748009230 VERSAPHARM INCORPORATED yPYRIDOXINE TAB 50MG 61748009501 VERSAPHARM INCORPORATED yPYRIDOXINE TAB 50MG 61748009510 VERSAPHARM INCORPORATED yPYRIDOXINE TAB 50MG 61748009530 VERSAPHARM INCORPORATED yDOXYCYCL HYC CAP 100MG 61748011114 VERSAPHARM INCORPORATED yZOTEX SYP 68025000116 VERTICAL PHARMACEUTICALS, INC. yZOTEX-LA TAB 68025000210 VERTICAL PHARMACEUTICALS, INC. yZOTEX PED DRO 68025000330 VERTICAL PHARMACEUTICALS, INC. yACUFLEX TAB 68025000410 VERTICAL PHARMACEUTICALS, INC. yZOTEX-GP TAB 68025000510 VERTICAL PHARMACEUTICALS, INC. yOB COMPLETE TAB 68025001010 VERTICAL PHARMACEUTICALS, INC. yCORVITE TAB 68025001110 VERTICAL PHARMACEUTICALS, INC. y

Page 717: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ZOTEX LAX TAB 68025001810 VERTICAL PHARMACEUTICALS, INC. yZOTEX GPX TAB 68025002010 VERTICAL PHARMACEUTICALS, INC. yCODIMAL DH SYP 68453012904 VICTORY PHARMA, INC yCODIMAL DH SYP 68453012916 VICTORY PHARMA, INC yCODIMAL DM SYP 68453013104 VICTORY PHARMA, INC yCODIMAL DM SYP 68453013116 VICTORY PHARMA, INC yCODICLEAR DH SYP 3.5-100 68453013404 VICTORY PHARMA, INC yCODICLEAR DH SYP 3.5-100 68453013416 VICTORY PHARMA, INC yCODICLEAR DH SYP 68453014004 VICTORY PHARMA, INC yCODICLEAR DH SYP 68453014016 VICTORY PHARMA, INC yBROMFED CAP 12-15MG 68453020010 VICTORY PHARMA, INC yBROMFED-PD CAP 6-7.5MG 68453020110 VICTORY PHARMA, INC yGUAIFED-PD CAP 7.5-200 68453030103 VICTORY PHARMA, INC yGUAIFED-PD CAP 7.5-200 68453030110 VICTORY PHARMA, INC yGUAIFED CAP 15-400MG 68453031003 VICTORY PHARMA, INC yGUAIFED CAP 15-400MG 68453031010 VICTORY PHARMA, INC yDURATUSS HD ELX 68453040016 VICTORY PHARMA, INC yLIBRAX CAP 5-2.5MG 68453041010 VICTORY PHARMA, INC yDURATUSS DM ELX 68453050016 VICTORY PHARMA, INC yDURATUSS TAB 120-600 68453061210 VICTORY PHARMA, INC yDURATUSS TAB 25-900MG 68453061510 VICTORY PHARMA, INC yDURATUSS GP TAB 120/1200 68453064010 VICTORY PHARMA, INC yDURATUSS GP TAB 25-1200 68453064510 VICTORY PHARMA, INC yDURATUSS SUS DM 12 68453068016 VICTORY PHARMA, INC yDURATUSS SUS AC 12 68453068516 VICTORY PHARMA, INC yTUSSI-ORGANI LIQ DM NR 68453071416 VICTORY PHARMA, INC yTUSSI-ORGANI LIQ DM-S NR 68453071504 VICTORY PHARMA, INC yDURATUSS A TAB 68453075010 VICTORY PHARMA, INC yDURATUSS PE TAB 30-1050 68453077010 VICTORY PHARMA, INC yTUSSI-ORGANI LIQ NR 68453081416 VICTORY PHARMA, INC yTUSSI-ORGANI LIQ -S NR 68453081504 VICTORY PHARMA, INC yHISTUSSIN HC SYP 68453086016 VICTORY PHARMA, INC ySITREX PD LIQ 7.5-75MG 67204004216 VINDEX PHARMACEUTICALS, INC. ySITREX TAB 30-1200 67204006401 VINDEX PHARMACEUTICALS, INC. yORATUSS LIQ 20-75MG/ 67204021016 VINDEX PHARMACEUTICALS, INC. yZYMINE-D LIQ 1.25-45 67204024516 VINDEX PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ORATUSS 12 TAB 67204027301 VINDEX PHARMACEUTICALS, INC. yZYMINE SYP 1.25/5ML 67204032016 VINDEX PHARMACEUTICALS, INC. yZYMINE HC LIQ 67204039016 VINDEX PHARMACEUTICALS, INC. yURISYM CAP 67204053101 VINDEX PHARMACEUTICALS, INC. yNARVOX TAB 10-500MG 67204096001 VINDEX PHARMACEUTICALS, INC. yVANCOCIN HCL CAP 125MG 66593312502 VIRO PHARMA, INCORPORATED yVANCOCIN HCL CAP 250MG 66593312602 VIRO PHARMA, INCORPORATED yCOLCHICINE TAB 0.6MG 68013000101 VISION PHARMA, LLC yCOLCHICINE TAB 0.6MG 68013000105 VISION PHARMA, LLC yCOLCHICINE TAB 0.6MG 68013000110 VISION PHARMA, LLC yHYOSCYAMINE TAB 0.125MG 68013000501 VISION PHARMA, LLC yVISVEX HC LIQ 68013000616 VISION PHARMA, LLC yBROMPHENIRAM CHW 12MG 68013000701 VISION PHARMA, LLC yBROMPHENIRAM CHW 12MG 68013000760 VISION PHARMA, LLC yVIS-PHOS N TAB 68013000801 VISION PHARMA, LLC yQUIXIN SOL 0.5% 68669013505 VISTAKON PHARMACEUTICALS, LLC yBETIMOL SOL 0.25% 68669052205 VISTAKON PHARMACEUTICALS, LLC yBETIMOL SOL 0.25% 68669052210 VISTAKON PHARMACEUTICALS, LLC yBETIMOL SOL 0.25% 68669052215 VISTAKON PHARMACEUTICALS, LLC yBETIMOL SOL 0.5% 68669052505 VISTAKON PHARMACEUTICALS, LLC yBETIMOL SOL 0.5% 68669052510 VISTAKON PHARMACEUTICALS, LLC yBETIMOL SOL 0.5% 68669052515 VISTAKON PHARMACEUTICALS, LLC yALAMAST DRO 0.1% 68669071110 VISTAKON PHARMACEUTICALS, LLC yFOLIC ACID TAB 1MG 66689000260 VISTAPHARM, INC. yCARBAMAZEPIN TAB 200MG 66689000560 VISTAPHARM, INC. yHYDROCO/APAP TAB 5-500MG 66689000660 VISTAPHARM, INC. yHYDROCO/APAP TAB 7.5-500 66689000760 VISTAPHARM, INC. yIBUPROFEN SUS 100/5ML 66689000950 VISTAPHARM, INC. yCARBAMAZEPIN SUS 100/5ML 66689032350 VISTAPHARM, INC. yMETHADONE CON 10MG/ML 66689069439 VISTAPHARM, INC. yMETHADONE CON 10MG/ML 66689069479 VISTAPHARM, INC. ySUCRALFATE SUS 1GM/10ML 66689079050 VISTAPHARM, INC. yMETHADONE TAB 10MG 66689081010 VISTAPHARM, INC. yMETHADONE TAB 40MG 66689089840 VISTAPHARM, INC. yMUSE SUP 125MCG 62541011001 VIVUS, INC. yMUSE SUP 125MCG 62541011006 VIVUS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MUSE SUP 250MCG 62541012001 VIVUS, INC. yMUSE SUP 250MCG 62541012006 VIVUS, INC. yMUSE SUP 500MCG 62541013001 VIVUS, INC. yMUSE SUP 500MCG 62541013006 VIVUS, INC. yMUSE SUP 1000MCG 62541014001 VIVUS, INC. yMUSE SUP 1000MCG 62541014006 VIVUS, INC. yESTRACE TAB 1MG 00430002324 WARNER CHILCOTT LABORATORIES yESTRACE TAB 1MG 00430002330 WARNER CHILCOTT LABORATORIES yESTRACE TAB 2MG 00430002424 WARNER CHILCOTT LABORATORIES yESTRACE TAB 2MG 00430002430 WARNER CHILCOTT LABORATORIES yDORYX TAB 75MG 00430011120 WARNER CHILCOTT LABORATORIES yDORYX TAB 100MG 00430011224 WARNER CHILCOTT LABORATORIES yFEMHRT TAB 0.5-2.5 00430014514 WARNER CHILCOTT LABORATORIES yFEMHRT TAB 0.5-2.5 00430014523 WARNER CHILCOTT LABORATORIES yMANDELAMINE TAB 0.5GM 00430016624 WARNER CHILCOTT LABORATORIES yMANDELAMINE TAB 1GM 00430016724 WARNER CHILCOTT LABORATORIES yPYRIDIUM TAB 100MG 00430018024 WARNER CHILCOTT LABORATORIES yPYRIDIUM TAB 200MG 00430018124 WARNER CHILCOTT LABORATORIES yPYRIDIUM TAB PLUS 00430018215 WARNER CHILCOTT LABORATORIES yNATAFORT TAB 00430022640 WARNER CHILCOTT LABORATORIES yNATACHEW CHW 00430022723 WARNER CHILCOTT LABORATORIES yFEMTRACE TAB 0.45MG 00430038924 WARNER CHILCOTT LABORATORIES yFEMTRACE TAB 0.9MG 00430039024 WARNER CHILCOTT LABORATORIES yFEMTRACE TAB 1.8MG 00430039124 WARNER CHILCOTT LABORATORIES ySARAFEM CAP 10MG 00430043514 WARNER CHILCOTT LABORATORIES ySARAFEM CAP 20MG 00430043614 WARNER CHILCOTT LABORATORIES yFEMCON FE CHW 00430048214 WARNER CHILCOTT LABORATORIES yLOESTRIN 24 TAB FE 00430053014 WARNER CHILCOTT LABORATORIES yFEMHRT 1/5 TAB 00430054414 WARNER CHILCOTT LABORATORIES yFEMHRT 1/5 TAB 00430054423 WARNER CHILCOTT LABORATORIES yESTROSTEP FE TAB 00430057014 WARNER CHILCOTT LABORATORIES yOVCON-35 TAB 00430058014 WARNER CHILCOTT LABORATORIES yOVCON 50 TAB 28 00430058514 WARNER CHILCOTT LABORATORIES yERYC CAP 250MG EC 00430069624 WARNER CHILCOTT LABORATORIES yESTRACE TAB 0.5MG 00430072024 WARNER CHILCOTT LABORATORIES yDORYX CAP 100MG EC 00430083819 WARNER CHILCOTT LABORATORIES y

Page 720: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DURICEF SUS 250/5ML 00430278215 WARNER CHILCOTT LABORATORIES yDURICEF SUS 250/5ML 00430278217 WARNER CHILCOTT LABORATORIES yDURICEF SUS 500/5ML 00430278316 WARNER CHILCOTT LABORATORIES yDURICEF SUS 500/5ML 00430278317 WARNER CHILCOTT LABORATORIES yDOVONEX OIN 0.005% 00430301015 WARNER CHILCOTT LABORATORIES yDOVONEX OIN 0.005% 00430301017 WARNER CHILCOTT LABORATORIES yDOVONEX CRE 0.005% 00430302015 WARNER CHILCOTT LABORATORIES yDOVONEX CRE 0.005% 00430302017 WARNER CHILCOTT LABORATORIES yDOVONEX SOL 0.005% 00430303015 WARNER CHILCOTT LABORATORIES yMOISTUREL LOT 00430310010 WARNER CHILCOTT LABORATORIES yMOISTUREL LOT 00430310011 WARNER CHILCOTT LABORATORIES yTACLONEX OIN 00430323015 WARNER CHILCOTT LABORATORIES yMOISTUREL CRE 00430350008 WARNER CHILCOTT LABORATORIES yMOISTUREL CRE 00430350011 WARNER CHILCOTT LABORATORIES yESTRACE VAG CRE 0.1MG/GM 00430375414 WARNER CHILCOTT LABORATORIES yFEMRING MIS 0.05/24H 00430620140 WARNER CHILCOTT LABORATORIES yFEMRING MIS 0.1MG/24 00430620240 WARNER CHILCOTT LABORATORIES yISOSORB MONO TAB 30MG ER 59930150201 WARRICK PHARMACEUTICALS yCLOTRIM/BETA CRE DIPROP 59930150301 WARRICK PHARMACEUTICALS yCLOTRIM/BETA CRE DIPROP 59930150302 WARRICK PHARMACEUTICALS yALBUTEROL NEB 0.083% 59930151701 WARRICK PHARMACEUTICALS yALBUTEROL NEB 0.083% 59930151702 WARRICK PHARMACEUTICALS yRIBAVIRIN CAP 200MG 59930152301 WARRICK PHARMACEUTICALS yRIBAVIRIN CAP 200MG 59930152302 WARRICK PHARMACEUTICALS yRIBAVIRIN CAP 200MG 59930152303 WARRICK PHARMACEUTICALS yRIBAVIRIN CAP 200MG 59930152304 WARRICK PHARMACEUTICALS yMOMETASONE CRE 0.1% 59930152601 WARRICK PHARMACEUTICALS yMOMETASONE CRE 0.1% 59930152602 WARRICK PHARMACEUTICALS yCLOTRIM/BETA LOT DIPROP 59930154201 WARRICK PHARMACEUTICALS yMOMETASONE SOL 0.1% 59930154702 WARRICK PHARMACEUTICALS yMOMETASONE SOL 0.1% 59930154703 WARRICK PHARMACEUTICALS yISOSORB MONO TAB 60MG ER 59930154901 WARRICK PHARMACEUTICALS yALBUTEROL AER 90MCG 59930156001 WARRICK PHARMACEUTICALS yAUG BETAMET OIN 0.05% 59930157501 WARRICK PHARMACEUTICALS yAUG BETAMET OIN 0.05% 59930157503 WARRICK PHARMACEUTICALS yISOSORB MONO TAB 120MG ER 59930158701 WARRICK PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALBUTEROL NEB 0.5% 59930164702 WARRICK PHARMACEUTICALS yPOT CHLORIDE TAB 20MEQ CR 59930171401 WARRICK PHARMACEUTICALS yPOT CHLORIDE TAB 20MEQ CR 59930171402 WARRICK PHARMACEUTICALS yPOT CHLORIDE TAB 20MEQ CR 59930171403 WARRICK PHARMACEUTICALS yPOT CHLORIDE TAB 10MEQ CR 59930171501 WARRICK PHARMACEUTICALS yISOSORB MONO TAB 30MG ER 59930309401 WARRICK PHARMACEUTICALS yISOSORB MONO TAB 60MG ER 59930314403 WARRICK PHARMACEUTICALS yISOSORB MONO TAB 120MG ER 59930360501 WARRICK PHARMACEUTICALS yPENICILLN GK INJ 5MU 00364290638 WATSON PHARMA, INC. yPENICILLN GK INJ 20MU 00364290861 WATSON PHARMA, INC. yORALYTE SOL 00536000486 WATSON PHARMA, INC. yALMACONE-II SUS DS 00536001583 WATSON PHARMA, INC. yALMACONE-II SUS DS 00536001590 WATSON PHARMA, INC. yALMACONE SUS 00536002583 WATSON PHARMA, INC. yALMACONE SUS 00536002590 WATSON PHARMA, INC. yALUM HYDROX SUS 320/5ML 00536009185 WATSON PHARMA, INC. yALUM HYDROX SUS 320/5ML 00536009190 WATSON PHARMA, INC. yALENIC ALKA SUS 00536011183 WATSON PHARMA, INC. yACETAMIN ELX 160/5ML 00536012247 WATSON PHARMA, INC. yACETAMIN ELX 160/5ML 00536012285 WATSON PHARMA, INC. yACETAMIN ELX 160/5ML 00536012290 WATSON PHARMA, INC. yACETAMIN ELX 160/5ML 00536012297 WATSON PHARMA, INC. yCHILD PN/FEV DRO 80/0.8ML 00536012372 WATSON PHARMA, INC. yVITAMIN C SYP 500/5ML 00536016085 WATSON PHARMA, INC. yVITAMIN C SYP 500/5ML 00536016097 WATSON PHARMA, INC. ySENNA-DOCUSA TAB 8.6-50MG 00536035501 WATSON PHARMA, INC. ySENNA-DOCUSA TAB 8.6-50MG 00536035510 WATSON PHARMA, INC. yALLER-CHLOR SYP 2MG/5ML 00536037085 WATSON PHARMA, INC. yALLER-CHLOR SYP 2MG/5ML 00536037090 WATSON PHARMA, INC. yALLER-CHLOR SYP 2MG/5ML 00536037097 WATSON PHARMA, INC. yDAILY VITAMI LIQ 00536041059 WATSON PHARMA, INC. yDAILY VITAMI LIQ 00536041085 WATSON PHARMA, INC. ySOD CHLORIDE SOL 5% OP 00536041772 WATSON PHARMA, INC. ySOD CHLORIDE OIN 5% OP 00536041891 WATSON PHARMA, INC. yALLERFRIM SYP 1.25-30 00536051085 WATSON PHARMA, INC. yALLERFRIM SYP 1.25-30 00536051097 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIOCTO LIQ 150/15ML 00536059085 WATSON PHARMA, INC. yDIOCTO SYP 60/15ML 00536060085 WATSON PHARMA, INC. yFER-IRON DRO 15/0.6ML 00536071080 WATSON PHARMA, INC. yDIPHENHIST ELX 12.5/5ML 00536077047 WATSON PHARMA, INC. yDIPHENHIST ELX 12.5/5ML 00536077085 WATSON PHARMA, INC. yDIPHENHIST ELX 12.5/5ML 00536077090 WATSON PHARMA, INC. yDIPHENHIST ELX 12.5/5ML 00536077097 WATSON PHARMA, INC. yBENZOYL PER LOT 5% 00536081095 WATSON PHARMA, INC. yBENZOYL PER LOT 10% 00536081595 WATSON PHARMA, INC. yGUAIFENESIN SYP 100/5ML 00536082585 WATSON PHARMA, INC. yGUAIFENESIN SYP 100/5ML 00536082597 WATSON PHARMA, INC. yBROMALINE SOL 1-15/5ML 00536088085 WATSON PHARMA, INC. yBROMALINE SOL 1-15/5ML 00536088097 WATSON PHARMA, INC. yEYE IRRIGATI SOL OP 00536090197 WATSON PHARMA, INC. yORALYTE SOL 00536093586 WATSON PHARMA, INC. yORALYTE SOL 00536093686 WATSON PHARMA, INC. yTETRAHYDROZ SOL 0.05% OP 00536094094 WATSON PHARMA, INC. yGG/DM SYP 100-10/5 00536097047 WATSON PHARMA, INC. yGG/DM SYP 100-10/5 00536097058 WATSON PHARMA, INC. yGG/DM SYP 100-10/5 00536097085 WATSON PHARMA, INC. yGG/DM SYP 100-10/5 00536097090 WATSON PHARMA, INC. yGG/DM SYP 100-10/5 00536097097 WATSON PHARMA, INC. yTRIPLE ANTIB OIN 00536110094 WATSON PHARMA, INC. yTRIPLE ANTIB OIN 00536110095 WATSON PHARMA, INC. yTRIPLE ANTIB OIN 00536110098 WATSON PHARMA, INC. yACETAMIN SUP 120MG 00536125501 WATSON PHARMA, INC. yACETAMIN SUP 120MG 00536125512 WATSON PHARMA, INC. yACETAMIN SUP 650MG 00536126001 WATSON PHARMA, INC. yACETAMIN SUP 650MG 00536126012 WATSON PHARMA, INC. yLOPERAMIDE LIQ 1MG/5ML 00536127497 WATSON PHARMA, INC. ySENEXON LIQ 8.8MG/5 00536127559 WATSON PHARMA, INC. yLOW SOD ANTA SUS 540/5ML 00536128083 WATSON PHARMA, INC. yLOWSIUM PLUS SUS IMPROVED 00536128583 WATSON PHARMA, INC. yACETAMIN SUP 325MG 00536132012 WATSON PHARMA, INC. yBISACODYL SUP 10MG 00536135501 WATSON PHARMA, INC. yBISACODYL SUP 10MG 00536135512 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BROMALINE DM ELX 15-1-5/5 00536136085 WATSON PHARMA, INC. yBROMALINE DM ELX 15-1-5/5 00536136097 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG REF 00536136206 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG STRT 00536136223 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG REF 00536136234 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG REF 00536137206 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG STRT 00536137223 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG REF 00536137234 WATSON PHARMA, INC. yORALYTE SOL 00536138586 WATSON PHARMA, INC. yHEMORRHOIDAL SUP 00536138912 WATSON PHARMA, INC. yORALYTE SOL FREEZE 00536139517 WATSON PHARMA, INC. yMICONAZOLE 7 CRE 2% 00536142326 WATSON PHARMA, INC. yK-PEK SUS 262/15ML 00536146459 WATSON PHARMA, INC. yK-PEK SUS 262/15ML 00536146485 WATSON PHARMA, INC. yREGULOID CAP 0.52GM 00536150060 WATSON PHARMA, INC. yPEPTIC RELF SUS 527/30ML 00536181059 WATSON PHARMA, INC. yPSEUDOEPHEDR SYP 30MG/5ML 00536185085 WATSON PHARMA, INC. yNASAL DECONG LIQ 30MG/5ML 00536185097 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536187516 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536187559 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536187579 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536187583 WATSON PHARMA, INC. yREGULOID POW 50% 00536188116 WATSON PHARMA, INC. yREGULOID POW 50% 00536188123 WATSON PHARMA, INC. yREGULOID POW 50% 00536188146 WATSON PHARMA, INC. yREGULOID POW 50% 00536188179 WATSON PHARMA, INC. yCHILD PN/FEV DRO 80/0.8ML 00536193672 WATSON PHARMA, INC. yRULOX SUS 00536195083 WATSON PHARMA, INC. ySEBEX SHA 00536196297 WATSON PHARMA, INC. yARTIFI TEARS SOL OP 00536197072 WATSON PHARMA, INC. yRULOX PLUS SUS 00536199083 WATSON PHARMA, INC. ySELENIUM SUL SHA 1% 00536199553 WATSON PHARMA, INC. yGREEN SOAP TIN 00536217090 WATSON PHARMA, INC. ySIMETHICONE DRO 40/0.6ML 00536222075 WATSON PHARMA, INC. yBLUE MUSCLE GEL RELIEF 00536230259 WATSON PHARMA, INC. yKIDKARE DECO DRO 7.5/0.8 00536230375 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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KIDKARE LIQ CGH/COLD 00536231097 WATSON PHARMA, INC. yKALMZ SOL ANTI-NAU 00536231697 WATSON PHARMA, INC. yVIGORTOL LIQ 00536238085 WATSON PHARMA, INC. yPHENASEPTIC LIQ CHERRY 00536242558 WATSON PHARMA, INC. yMILK OF MAGN SUS 00536247083 WATSON PHARMA, INC. yMILK OF MAGN SUS 00536247085 WATSON PHARMA, INC. yMILK OF MAGN SUS 00536247090 WATSON PHARMA, INC. ySALINE MIST SPR 0.65% 00536250676 WATSON PHARMA, INC. yCAPSAICIN CRE 0.025% 00536252525 WATSON PHARMA, INC. yCAPSAICIN CRE 0.025% 00536252526 WATSON PHARMA, INC. yCALCIONATE SYP 1.8GM/5 00536277085 WATSON PHARMA, INC. yCEROVITE LIQ 00536279059 WATSON PHARMA, INC. yEAR WAX DROP SOL 6.5% OT 00536300094 WATSON PHARMA, INC. yALENIC ALKA CHW 00536301301 WATSON PHARMA, INC. yACETA-GESIC TAB 30-325MG 00536301401 WATSON PHARMA, INC. yACETA-GESIC TAB 30-325MG 00536301410 WATSON PHARMA, INC. yACETA-GESIC TAB 30-325MG 00536301435 WATSON PHARMA, INC. yALMACONE MLT CHW 00536303501 WATSON PHARMA, INC. yALMACONE MLT CHW 00536303510 WATSON PHARMA, INC. yASPIRIN TAB 81MG EC 00536308610 WATSON PHARMA, INC. yASPIRIN TAB 81MG EC 00536308641 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG 00536310606 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG 00536310618 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG 00536310623 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG 00536310634 WATSON PHARMA, INC. yNICOTINE POL GUM 2MG 00536310643 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG 00536310706 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG 00536310718 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG 00536310723 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG 00536310734 WATSON PHARMA, INC. yNICOTINE POL GUM 4MG 00536310743 WATSON PHARMA, INC. yACETAMIN TAB 500MG 00536321801 WATSON PHARMA, INC. yACETAMIN TAB 500MG 00536321810 WATSON PHARMA, INC. yACETAMIN TAB 325MG 00536322201 WATSON PHARMA, INC. yACETAMIN TAB 325MG 00536322210 WATSON PHARMA, INC. yCIT CALCIUM TAB 200MG 00536322301 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIT CALCIUM TAB 1500 + D 00536322408 WATSON PHARMA, INC. yACETAMIN TAB 500MG 00536323101 WATSON PHARMA, INC. yACETAMIN TAB 500MG 00536323110 WATSON PHARMA, INC. yACETAMIN CHW 80MG 00536323307 WATSON PHARMA, INC. yACETAMIN CHW 80MG GRP 00536323407 WATSON PHARMA, INC. yVITAMIN C CHW 500MG 00536329101 WATSON PHARMA, INC. yVITAMIN C TAB 500MG 00536329201 WATSON PHARMA, INC. yVITAMIN C TAB 500MG 00536329210 WATSON PHARMA, INC. yASCORBIC ACD TAB 1000MG 00536329401 WATSON PHARMA, INC. yASPIRIN CHW 81MG 00536329710 WATSON PHARMA, INC. yASPIRIN CHW 81MG 00536329736 WATSON PHARMA, INC. yASPIRIN TAB 325MG 00536330501 WATSON PHARMA, INC. yASPIRIN TAB 325MG 00536330510 WATSON PHARMA, INC. yASPIRIN TAB 325MG 00536330512 WATSON PHARMA, INC. yASPIRIN EC TAB 325MG 00536331301 WATSON PHARMA, INC. yASPIRIN EC TAB 325MG 00536331310 WATSON PHARMA, INC. yASPIRIN TAB 325MG EC 00536331801 WATSON PHARMA, INC. yASPIRIN EC TAB 325MG 00536331810 WATSON PHARMA, INC. yASPIRIN TAB 650MG EC 00536332601 WATSON PHARMA, INC. yASPIRIN TAB 650MG EC 00536332610 WATSON PHARMA, INC. yBEE-ZEE TAB 00536335708 WATSON PHARMA, INC. yBISACODYL TAB 5MG EC 00536338101 WATSON PHARMA, INC. yBISACODYL TAB 5MG EC 00536338110 WATSON PHARMA, INC. yCALCIUM CARB TAB 650MG 00536341410 WATSON PHARMA, INC. yCALCIUM GLUC TAB 650MG 00536341610 WATSON PHARMA, INC. yCALCIUM GLUC TAB 975MG 00536341710 WATSON PHARMA, INC. yALLERFRIM TAB 2.5-60MG 00536342101 WATSON PHARMA, INC. yALLERFRIM TAB 2.5-60MG 00536342135 WATSON PHARMA, INC. yCALCIUM LACT TAB 650MG 00536342201 WATSON PHARMA, INC. yCALCIUM LACT TAB 650MG 00536342210 WATSON PHARMA, INC. yCALCIUM 600 TAB -D 00536342408 WATSON PHARMA, INC. yCALCIUM TAB 600MG 00536342608 WATSON PHARMA, INC. yCHOLINE BIT TAB 500MG 00536343901 WATSON PHARMA, INC. yCEROVITE ADV TAB FORMULA 00536344238 WATSON PHARMA, INC. yCEROVITE JR CHW 00536344308 WATSON PHARMA, INC. yCEROVITE TAB SILVER 00536344508 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BRONTO-VITES CHW 00536344801 WATSON PHARMA, INC. yBRONTO-VITES CHW 00536344808 WATSON PHARMA, INC. yBRONTO-VITES CHW 00536344810 WATSON PHARMA, INC. yBRONTO-VITE CHW /IRON 00536344901 WATSON PHARMA, INC. yBRONTO-VITE CHW /IRON 00536344908 WATSON PHARMA, INC. yCHLOROPHYLL CHW 00536345101 WATSON PHARMA, INC. yALLER-CHLOR TAB 4MG 00536346701 WATSON PHARMA, INC. yALLER-CHLOR TAB 4MG 00536346710 WATSON PHARMA, INC. yALLER-CHLOR TAB 4MG 00536346735 WATSON PHARMA, INC. yVITAMIN B-12 TAB 100MCG 00536354201 WATSON PHARMA, INC. yDAILY VITE TAB 00536354601 WATSON PHARMA, INC. yDAILY VITE TAB 00536354610 WATSON PHARMA, INC. yDAILY VITE TAB 00536354614 WATSON PHARMA, INC. yDAILY VITE TAB 00536354701 WATSON PHARMA, INC. yDAILY VITE TAB 00536354710 WATSON PHARMA, INC. yVITAMIN B-12 TAB 500MCG 00536355101 WATSON PHARMA, INC. yVITAMIN B-12 TAB 1000MCG 00536355601 WATSON PHARMA, INC. yDIPHENHIST CAP 25MG 00536359401 WATSON PHARMA, INC. yDIPHENHIST CAP 25MG 00536359410 WATSON PHARMA, INC. yDIPHENHIST CAP 25MG 00536359435 WATSON PHARMA, INC. yDIPHENHIST TAB 25MG 00536359701 WATSON PHARMA, INC. yDIPHENHIST TAB 25MG 00536359735 WATSON PHARMA, INC. yDIMENHYDRIN TAB 50MG 00536374501 WATSON PHARMA, INC. yDIMENHYDRIN TAB 50MG 00536374510 WATSON PHARMA, INC. yDIMENHYDRIN TAB 50MG 00536374512 WATSON PHARMA, INC. yDOCUSATE CAL CAP 240MG 00536375501 WATSON PHARMA, INC. yDOCUSATE CAL CAP 240MG 00536375505 WATSON PHARMA, INC. yDOCUSATE CAL CAP 240MG 00536375510 WATSON PHARMA, INC. yDOCUSATE SOD CAP 100MG 00536375601 WATSON PHARMA, INC. yDOCUSATE SOD CAP 100MG 00536375608 WATSON PHARMA, INC. yDOCUSATE SOD CAP 100MG 00536375610 WATSON PHARMA, INC. yDOCUSATE SOD CAP 250MG 00536375701 WATSON PHARMA, INC. yDOCUSATE SOD CAP 250MG 00536375710 WATSON PHARMA, INC. yDIPHENHYDRAM TAB 50MG 00536377206 WATSON PHARMA, INC. yFOLIC ACID TAB 800MCG 00536384301 WATSON PHARMA, INC. yFOLIC ACID TAB 400MCG 00536384401 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LIPOGEN CAP SG 00536390808 WATSON PHARMA, INC. yMAGNA C-7 TAB 00536391008 WATSON PHARMA, INC. yIBUPROFEN TAB 200MG 00536393901 WATSON PHARMA, INC. yIBUPROFEN TAB 200MG 00536393902 WATSON PHARMA, INC. yIBUPROFEN TAB 200MG 00536393906 WATSON PHARMA, INC. yIBUPROFEN TAB 200MG 00536393910 WATSON PHARMA, INC. yLOPERAMIDE TAB 2MG 00536396612 WATSON PHARMA, INC. yINOSITOL TAB 500MG 00536398401 WATSON PHARMA, INC. yMECLIZINE TAB 12.5MG 00536398501 WATSON PHARMA, INC. yMECLIZINE TAB 12.5MG 00536398510 WATSON PHARMA, INC. yMECLIZINE CHW 25MG 00536399001 WATSON PHARMA, INC. yMECLIZINE CHW 25MG 00536399010 WATSON PHARMA, INC. yMULTILEX TAB 00536404401 WATSON PHARMA, INC. yMULTIVITAMIN TAB 00536404610 WATSON PHARMA, INC. yMULTILEX-T&M TAB 00536406001 WATSON PHARMA, INC. yMULTILEX-T&M TAB 00536406010 WATSON PHARMA, INC. yPRENAVITE PR TAB COATED 00536406301 WATSON PHARMA, INC. yNIACINAMIDE TAB 100MG 00536406801 WATSON PHARMA, INC. yNIACINAMIDE TAB 100MG 00536406810 WATSON PHARMA, INC. yNIACINAMIDE TAB 500MG 00536406901 WATSON PHARMA, INC. yNIACINAMIDE TAB 500MG 00536406910 WATSON PHARMA, INC. yNIACIN TAB 50MG 00536407001 WATSON PHARMA, INC. yNIACIN TAB 50MG 00536407003 WATSON PHARMA, INC. yNIACIN TAB 50MG 00536407010 WATSON PHARMA, INC. yNIACIN CAP 125MG SR 00536407301 WATSON PHARMA, INC. yNIACIN CAP 125MG SR 00536407310 WATSON PHARMA, INC. yNICOTINIC AC CAP 250MG SR 00536407401 WATSON PHARMA, INC. yNICOTINIC AC CAP 250MG SR 00536407410 WATSON PHARMA, INC. yNICOTINIC AC CAP 400MG SR 00536407501 WATSON PHARMA, INC. yNICOTINIC AC CAP 400MG SR 00536407510 WATSON PHARMA, INC. yNIACIN TAB 100MG 00536407601 WATSON PHARMA, INC. yNIACIN TAB 100MG 00536407603 WATSON PHARMA, INC. yNIACIN TAB 100MG 00536407610 WATSON PHARMA, INC. yNIACIN CAP 500MG SR 00536407701 WATSON PHARMA, INC. yNIACIN TAB 500MG 00536407810 WATSON PHARMA, INC. yPRENAVITE TAB MULT VIT 00536408501 WATSON PHARMA, INC. y

Page 728: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BENZOYL PER GEL 5% 00536408956 WATSON PHARMA, INC. yBENZOYL PER GEL 10% 00536409256 WATSON PHARMA, INC. yOYSCO D TAB 00536410301 WATSON PHARMA, INC. yOYSCO D TAB 00536410302 WATSON PHARMA, INC. yOYSCO D TAB 00536410310 WATSON PHARMA, INC. yRULETS-M 500 TAB 500MG 00536410501 WATSON PHARMA, INC. yOYSCO 500 TAB 00536410602 WATSON PHARMA, INC. yOYSCO 500 TAB 00536410608 WATSON PHARMA, INC. yI-VITE PROTE TAB 00536417841 WATSON PHARMA, INC. yDIPHENHIST CRE /ZN ACE 00536418095 WATSON PHARMA, INC. yPEPTIC RELF CHW 300MG 00536430107 WATSON PHARMA, INC. yPEPTIC RELF CHW 300MG 00536430135 WATSON PHARMA, INC. yPOLY-VITAMIN CHW 00536430401 WATSON PHARMA, INC. yFIBER-LAX TAB 625MG 00536430605 WATSON PHARMA, INC. yFIBER-LAX TAB 625MG 00536430608 WATSON PHARMA, INC. yFIBER-LAX TAB 625MG 00536430611 WATSON PHARMA, INC. yPSEUDOEPHEDR TAB 30MG 00536439101 WATSON PHARMA, INC. yPSEUDOEPHEDR TAB 30MG 00536439110 WATSON PHARMA, INC. yPSEUDOEPHEDR TAB 30MG 00536439135 WATSON PHARMA, INC. yPYRIDOXINE TAB 25MG 00536440601 WATSON PHARMA, INC. yPYRIDOXINE TAB 50MG 00536440801 WATSON PHARMA, INC. yPYRIDOXINE TAB 50MG 00536440810 WATSON PHARMA, INC. yPYRIDOXINE TAB 100MG 00536440901 WATSON PHARMA, INC. yPYRIDOXINE TAB 100MG 00536440910 WATSON PHARMA, INC. yREGULOID POW 50% 00536444454 WATSON PHARMA, INC. yREGULOID POW 50% 00536444455 WATSON PHARMA, INC. yREGULOID POW 50% 00536444488 WATSON PHARMA, INC. yREGULOID POW 50% 00536444489 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536444554 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536444555 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536444588 WATSON PHARMA, INC. yREGULOID POW ORANGE 00536444589 WATSON PHARMA, INC. ySIMETHICONE CHW 80MG 00536453301 WATSON PHARMA, INC. ySIMETHICONE CHW 125MG 00536453408 WATSON PHARMA, INC. ySODIUM BICAR TAB 325MG 00536454010 WATSON PHARMA, INC. ySODIUM BICAR TAB 650MG 00536454410 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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T-VITES TAB 00536462401 WATSON PHARMA, INC. yTHEREMS TAB 00536466010 WATSON PHARMA, INC. yTHEREMS TAB 00536466038 WATSON PHARMA, INC. yTHEREMS M TAB 00536466110 WATSON PHARMA, INC. yTHEREMS M TAB 00536466138 WATSON PHARMA, INC. yTHEREMS H TAB 00536466710 WATSON PHARMA, INC. yTHEREMS H TAB 00536466711 WATSON PHARMA, INC. yVITAMIN B-1 TAB 50MG 00536467801 WATSON PHARMA, INC. yVITAMIN B-1 TAB 50MG 00536467810 WATSON PHARMA, INC. yTHIAMINE HCL TAB 100MG 00536468001 WATSON PHARMA, INC. yTHIAMINE HCL TAB 100MG 00536468010 WATSON PHARMA, INC. yCAL-GEST CHW 500MG 00536474297 WATSON PHARMA, INC. yUNICOMPLEX-M TAB 00536475010 WATSON PHARMA, INC. yUNICOMPLEX-M TAB 00536475011 WATSON PHARMA, INC. yVI-STRESS TAB 00536475308 WATSON PHARMA, INC. yVI-STRESS TAB W/IRON 00536475408 WATSON PHARMA, INC. yVI-STRESS TAB W/ZINC 00536475508 WATSON PHARMA, INC. yVITABEE W/C TAB 00536476301 WATSON PHARMA, INC. yVITABEE W/C TAB 00536476310 WATSON PHARMA, INC. yVITAMIN B CO CAP 00536478701 WATSON PHARMA, INC. yVITAMIN E CAP 100UNIT 00536479301 WATSON PHARMA, INC. yVITAMIN E CAP 200UNIT 00536479801 WATSON PHARMA, INC. yVITAMIN E CAP 400UNIT 00536479901 WATSON PHARMA, INC. yVITAMIN E CAP 400IU 00536479905 WATSON PHARMA, INC. yVITAMIN E CAP 400UNIT 00536479910 WATSON PHARMA, INC. yVITAMIN E CAP 1000UNIT 00536480101 WATSON PHARMA, INC. yVITAMIN E CAP 1000UNIT 00536480106 WATSON PHARMA, INC. yBETA CAROTEN CAP 25000UNT 00536490201 WATSON PHARMA, INC. yNRS NASAL SPR 0.05% 00536500572 WATSON PHARMA, INC. yNRS NASAL SPR 0.05% 00536500575 WATSON PHARMA, INC. yI-VITE TAB 00536509008 WATSON PHARMA, INC. yHYDROCORT LOT 1% 00536510597 WATSON PHARMA, INC. yHYDROCORT CRE 1% 00536510895 WATSON PHARMA, INC. yHYDROCORT CRE 1% 00536510897 WATSON PHARMA, INC. yHYDROCORT CRE 1% 00536510898 WATSON PHARMA, INC. yTOLNAFTATE POW 1% 00536515026 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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C/ROSE HIPS TAB 500MG 00536515501 WATSON PHARMA, INC. yC/ROSE HIPS TAB 500MG 00536515505 WATSON PHARMA, INC. yVIT E D-ALPH CAP 400UNIT 00536544001 WATSON PHARMA, INC. yANTIOXIDANT CAP 00536558806 WATSON PHARMA, INC. yANTIOXIDANT CAP ULTRA 00536558908 WATSON PHARMA, INC. yZINC OXIDE OIN 20% 00536570095 WATSON PHARMA, INC. yZINC OXIDE OIN 20% 00536570096 WATSON PHARMA, INC. yZINC OXIDE OIN 20% 00536570098 WATSON PHARMA, INC. yFERROUS SULF TAB 325MG 00536589001 WATSON PHARMA, INC. ySENEXON TAB 8.6MG 00536590401 WATSON PHARMA, INC. ySENEXON TAB 8.6MG 00536590410 WATSON PHARMA, INC. ySUPER HIGH TAB VIT/MIN 00536594701 WATSON PHARMA, INC. ySUPER HIGH TAB VIT/MIN 00536594713 WATSON PHARMA, INC. yHIGH B CPLX TAB 100 00536598601 WATSON PHARMA, INC. yHIGH B CPLX TAB 100 00536598613 WATSON PHARMA, INC. yNATURE'S SOL TEARS 00536623772 WATSON PHARMA, INC. yCOD LIVER OI CAP 00536638401 WATSON PHARMA, INC. yMELATONIN TAB 3MG 00536641208 WATSON PHARMA, INC. yPAPAYA ENZYM CHW 00536650601 WATSON PHARMA, INC. yARTIFI TEARS OIN OP 00536655091 WATSON PHARMA, INC. yBIOTIN TAB 300MCG 00536665901 WATSON PHARMA, INC. yCHROMIUM PIC CAP 200MCG 00536666808 WATSON PHARMA, INC. yCHELATED ZN TAB 50MG 00536667101 WATSON PHARMA, INC. yMAGNESIUM GL TAB 500MG 00536668001 WATSON PHARMA, INC. yPANTOTHENIC TAB 500MG 00536671701 WATSON PHARMA, INC. yL-LYSINE ACE TAB 500MG 00536673101 WATSON PHARMA, INC. yCALCIUM CARB CHW 500MG 00536688908 WATSON PHARMA, INC. yNIACIN TAB 500MG TR 00536703001 WATSON PHARMA, INC. yNIACIN TAB 750MG TR 00536703301 WATSON PHARMA, INC. yNIACIN TR TAB 1000MG 00536703801 WATSON PHARMA, INC. yL-TYROSINE TAB 500MG 00536704906 WATSON PHARMA, INC. yACIDOPHILUS/ TAB CIT PECT 00536718001 WATSON PHARMA, INC. yACIDOPHILUS/ TAB CIT PECT 00536718002 WATSON PHARMA, INC. yACIDOPHILUS TAB 00536718101 WATSON PHARMA, INC. yZINC/VIT C LOZ 00536718301 WATSON PHARMA, INC. ySEA-OMEGA CAP 300MG 00536718601 WATSON PHARMA, INC. y

Page 731: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SEA-OMEGA CAP 500MG 00536718706 WATSON PHARMA, INC. ySEA-OMEGA CAP 500MG 00536718733 WATSON PHARMA, INC. yENEMA DISPOS ENE 00536741551 WATSON PHARMA, INC. yLAC-DOSE TAB 3000UNIT 00536781106 WATSON PHARMA, INC. yPOLYVITAMIN CHW IRON 00536781601 WATSON PHARMA, INC. yOYSCO 500+D TAB 500-200 00536781708 WATSON PHARMA, INC. yTRI-VITAMINS DRO 00536850180 WATSON PHARMA, INC. yPOLY-VITAMIN DRO /IRON 00536853080 WATSON PHARMA, INC. yVITAMIN E OIL 28000UNT 00536853396 WATSON PHARMA, INC. yVIT FOR HAIR TAB 00536854006 WATSON PHARMA, INC. yDRY SKIN OIL BATH 00536896059 WATSON PHARMA, INC. yDRY SKIN OIL BATH 00536896085 WATSON PHARMA, INC. yDRY SKIN OIL BATH 00536896090 WATSON PHARMA, INC. yALCOHOL PREP PAD 00536992001 WATSON PHARMA, INC. yLORAZEPAM TAB 0.5MG 00591024001 WATSON PHARMA, INC. yLORAZEPAM TAB 0.5MG 00591024005 WATSON PHARMA, INC. yLORAZEPAM TAB 0.5MG 00591024010 WATSON PHARMA, INC. yLORAZEPAM TAB 1MG 00591024101 WATSON PHARMA, INC. yLORAZEPAM TAB 1MG 00591024105 WATSON PHARMA, INC. yLORAZEPAM TAB 1MG 00591024110 WATSON PHARMA, INC. yLORAZEPAM TAB 2MG 00591024201 WATSON PHARMA, INC. yLORAZEPAM TAB 2MG 00591024205 WATSON PHARMA, INC. yLORAZEPAM TAB 2MG 00591024210 WATSON PHARMA, INC. yFUROSEMIDE TAB 20MG 00591030001 WATSON PHARMA, INC. yFUROSEMIDE TAB 20MG 00591030010 WATSON PHARMA, INC. yFUROSEMIDE TAB 40MG 00591030101 WATSON PHARMA, INC. yFUROSEMIDE TAB 40MG 00591030110 WATSON PHARMA, INC. yFUROSEMIDE TAB 80MG 00591030201 WATSON PHARMA, INC. yFUROSEMIDE TAB 80MG 00591030205 WATSON PHARMA, INC. yACYCLOVIR TAB 400MG 00591033501 WATSON PHARMA, INC. yACYCLOVIR TAB 400MG 00591033505 WATSON PHARMA, INC. yACYCLOVIR TAB 800MG 00591033601 WATSON PHARMA, INC. yACYCLOVIR TAB 800MG 00591033605 WATSON PHARMA, INC. yDICLOFENAC TAB 50MG DR 00591033801 WATSON PHARMA, INC. yDICLOFENAC TAB 50MG DR 00591033810 WATSON PHARMA, INC. yDICLOFENAC TAB 50MG DR 00591033860 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DICLOFENAC TAB 75MG DR 00591033901 WATSON PHARMA, INC. yDICLOFENAC TAB 75MG DR 00591033905 WATSON PHARMA, INC. yDICLOFENAC TAB 75MG DR 00591033910 WATSON PHARMA, INC. yDICLOFENAC TAB 75MG DR 00591033960 WATSON PHARMA, INC. yVERAPAMIL TAB 80MG 00591034301 WATSON PHARMA, INC. yVERAPAMIL TAB 80MG 00591034305 WATSON PHARMA, INC. yVERAPAMIL TAB 80MG 00591034310 WATSON PHARMA, INC. yVERAPAMIL TAB 80MG 00591034401 WATSON PHARMA, INC. yVERAPAMIL TAB 80MG 00591034405 WATSON PHARMA, INC. yVERAPAMIL TAB 80MG 00591034410 WATSON PHARMA, INC. yVERAPAMIL TAB 120MG 00591034501 WATSON PHARMA, INC. yVERAPAMIL TAB 120MG 00591034505 WATSON PHARMA, INC. yVERAPAMIL TAB 120MG 00591034510 WATSON PHARMA, INC. yVERAPAMIL TAB 120MG 00591034601 WATSON PHARMA, INC. yVERAPAMIL TAB 120MG 00591034605 WATSON PHARMA, INC. yVERAPAMIL TAB 120MG 00591034610 WATSON PHARMA, INC. yTRIAMT/HCTZ TAB 75-50MG 00591034801 WATSON PHARMA, INC. yTRIAMT/HCTZ TAB 75-50MG 00591034805 WATSON PHARMA, INC. yTRIAMT/HCTZ TAB 75-50MG 00591034810 WATSON PHARMA, INC. yHYDROCO/APAP TAB 5-500MG 00591034901 WATSON PHARMA, INC. yHYDROCO/APAP TAB 5-500MG 00591034905 WATSON PHARMA, INC. yCLORAZ DIPOT TAB 3.75MG 00591036301 WATSON PHARMA, INC. yCLORAZ DIPOT TAB 3.75MG 00591036305 WATSON PHARMA, INC. yCLORAZ DIPOT TAB 7.5MG 00591036401 WATSON PHARMA, INC. yCLORAZ DIPOT TAB 7.5MG 00591036405 WATSON PHARMA, INC. yCLORAZ DIPOT TAB 15MG 00591036501 WATSON PHARMA, INC. yLOXAPINE CAP 5MG 00591036901 WATSON PHARMA, INC. yLOXAPINE CAP 10MG 00591037001 WATSON PHARMA, INC. yLOXAPINE CAP 25MG 00591037101 WATSON PHARMA, INC. yLOXAPINE CAP 50MG 00591037201 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-500 00591038501 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-500 00591038505 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-750 00591038701 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-750 00591038705 WATSON PHARMA, INC. yHYDROCO/APAP TAB 2.5-500 00591038801 WATSON PHARMA, INC. yPENTAZOCINE/ TAB NALOXONE 00591039501 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PENTA/APAP TAB 25-650MG 00591039601 WATSON PHARMA, INC. yVERAPAMIL TAB 40MG 00591040401 WATSON PHARMA, INC. yLISINOPRIL TAB 2.5MG 00591040501 WATSON PHARMA, INC. yLISINOPRIL TAB 2.5MG 00591040505 WATSON PHARMA, INC. yLISINOPRIL TAB 5MG 00591040601 WATSON PHARMA, INC. yLISINOPRIL TAB 5MG 00591040610 WATSON PHARMA, INC. yLISINOPRIL TAB 10MG 00591040701 WATSON PHARMA, INC. yLISINOPRIL TAB 10MG 00591040710 WATSON PHARMA, INC. yLISINOPRIL TAB 20MG 00591040801 WATSON PHARMA, INC. yLISINOPRIL TAB 20MG 00591040810 WATSON PHARMA, INC. yLISINOPRIL TAB 40MG 00591040901 WATSON PHARMA, INC. yLISINOPRIL TAB 40MG 00591040905 WATSON PHARMA, INC. yDOXYCYC MONO CAP 50MG 00591041001 WATSON PHARMA, INC. yDOXYCYC MONO CAP 100MG 00591041150 WATSON PHARMA, INC. yESTROPIPATE TAB 0.75MG 00591041401 WATSON PHARMA, INC. yESTROPIPATE TAB 1.5MG 00591041501 WATSON PHARMA, INC. yTRIAMT/HCTZ TAB 37.5-25 00591042401 WATSON PHARMA, INC. yTRIAMT/HCTZ TAB 37.5-25 00591042405 WATSON PHARMA, INC. yBUT/ASA/CAF/ CAP COD 30MG 00591042501 WATSON PHARMA, INC. yBUT/ASA/CAF/ CAP COD 30MG 00591042505 WATSON PHARMA, INC. yVALPROIC ACD SYP 250/5ML 00591042616 WATSON PHARMA, INC. yGUANFACINE TAB 1MG 00591044401 WATSON PHARMA, INC. yGUANFACINE TAB 2MG 00591045301 WATSON PHARMA, INC. yGEMFIBROZIL TAB 600MG 00591045405 WATSON PHARMA, INC. yGEMFIBROZIL TAB 600MG 00591045460 WATSON PHARMA, INC. yGLIPIZIDE TAB 5MG 00591046001 WATSON PHARMA, INC. yGLIPIZIDE TAB 5MG 00591046005 WATSON PHARMA, INC. yGLIPIZIDE TAB 5MG 00591046010 WATSON PHARMA, INC. yGLIPIZIDE TAB 10MG 00591046101 WATSON PHARMA, INC. yGLIPIZIDE TAB 10MG 00591046105 WATSON PHARMA, INC. yGLIPIZIDE TAB 10MG 00591046110 WATSON PHARMA, INC. yMETOPROLOL TAB 50MG 00591046201 WATSON PHARMA, INC. yMETOPROLOL TAB 50MG 00591046210 WATSON PHARMA, INC. yMETOPROLOL TAB 100MG 00591046301 WATSON PHARMA, INC. yMETOPROLOL TAB 100MG 00591046310 WATSON PHARMA, INC. yESTRADIOL TAB 1MG 00591048701 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ESTRADIOL TAB 1MG 00591048705 WATSON PHARMA, INC. yESTRADIOL TAB 2MG 00591048801 WATSON PHARMA, INC. yESTRADIOL TAB 2MG 00591048805 WATSON PHARMA, INC. yHALOTUSSIN SOL DAC 00591049016 WATSON PHARMA, INC. yMEXILETINE CAP 150MG 00591049101 WATSON PHARMA, INC. yMEXILETINE CAP 200MG 00591049201 WATSON PHARMA, INC. yMEXILETINE CAP 250MG 00591049301 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-650 00591050201 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-650 00591050205 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-650MG 00591050301 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-650MG 00591050305 WATSON PHARMA, INC. yESTRADIOL TAB 0.5MG 00591052801 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-500MG 00591054001 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-500MG 00591054005 WATSON PHARMA, INC. yPROPAFENONE TAB 150MG 00591058201 WATSON PHARMA, INC. yPROPAFENONE TAB 225MG 00591058301 WATSON PHARMA, INC. yLABETALOL TAB 100MG 00591060501 WATSON PHARMA, INC. yLABETALOL TAB 100MG 00591060505 WATSON PHARMA, INC. yLABETALOL TAB 200MG 00591060601 WATSON PHARMA, INC. yLABETALOL TAB 200MG 00591060605 WATSON PHARMA, INC. yLABETALOL TAB 300MG 00591060701 WATSON PHARMA, INC. yMORPHINE SUL TAB 100MG ER 00591061701 WATSON PHARMA, INC. yBUSPIRONE TAB 5MG 00591065701 WATSON PHARMA, INC. yBUSPIRONE TAB 5MG 00591065705 WATSON PHARMA, INC. yBUSPIRONE TAB 5MG 00591065710 WATSON PHARMA, INC. yBUSPIRONE TAB 10MG 00591065801 WATSON PHARMA, INC. yBUSPIRONE TAB 10MG 00591065805 WATSON PHARMA, INC. yBUSPIRONE TAB 10MG 00591065810 WATSON PHARMA, INC. yENALAPRIL TAB 2.5MG 00591066801 WATSON PHARMA, INC. yENALAPRIL TAB 2.5MG 00591066805 WATSON PHARMA, INC. yENALAPRIL TAB 5MG 00591066901 WATSON PHARMA, INC. yENALAPRIL TAB 5MG 00591066905 WATSON PHARMA, INC. yENALAPRIL TAB 10MG 00591067001 WATSON PHARMA, INC. yENALAPRIL TAB 10MG 00591067005 WATSON PHARMA, INC. yENALAPRIL TAB 20MG 00591067101 WATSON PHARMA, INC. yENALAPRIL TAB 20MG 00591067105 WATSON PHARMA, INC. y

Page 735: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DICLOFENAC TAB 100MG ER 00591067601 WATSON PHARMA, INC. yHYDROXYCHLOR TAB 200MG 00591069801 WATSON PHARMA, INC. yHYDROXYCHLOR TAB 200MG 00591069805 WATSON PHARMA, INC. yPROPOXY/APAP TAB 65-650MG 00591071401 WATSON PHARMA, INC. yPROPOXY/APAP TAB 65-650MG 00591071405 WATSON PHARMA, INC. yQUININE SULF TAB 260MG 00591071501 WATSON PHARMA, INC. yQUININE SULF TAB 260MG 00591071505 WATSON PHARMA, INC. yQUININE SULF TAB 260MG 00591071510 WATSON PHARMA, INC. yQUININE SULF CAP 325MG 00591071601 WATSON PHARMA, INC. yQUININE SULF CAP 325MG 00591071610 WATSON PHARMA, INC. yBUSPIRONE TAB 15MG 00591071805 WATSON PHARMA, INC. yBUSPIRONE TAB 15MG 00591071818 WATSON PHARMA, INC. yBUSPIRONE TAB 15MG 00591071860 WATSON PHARMA, INC. yMEPERIDINE TAB 50MG 00591072601 WATSON PHARMA, INC. yMEPERIDINE TAB 100MG 00591072701 WATSON PHARMA, INC. yOXYCOD/APAP CAP 5-500MG 00591073701 WATSON PHARMA, INC. yOXYCOD/APAP CAP 5-500MG 00591073705 WATSON PHARMA, INC. yESTAZOLAM TAB 1MG 00591074401 WATSON PHARMA, INC. yESTAZOLAM TAB 2MG 00591074501 WATSON PHARMA, INC. yCLONAZEPAM TAB 0.5MG 00591074601 WATSON PHARMA, INC. yCLONAZEPAM TAB 0.5MG 00591074605 WATSON PHARMA, INC. yCLONAZEPAM TAB 1MG 00591074701 WATSON PHARMA, INC. yCLONAZEPAM TAB 1MG 00591074705 WATSON PHARMA, INC. yCLONAZEPAM TAB 2MG 00591074801 WATSON PHARMA, INC. yCLONAZEPAM TAB 2MG 00591074805 WATSON PHARMA, INC. yOXYCOD/APAP TAB 5-325MG 00591074901 WATSON PHARMA, INC. yOXYCOD/APAP TAB 5-325MG 00591074905 WATSON PHARMA, INC. yRANITIDINE TAB 150MG 00591076005 WATSON PHARMA, INC. yRANITIDINE TAB 150MG 00591076060 WATSON PHARMA, INC. yRANITIDINE TAB 300MG 00591076101 WATSON PHARMA, INC. yRANITIDINE TAB 300MG 00591076130 WATSON PHARMA, INC. yNEFAZODONE TAB 100MG 00591076460 WATSON PHARMA, INC. yNEFAZODONE TAB 250MG 00591076760 WATSON PHARMA, INC. yDILTIAZEM TAB 30MG 00591077501 WATSON PHARMA, INC. yDILTIAZEM TAB 60MG 00591077601 WATSON PHARMA, INC. yDILTIAZEM TAB 60MG 00591077605 WATSON PHARMA, INC. y

Page 736: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DILTIAZEM TAB 90MG 00591077701 WATSON PHARMA, INC. yDILTIAZEM TAB 120MG 00591077801 WATSON PHARMA, INC. yOXYBUTYNIN TAB 5MG 00591077901 WATSON PHARMA, INC. yOXYBUTYNIN TAB 5MG 00591077905 WATSON PHARMA, INC. ySUCRALFATE TAB 1GM 00591078001 WATSON PHARMA, INC. ySUCRALFATE TAB 1GM 00591078005 WATSON PHARMA, INC. yCLOMIPHENE TAB 50MG 00591078130 WATSON PHARMA, INC. yDIETHYLPROP TAB 75MG ER 00591078201 WATSON PHARMA, INC. yDIETHYLPROP TAB 25MG 00591078301 WATSON PHARMA, INC. yCHLORDIAZEP CAP 5MG 00591078501 WATSON PHARMA, INC. yCHLORDIAZEP CAP 5MG 00591078505 WATSON PHARMA, INC. yCHLORDIAZEP CAP 10MG 00591078601 WATSON PHARMA, INC. yCHLORDIAZEP CAP 10MG 00591078605 WATSON PHARMA, INC. yCHLORDIAZEP CAP 10MG 00591078610 WATSON PHARMA, INC. yCHLORDIAZEP CAP 25MG 00591078701 WATSON PHARMA, INC. yCHLORDIAZEP CAP 25MG 00591078705 WATSON PHARMA, INC. yMETHYLPRED TAB 4MG 00591079001 WATSON PHARMA, INC. yMETHYLPRED PAK 4MG 00591079021 WATSON PHARMA, INC. yNAPROXEN TAB 500MG 00591079101 WATSON PHARMA, INC. yNAPROXEN TAB 500MG 00591079105 WATSON PHARMA, INC. yNAPROXEN SOD TAB 275MG 00591079201 WATSON PHARMA, INC. yNAPROXEN SOD TAB 275MG 00591079205 WATSON PHARMA, INC. yNAPROXEN SOD TAB 550MG 00591079301 WATSON PHARMA, INC. yNAPROXEN SOD TAB 550MG 00591079305 WATSON PHARMA, INC. yDICYCLOMINE CAP 10MG 00591079401 WATSON PHARMA, INC. yDICYCLOMINE CAP 10MG 00591079410 WATSON PHARMA, INC. yDICYCLOMINE TAB 20MG 00591079501 WATSON PHARMA, INC. yDICYCLOMINE TAB 20MG 00591079510 WATSON PHARMA, INC. ySULFASALAZIN TAB 500MG 00591079601 WATSON PHARMA, INC. ySULFASALAZIN TAB 500MG 00591079605 WATSON PHARMA, INC. ySULFASALAZIN TAB 500MG 00591079610 WATSON PHARMA, INC. yHYDROXYZ PAM CAP 25MG 00591080001 WATSON PHARMA, INC. yHYDROXYZ PAM CAP 25MG 00591080005 WATSON PHARMA, INC. yHYDROXYZ PAM CAP 50MG 00591080101 WATSON PHARMA, INC. yHYDROXYZ PAM CAP 50MG 00591080105 WATSON PHARMA, INC. yMECLIZINE TAB 25MG 00591080301 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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MECLIZINE TAB 25MG 00591080310 WATSON PHARMA, INC. yDESIPRAMINE TAB 50MG 00591080901 WATSON PHARMA, INC. yDESIPRAMINE TAB 50MG 00591080905 WATSON PHARMA, INC. ySILVER SULFA CRE 1% 00591081046 WATSON PHARMA, INC. ySILVER SULFA CRE 1% 00591081055 WATSON PHARMA, INC. ySILVER SULFA CRE 1% 00591081083 WATSON PHARMA, INC. ySILVER SULFA CRE 1% 00591081085 WATSON PHARMA, INC. yOXYCOD/ASA TAB 00591082001 WATSON PHARMA, INC. yOXYCOD/ASA TAB 00591082005 WATSON PHARMA, INC. yNAPROXEN TAB 250MG 00591082101 WATSON PHARMA, INC. yNAPROXEN TAB 375MG 00591082201 WATSON PHARMA, INC. yNAPROXEN TAB 375MG 00591082205 WATSON PHARMA, INC. yOXYCO/APAP TAB 7.5-500 00591082401 WATSON PHARMA, INC. yOXYCO/APAP TAB 10-650 00591082501 WATSON PHARMA, INC. yBUPROPION TAB 150MG SR 00591083925 WATSON PHARMA, INC. yBUPROPION TAB 150MG SR 00591083960 WATSON PHARMA, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00591084101 WATSON PHARMA, INC. yBISOPRL/HCTZ TAB 2.5/6.25 00591084105 WATSON PHARMA, INC. yBISOPRL/HCTZ TAB 5/6.25MG 00591084201 WATSON PHARMA, INC. yBISOPRL/HCTZ TAB 5/6.25MG 00591084205 WATSON PHARMA, INC. yBISOPRL/HCTZ TAB 10/6.25 00591084301 WATSON PHARMA, INC. yBISOPRL/HCTZ TAB 10/6.25 00591084330 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 5MG 00591084401 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 5MG 00591084410 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 10MG 00591084501 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 10MG 00591084510 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-15MG 00591085001 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-30MG 00591085101 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-60MG 00591085201 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-60MG 00591085205 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-325MG 00591085301 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-325MG 00591085305 WATSON PHARMA, INC. yBUPROPION TAB 100MG SR 00591085860 WATSON PHARMA, INC. yLISINOP/HCTZ TAB 10-12.5 00591086001 WATSON PHARMA, INC. yLISINOP/HCTZ TAB 10-12.5 00591086005 WATSON PHARMA, INC. yLISINOP/HCTZ TAB 20-12.5 00591086101 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LISINOP/HCTZ TAB 20-12.5 00591086105 WATSON PHARMA, INC. yLISINOP/HCTZ TAB 20-25MG 00591086201 WATSON PHARMA, INC. yLISINOP/HCTZ TAB 20-25MG 00591086205 WATSON PHARMA, INC. yLISINOPRIL TAB 30MG 00591088501 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 2.5MG 00591090030 WATSON PHARMA, INC. yOXYCODO-APAP TAB 10-325 00591093201 WATSON PHARMA, INC. yOXYCOD-APAP TAB 7.5-325 00591093301 WATSON PHARMA, INC. yCOLCHICINE TAB 0.6MG 00591094401 WATSON PHARMA, INC. yCOLCHICINE TAB 0.6MG 00591094404 WATSON PHARMA, INC. yCOLCHICINE TAB 0.6MG 00591094410 WATSON PHARMA, INC. yMIRTAZAPINE TAB 15MG 00591111730 WATSON PHARMA, INC. yMIRTAZAPINE TAB 30MG 00591111830 WATSON PHARMA, INC. yMIRTAZAPINE TAB 45MG 00591111930 WATSON PHARMA, INC. yIBUPROFEN TAB 800MG 00591213701 WATSON PHARMA, INC. yIBUPROFEN TAB 800MG 00591213705 WATSON PHARMA, INC. yNANDROL DEC INJ 200MG/ML 00591218653 WATSON PHARMA, INC. yNEO/POLY GU SOL 40/ML IR 00591219045 WATSON PHARMA, INC. yNEO/POLY GU SOL 40/ML IR 00591219050 WATSON PHARMA, INC. yTRIAM DENTAL PST 0.1% 00591221826 WATSON PHARMA, INC. yTRAZODONE TAB 150MG 00591230001 WATSON PHARMA, INC. yLACTULOSE SOL 10GM/15 00591234716 WATSON PHARMA, INC. yLACTULOSE SOL 10GM/15 00591234764 WATSON PHARMA, INC. yCEFAZOLIN INJ 1GM 00591236569 WATSON PHARMA, INC. yCEFAZOLIN INJ 10GM 00591236668 WATSON PHARMA, INC. yHYDROCORT CRE 2.5% 00591244630 WATSON PHARMA, INC. yMETFORMIN TAB 1000MG 00591245501 WATSON PHARMA, INC. yMETFORMIN TAB 1000MG 00591245505 WATSON PHARMA, INC. yLACTULOSE SOL 10GM/15 00591251938 WATSON PHARMA, INC. yLACTULOSE SOL 10GM/15 00591251965 WATSON PHARMA, INC. yACYCLOVIR CAP 200MG 00591269201 WATSON PHARMA, INC. yACYCLOVIR CAP 200MG 00591269205 WATSON PHARMA, INC. yMETFORMIN TAB 500MG 00591271301 WATSON PHARMA, INC. yMETFORMIN TAB 500MG 00591271305 WATSON PHARMA, INC. yMETFORMIN TAB 850MG 00591277501 WATSON PHARMA, INC. yMETFORMIN TAB 850MG 00591277525 WATSON PHARMA, INC. yORPHENADRINE TAB 100MG CR 00591283001 WATSON PHARMA, INC. y

Page 739: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ORPHENADRINE TAB 100MG CR 00591283025 WATSON PHARMA, INC. yVERAPAMIL CAP 180MG SR 00591288201 WATSON PHARMA, INC. yVERAPAMIL CAP 240MG SR 00591288401 WATSON PHARMA, INC. yVERAPAMIL CAP 360MG SR 00591288601 WATSON PHARMA, INC. yHYDROXOCOBAL INJ 1000MCG 00591288830 WATSON PHARMA, INC. yNICOTINE DIS 7MG/24HR 00591289030 WATSON PHARMA, INC. yNICOTINE DIS 14MG/24H 00591289330 WATSON PHARMA, INC. yNICOTINE DIS 21MG/24H 00591290130 WATSON PHARMA, INC. yMETHYLPHENID TAB 20MG ER 00591311101 WATSON PHARMA, INC. yCLINDAMYCIN CAP 300MG 00591312001 WATSON PHARMA, INC. yCLINDAMYCIN CAP 300MG 00591312016 WATSON PHARMA, INC. yPROGESTERONE INJ 50MG/ML 00591312879 WATSON PHARMA, INC. yNIZATIDINE CAP 150MG 00591313705 WATSON PHARMA, INC. yNIZATIDINE CAP 150MG 00591313760 WATSON PHARMA, INC. yNIZATIDINE CAP 300MG 00591313830 WATSON PHARMA, INC. yMINOCYCLINE CAP 75MG 00591315301 WATSON PHARMA, INC. yPROMETHAZINE INJ 25MG/ML 00591315783 WATSON PHARMA, INC. yPROMETHAZINE INJ 50MG/ML 00591315883 WATSON PHARMA, INC. yURSODIOL CAP 300MG 00591315901 WATSON PHARMA, INC. yHYDROCOD/IBU TAB 7.5-200 00591316801 WATSON PHARMA, INC. yCITALOPRAM TAB 10MG 00591317601 WATSON PHARMA, INC. yCITALOPRAM TAB 10MG 00591317605 WATSON PHARMA, INC. yCITALOPRAM TAB 20MG 00591317701 WATSON PHARMA, INC. yCITALOPRAM TAB 20MG 00591317705 WATSON PHARMA, INC. yCITALOPRAM TAB 40MG 00591317801 WATSON PHARMA, INC. yCITALOPRAM TAB 40MG 00591317805 WATSON PHARMA, INC. yPYRIDOSTIGM TAB 60MG 00591319101 WATSON PHARMA, INC. yPYRIDOSTIGM TAB 60MG 00591319105 WATSON PHARMA, INC. yAFEDITAB TAB 30MG CR 00591319301 WATSON PHARMA, INC. yAFEDITAB TAB 60MG CR 00591319401 WATSON PHARMA, INC. yMETOPROLOL INJ 1MG/ML 00591319578 WATSON PHARMA, INC. yTERCONAZOLE CRE 0.4% 00591319689 WATSON PHARMA, INC. yTERCONAZOLE CRE 0.8% 00591319752 WATSON PHARMA, INC. yHYDROCO/APAP TAB 5-325MG 00591320201 WATSON PHARMA, INC. yHYDROCO/APAP TAB 7.5-325 00591320301 WATSON PHARMA, INC. yPODOFILOX SOL 0.5% 00591320413 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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BUT/ASA/CAFF CAP 00591321901 WATSON PHARMA, INC. yBUT/APAP/CAF CAP CODEINE 00591322001 WATSON PHARMA, INC. yTESTOST ENAN INJ 200MG/ML 00591322126 WATSON PHARMA, INC. yORPHENADRINE INJ 30MG/ML 00591322247 WATSON PHARMA, INC. yTESTOST CYP INJ 200MG/ML 00591322379 WATSON PHARMA, INC. yCEFUROXIME TAB 250MG 00591322415 WATSON PHARMA, INC. yCEFUROXIME TAB 500MG 00591322515 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10-750MG 00591322801 WATSON PHARMA, INC. yMELOXICAM TAB 7.5MG 00591323001 WATSON PHARMA, INC. yMELOXICAM TAB 7.5MG 00591323010 WATSON PHARMA, INC. yMELOXICAM TAB 15MG 00591323101 WATSON PHARMA, INC. yMELOXICAM TAB 15MG 00591323110 WATSON PHARMA, INC. yNITROFURANTN CAP 100MG 00591325001 WATSON PHARMA, INC. yNITROFUR MAC CAP 50MG 00591325301 WATSON PHARMA, INC. yNITROFUR MAC CAP 100MG 00591325401 WATSON PHARMA, INC. yCYCLOBENZAPR TAB 5MG 00591325601 WATSON PHARMA, INC. yLORAZEPAM INJ 2MG/ML 00591336545 WATSON PHARMA, INC. yLORAZEPAM INJ 2MG/ML 00591336570 WATSON PHARMA, INC. yBUT/APAP/CAF TAB 00591341601 WATSON PHARMA, INC. yBUT/APAP/CAF TAB 00591341605 WATSON PHARMA, INC. yFUROSEMIDE TAB 20MG 00591343601 WATSON PHARMA, INC. yFUROSEMIDE TAB 20MG 00591343610 WATSON PHARMA, INC. yFUROSEMIDE TAB 40MG 00591343701 WATSON PHARMA, INC. yFUROSEMIDE TAB 40MG 00591343710 WATSON PHARMA, INC. yFUROSEMIDE TAB 80MG 00591343801 WATSON PHARMA, INC. yFUROSEMIDE TAB 80MG 00591343805 WATSON PHARMA, INC. yIBUPROFEN TAB 400MG 00591346401 WATSON PHARMA, INC. yIBUPROFEN TAB 400MG 00591346405 WATSON PHARMA, INC. yIBUPROFEN TAB 600MG 00591346501 WATSON PHARMA, INC. yIBUPROFEN TAB 600MG 00591346505 WATSON PHARMA, INC. yIBUPROFEN TAB 800MG 00591346601 WATSON PHARMA, INC. yIBUPROFEN TAB 800MG 00591346605 WATSON PHARMA, INC. yOXANDROLONE TAB 2.5MG 00591354401 WATSON PHARMA, INC. yOXANDROLONE TAB 10MG 00591354560 WATSON PHARMA, INC. yCEFAZOLIN INJ 10GM 00591355068 WATSON PHARMA, INC. yOXYTOCIN INJ 10UNT/ML 00591355369 WATSON PHARMA, INC. y

Page 741: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

741 of 774

DEXCHLORPHEN TAB 4MG CR 00591400801 WATSON PHARMA, INC. yIBUPROFEN TAB 400MG 00591401001 WATSON PHARMA, INC. yIBUPROFEN TAB 400MG 00591401005 WATSON PHARMA, INC. yIBUPROFEN TAB 600MG 00591401101 WATSON PHARMA, INC. yIBUPROFEN TAB 600MG 00591401105 WATSON PHARMA, INC. yVALPROIC ACD CAP 250MG 00591401201 WATSON PHARMA, INC. yPREDNISONE TAB 5MG 00591505201 WATSON PHARMA, INC. yPREDNISONE TAB 5MG 00591505204 WATSON PHARMA, INC. yPREDNISONE TAB 5MG 00591505210 WATSON PHARMA, INC. yPREDNISOLONE TAB 5MG 00591505901 WATSON PHARMA, INC. yPREDNISOLONE TAB 5MG 00591505904 WATSON PHARMA, INC. yPREDNISOLONE TAB 5MG 00591505910 WATSON PHARMA, INC. yFOLIC ACID TAB 1MG 00591521601 WATSON PHARMA, INC. yFOLIC ACID TAB 1MG 00591521604 WATSON PHARMA, INC. yFOLIC ACID TAB 1MG 00591521610 WATSON PHARMA, INC. yMEPROBAMATE TAB 400MG 00591523801 WATSON PHARMA, INC. yMEPROBAMATE TAB 400MG 00591523804 WATSON PHARMA, INC. yMEPROBAMATE TAB 400MG 00591523810 WATSON PHARMA, INC. yMEPROBAMATE TAB 200MG 00591523901 WATSON PHARMA, INC. yMEPROBAMATE TAB 200MG 00591523904 WATSON PHARMA, INC. yMEPROBAMATE TAB 200MG 00591523910 WATSON PHARMA, INC. yPROMETHAZINE TAB 25MG 00591530701 WATSON PHARMA, INC. yPROMETHAZINE TAB 25MG 00591530704 WATSON PHARMA, INC. yPROMETHAZINE TAB 25MG 00591530710 WATSON PHARMA, INC. yPROMETHAZINE TAB 50MG 00591531901 WATSON PHARMA, INC. yPROMETHAZINE TAB 50MG 00591531904 WATSON PHARMA, INC. yPRIMIDONE TAB 250MG 00591532101 WATSON PHARMA, INC. yPRIMIDONE TAB 250MG 00591532104 WATSON PHARMA, INC. yPRIMIDONE TAB 250MG 00591532110 WATSON PHARMA, INC. yPROBEN/COLCH TAB 500-0.5 00591532501 WATSON PHARMA, INC. yPROBEN/COLCH TAB 500/.5MG 00591532504 WATSON PHARMA, INC. yTRIHEXYPHEN TAB 2MG 00591533501 WATSON PHARMA, INC. yTRIHEXYPHEN TAB 2MG 00591533504 WATSON PHARMA, INC. yTRIHEXYPHEN TAB 2MG 00591533510 WATSON PHARMA, INC. yTRIHEXYPHEN TAB 5MG 00591533701 WATSON PHARMA, INC. yTRIHEXYPHEN TAB 5MG 00591533704 WATSON PHARMA, INC. y

Page 742: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIHEXYPHEN TAB 5MG 00591533710 WATSON PHARMA, INC. yPROBENECID TAB 500MG 00591534701 WATSON PHARMA, INC. yPROBENECID TAB 500MG 00591534704 WATSON PHARMA, INC. yPROBENECID TAB 500MG 00591534710 WATSON PHARMA, INC. yMETHOCARBAM TAB 500MG 00591538101 WATSON PHARMA, INC. yMETHOCARBAM TAB 500MG 00591538103 WATSON PHARMA, INC. yMETHOCARBAM TAB 500MG 00591538105 WATSON PHARMA, INC. yMETHOCARBAM TAB 750MG 00591538201 WATSON PHARMA, INC. yMETHOCARBAM TAB 750MG 00591538203 WATSON PHARMA, INC. yMETHOCARBAM TAB 750MG 00591538205 WATSON PHARMA, INC. yQUINIDINE SU TAB 200MG 00591543801 WATSON PHARMA, INC. yQUINIDINE SU TAB 200MG 00591543804 WATSON PHARMA, INC. yQUINIDINE SU TAB 200MG 00591543810 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 100MG 00591544000 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 100MG 00591544003 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 100MG 00591544005 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 100MG 00591544050 WATSON PHARMA, INC. yPREDNISONE TAB 10MG 00591544201 WATSON PHARMA, INC. yPREDNISONE TAB 10MG 00591544203 WATSON PHARMA, INC. yPREDNISONE TAB 10MG 00591544204 WATSON PHARMA, INC. yPREDNISONE TAB 10MG 00591544205 WATSON PHARMA, INC. yPREDNISONE TAB 10MG 00591544210 WATSON PHARMA, INC. yPREDNISONE TAB 20MG 00591544301 WATSON PHARMA, INC. yPREDNISONE TAB 20MG 00591544303 WATSON PHARMA, INC. yPREDNISONE TAB 20MG 00591544304 WATSON PHARMA, INC. yPREDNISONE TAB 20MG 00591544305 WATSON PHARMA, INC. yPREDNISONE TAB 20MG 00591544310 WATSON PHARMA, INC. yQUINIDINE SU TAB 300MG 00591545401 WATSON PHARMA, INC. yCARISOPRODOL TAB 350MG 00591551301 WATSON PHARMA, INC. yCARISOPRODOL TAB 350MG 00591551303 WATSON PHARMA, INC. yCARISOPRODOL TAB 350MG 00591551304 WATSON PHARMA, INC. yCARISOPRODOL TAB 350MG 00591551305 WATSON PHARMA, INC. yCARISOPRODOL TAB 350MG 00591551310 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 10MG 00591552201 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 10MG 00591552203 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 10MG 00591552204 WATSON PHARMA, INC. y

Page 743: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

743 of 774

HYDROXYZ HCL TAB 10MG 00591552205 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 25MG 00591552301 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 25MG 00591552303 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 25MG 00591552304 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 25MG 00591552305 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 25MG 00591552310 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 50MG 00591553500 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 50MG 00591553503 WATSON PHARMA, INC. yDOXYCYCL HYC CAP 50MG 00591553550 WATSON PHARMA, INC. yQUINIDINE GL TAB 324MG SA 00591553801 WATSON PHARMA, INC. yQUINIDINE GL TAB 324MG SA 00591553802 WATSON PHARMA, INC. yQUINIDINE GL TAB 324MG SA 00591553803 WATSON PHARMA, INC. yQUINIDINE GL TAB 324MG SA 00591553805 WATSON PHARMA, INC. yQUINIDINE GL TAB 324MG SA 00591553825 WATSON PHARMA, INC. yMETRONIDAZOL TAB 250MG 00591554001 WATSON PHARMA, INC. yMETRONIDAZOL TAB 250MG 00591554002 WATSON PHARMA, INC. yMETRONIDAZOL TAB 250MG 00591554003 WATSON PHARMA, INC. yMETRONIDAZOL TAB 250MG 00591554025 WATSON PHARMA, INC. yALLOPURINOL TAB 100MG 00591554301 WATSON PHARMA, INC. yALLOPURINOL TAB 100MG 00591554303 WATSON PHARMA, INC. yALLOPURINOL TAB 100MG 00591554304 WATSON PHARMA, INC. yALLOPURINOL TAB 100MG 00591554310 WATSON PHARMA, INC. yALLOPURINOL TAB 300MG 00591554401 WATSON PHARMA, INC. yALLOPURINOL TAB 300MG 00591554403 WATSON PHARMA, INC. yALLOPURINOL TAB 300MG 00591554405 WATSON PHARMA, INC. yMETRONIDAZOL TAB 500MG 00591555200 WATSON PHARMA, INC. yMETRONIDAZOL TAB 500MG 00591555250 WATSON PHARMA, INC. yDOXYCYCL HYC TAB 100MG 00591555300 WATSON PHARMA, INC. yDOXYCYCL HYC TAB 100MG 00591555303 WATSON PHARMA, INC. yDOXYCYCL HYC TAB 100MG 00591555305 WATSON PHARMA, INC. yDOXYCYCL HYC TAB 100MG 00591555350 WATSON PHARMA, INC. yPROPRANOLOL TAB 10MG 00591555401 WATSON PHARMA, INC. yPROPRANOLOL TAB 10MG 00591555404 WATSON PHARMA, INC. yPROPRANOLOL TAB 10MG 00591555410 WATSON PHARMA, INC. yPROPRANOLOL TAB 20MG 00591555501 WATSON PHARMA, INC. yPROPRANOLOL TAB 20MG 00591555504 WATSON PHARMA, INC. y

Page 744: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PROPRANOLOL TAB 20MG 00591555510 WATSON PHARMA, INC. yPROPRANOLOL TAB 40MG 00591555601 WATSON PHARMA, INC. yPROPRANOLOL TAB 40MG 00591555604 WATSON PHARMA, INC. yPROPRANOLOL TAB 40MG 00591555610 WATSON PHARMA, INC. yPROPRANOLOL TAB 80MG 00591555701 WATSON PHARMA, INC. yPROPRANOLOL TAB 80MG 00591555703 WATSON PHARMA, INC. yPROPRANOLOL TAB 80MG 00591555705 WATSON PHARMA, INC. yDISOPYRAMIDE CAP 100MG 00591556001 WATSON PHARMA, INC. yDISOPYRAMIDE CAP 100MG 00591556003 WATSON PHARMA, INC. yDISOPYRAMIDE CAP 150MG 00591556101 WATSON PHARMA, INC. yDISOPYRAMIDE CAP 150MG 00591556103 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 50MG 00591556501 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 50MG 00591556503 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 50MG 00591556504 WATSON PHARMA, INC. yHYDROXYZ HCL TAB 50MG 00591556505 WATSON PHARMA, INC. yTRIMETHOPRIM TAB 100MG 00591557101 WATSON PHARMA, INC. yTRAZODONE TAB 100MG 00591559901 WATSON PHARMA, INC. yTRAZODONE TAB 100MG 00591559904 WATSON PHARMA, INC. yTRAZODONE TAB 100MG 00591559910 WATSON PHARMA, INC. yTRAZODONE TAB 50MG 00591560001 WATSON PHARMA, INC. yTRAZODONE TAB 50MG 00591560004 WATSON PHARMA, INC. yTRAZODONE TAB 50MG 00591560010 WATSON PHARMA, INC. yDIAZEPAM TAB 5MG 00591561901 WATSON PHARMA, INC. yDIAZEPAM TAB 5MG 00591561903 WATSON PHARMA, INC. yDIAZEPAM TAB 5MG 00591561904 WATSON PHARMA, INC. yDIAZEPAM TAB 5MG 00591561905 WATSON PHARMA, INC. yDIAZEPAM TAB 5MG 00591561910 WATSON PHARMA, INC. yDIAZEPAM TAB 10MG 00591562001 WATSON PHARMA, INC. yDIAZEPAM TAB 10MG 00591562003 WATSON PHARMA, INC. yDIAZEPAM TAB 10MG 00591562004 WATSON PHARMA, INC. yDIAZEPAM TAB 10MG 00591562005 WATSON PHARMA, INC. yDIAZEPAM TAB 10MG 00591562010 WATSON PHARMA, INC. yDIAZEPAM TAB 2MG 00591562101 WATSON PHARMA, INC. yDIAZEPAM TAB 2MG 00591562103 WATSON PHARMA, INC. yDIAZEPAM TAB 2MG 00591562104 WATSON PHARMA, INC. yDIAZEPAM TAB 2MG 00591562105 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DIAZEPAM TAB 2MG 00591562110 WATSON PHARMA, INC. yDOXEPIN HCL CAP 25MG 00591563001 WATSON PHARMA, INC. yDOXEPIN HCL CAP 25MG 00591563004 WATSON PHARMA, INC. yDOXEPIN HCL CAP 25MG 00591563010 WATSON PHARMA, INC. yDOXEPIN HCL CAP 50MG 00591563101 WATSON PHARMA, INC. yDOXEPIN HCL CAP 50MG 00591563104 WATSON PHARMA, INC. yDOXEPIN HCL CAP 50MG 00591563110 WATSON PHARMA, INC. yDOXEPIN HCL CAP 75MG 00591563201 WATSON PHARMA, INC. yDOXEPIN HCL CAP 75MG 00591563204 WATSON PHARMA, INC. yDOXEPIN HCL CAP 100MG 00591563301 WATSON PHARMA, INC. yDOXEPIN HCL CAP 100MG 00591563304 WATSON PHARMA, INC. yMINOXIDIL TAB 2.5MG 00591564201 WATSON PHARMA, INC. yMINOXIDIL TAB 2.5MG 00591564203 WATSON PHARMA, INC. yMINOXIDIL TAB 2.5MG 00591564205 WATSON PHARMA, INC. yMINOXIDIL TAB 10MG 00591564301 WATSON PHARMA, INC. yMINOXIDIL TAB 10MG 00591564303 WATSON PHARMA, INC. yMINOXIDIL TAB 10MG 00591564305 WATSON PHARMA, INC. yCYCLOBENZAPR TAB 10MG 00591565801 WATSON PHARMA, INC. yCYCLOBENZAPR TAB 10MG 00591565803 WATSON PHARMA, INC. yCYCLOBENZAPR TAB 10MG 00591565805 WATSON PHARMA, INC. yCYCLOBENZAPR TAB 10MG 00591565810 WATSON PHARMA, INC. ySULINDAC TAB 200MG 00591566001 WATSON PHARMA, INC. ySULINDAC TAB 200MG 00591566002 WATSON PHARMA, INC. ySULINDAC TAB 200MG 00591566003 WATSON PHARMA, INC. ySULINDAC TAB 200MG 00591566005 WATSON PHARMA, INC. ySULINDAC TAB 200MG 00591566008 WATSON PHARMA, INC. ySULINDAC TAB 150MG 00591566101 WATSON PHARMA, INC. ySULINDAC TAB 150MG 00591566102 WATSON PHARMA, INC. ySULINDAC TAB 150MG 00591566103 WATSON PHARMA, INC. ySULINDAC TAB 150MG 00591566105 WATSON PHARMA, INC. ySULINDAC TAB 150MG 00591566108 WATSON PHARMA, INC. yMINOCYCLINE CAP 50MG 00591569401 WATSON PHARMA, INC. yMINOCYCLINE CAP 50MG 00591569460 WATSON PHARMA, INC. yMINOCYCLINE CAP 100MG 00591569500 WATSON PHARMA, INC. yMINOCYCLINE CAP 100MG 00591569550 WATSON PHARMA, INC. yCLINDAMYCIN CAP 150MG 00591570801 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AMOXAPINE TAB 25MG 00591571301 WATSON PHARMA, INC. yAMOXAPINE TAB 50MG 00591571401 WATSON PHARMA, INC. yAMOXAPINE TAB 100MG 00591571501 WATSON PHARMA, INC. yAMOXAPINE TAB 150MG 00591571630 WATSON PHARMA, INC. yHYDROXYZ PAM CAP 25MG 00591572601 WATSON PHARMA, INC. yHYDROXYZ PAM CAP 25MG 00591572605 WATSON PHARMA, INC. yBACLOFEN TAB 10MG 00591573001 WATSON PHARMA, INC. yBACLOFEN TAB 10MG 00591573005 WATSON PHARMA, INC. yATENOLOL TAB 50MG 00591577701 WATSON PHARMA, INC. yATENOLOL TAB 50MG 00591577704 WATSON PHARMA, INC. yATENOLOL TAB 50MG 00591577710 WATSON PHARMA, INC. yATENOLOL TAB 100MG 00591577801 WATSON PHARMA, INC. yATENOL/CHLOR TAB 50-25MG 00591578201 WATSON PHARMA, INC. yATENOL/CHLOR TAB 100-25MG 00591578301 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 10MG 00591578601 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 10MG 00591578605 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 25MG 00591578701 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 25MG 00591578703 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 25MG 00591578705 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 25MG 00591578710 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 50MG 00591578801 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 50MG 00591578805 WATSON PHARMA, INC. yNORTRIPTYLIN CAP 75MG 00591578901 WATSON PHARMA, INC. yMETHYLPHENID TAB 5MG 00591588201 WATSON PHARMA, INC. yMETHYLPHENID TAB 5MG 00591588210 WATSON PHARMA, INC. yMETHYLPHENID TAB 10MG 00591588301 WATSON PHARMA, INC. yMETHYLPHENID TAB 10MG 00591588310 WATSON PHARMA, INC. yMETHYLPHENID TAB 20MG 00591588401 WATSON PHARMA, INC. yMETHYLPHENID TAB 20MG 00591588410 WATSON PHARMA, INC. yPOT BICARBON TAB 25MEQ EF 00591603501 WATSON PHARMA, INC. yPOT BICARBON TAB 25MEQ EF 00591603530 WATSON PHARMA, INC. yNANDROL DEC INJ 100MG/ML 00591671747 WATSON PHARMA, INC. yTRIAMCINOLON CRE 0.025% 00591721186 WATSON PHARMA, INC. yTRIAMCINOLON CRE 0.1% 00591721230 WATSON PHARMA, INC. yTRIAMCINOLON CRE 0.1% 00591721284 WATSON PHARMA, INC. yTRIAMCINOLON CRE 0.5% 00591721386 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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TRIAMCINOLON LOT 0.1% 00591734660 WATSON PHARMA, INC. yPOT CHLORIDE POW 20MEQ 00591737830 WATSON PHARMA, INC. yAMINOPHYLLIN TAB 100MG 00591790401 WATSON PHARMA, INC. yAMINOPHYLLIN TAB 200MG 00591790501 WATSON PHARMA, INC. yLEENA TAB 52544021928 WATSON PHARMA, INC. yNOR-QD TAB 0.35MG 52544023528 WATSON PHARMA, INC. yBREVICON TAB 0.5/35 52544025428 WATSON PHARMA, INC. yNORINYL TAB 1+35-28 52544025928 WATSON PHARMA, INC. yNORINYL TAB 1+35-28 52544025988 WATSON PHARMA, INC. yNORINYL TAB 1+50-28 52544026528 WATSON PHARMA, INC. yNORINYL TAB 1+50-28 52544026531 WATSON PHARMA, INC. yTRI-NORINYL TAB 28 52544027428 WATSON PHARMA, INC. yLEVORA-28 TAB 0.15/30 52544027928 WATSON PHARMA, INC. yTRIVORA-28 TAB 52544029128 WATSON PHARMA, INC. yZOVIA 1/35E TAB 52544038328 WATSON PHARMA, INC. yZOVIA 1/50E TAB 52544038428 WATSON PHARMA, INC. yHYDROCO/APAP TAB 2.5-500 52544038801 WATSON PHARMA, INC. yPENTA/APAP TAB 25-650MG 52544039601 WATSON PHARMA, INC. yANDRODERM DIS 2.5MG/24 52544046960 WATSON PHARMA, INC. yANDRODERM DIS 5MG/24HR 52544047030 WATSON PHARMA, INC. yALORA DIS 0.05MG 52544047108 WATSON PHARMA, INC. yALORA DIS 0.05MG 52544047123 WATSON PHARMA, INC. yALORA DIS 0.075MG 52544047208 WATSON PHARMA, INC. yALORA DIS 0.1MG 52544047308 WATSON PHARMA, INC. yDILACOR XR CAP 120MG/24 52544048201 WATSON PHARMA, INC. yDILACOR XR CAP 120MG/24 52544048205 WATSON PHARMA, INC. yDILACOR XR CAP 180MG/24 52544048301 WATSON PHARMA, INC. yDILACOR XR CAP 180MG/24 52544048305 WATSON PHARMA, INC. yDILACOR XR CAP 240MG/24 52544048401 WATSON PHARMA, INC. yDILACOR XR CAP 240MG/24 52544048405 WATSON PHARMA, INC. yLOXITANE CAP 5MG 52544049401 WATSON PHARMA, INC. yLOXITANE CAP 10MG 52544049501 WATSON PHARMA, INC. yLOXITANE CAP 25MG 52544049601 WATSON PHARMA, INC. yLOXITANE CAP 50MG 52544049701 WATSON PHARMA, INC. yHYDROCOD/GG SYP 5-100/5 52544051916 WATSON PHARMA, INC. yMONONESSA TAB 52544052628 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NORCO TAB 10-325MG 52544053901 WATSON PHARMA, INC. yNORCO TAB 10-325MG 52544053905 WATSON PHARMA, INC. yNECON TAB 0.5/35 52544055028 WATSON PHARMA, INC. yNECON TAB 1/35-28 52544055228 WATSON PHARMA, INC. yNECON TAB 10/11-28 52544055428 WATSON PHARMA, INC. yNECON TAB 1/50-28 52544055628 WATSON PHARMA, INC. yMICROZIDE CAP 52544062201 WATSON PHARMA, INC. yNORA-BE TAB 0.35MG 52544062928 WATSON PHARMA, INC. yMICROGESTIN TAB FE 1/20 52544063028 WATSON PHARMA, INC. yMICROGESTIN TAB FE1.5/30 52544063128 WATSON PHARMA, INC. yMAXIDONE TAB 52544063401 WATSON PHARMA, INC. yDILACOR XR CAP 120MG/24 52544073201 WATSON PHARMA, INC. yDILACOR XR CAP 120MG/24 52544073210 WATSON PHARMA, INC. yDILACOR XR CAP 120MG/24 52544073230 WATSON PHARMA, INC. yDILACOR XR CAP 180MG/24 52544073301 WATSON PHARMA, INC. yDILACOR XR CAP 180MG/24 52544073310 WATSON PHARMA, INC. yDILACOR XR CAP 180MG/24 52544073330 WATSON PHARMA, INC. yDILACOR XR CAP 180MG/24 52544073344 WATSON PHARMA, INC. yDICYCLOMINE TAB 20MG 52544079501 WATSON PHARMA, INC. yDICYCLOMINE TAB 20MG 52544079510 WATSON PHARMA, INC. yOXYCOD/ASA TAB 52544082001 WATSON PHARMA, INC. yOXYCOD/ASA TAB 52544082005 WATSON PHARMA, INC. yLOW-OGESTREL TAB 52544084721 WATSON PHARMA, INC. yLOW-OGESTREL TAB 52544084728 WATSON PHARMA, INC. yOGESTREL TAB 52544084828 WATSON PHARMA, INC. yALORA DIS 0.025MG 52544088408 WATSON PHARMA, INC. yJOLIVETTE TAB 0.35MG 52544089228 WATSON PHARMA, INC. yUNITHROID TAB 88MCG 52544090501 WATSON PHARMA, INC. yOXYTROL DIS 3.9MG/24 52544092002 WATSON PHARMA, INC. yOXYTROL DIS 3.9MG/24 52544092008 WATSON PHARMA, INC. yOXYTROL DIS 3.9MG/24 52544092077 WATSON PHARMA, INC. yFERRLECIT SOL 12.5MG/M 52544092226 WATSON PHARMA, INC. yACTIGALL CAP 300MG 52544093001 WATSON PHARMA, INC. yINFED INJ 50MG/ML 52544093102 WATSON PHARMA, INC. yTRINESSA TAB 52544093528 WATSON PHARMA, INC. yNECON 7/7/7 TAB 28 DAY 52544093628 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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LUTERA TAB 52544094928 WATSON PHARMA, INC. yMICROGESTIN TAB 1/20 52544095021 WATSON PHARMA, INC. yMICROGESTIN TAB 1.5/30 52544095121 WATSON PHARMA, INC. yRECLIPSEN TAB 52544095428 WATSON PHARMA, INC. yFIORINAL CAP 52544095501 WATSON PHARMA, INC. yFIORICET TAB 52544095701 WATSON PHARMA, INC. yFIORICET TAB 52544095705 WATSON PHARMA, INC. yQUASENSE TAB 52544096691 WATSON PHARMA, INC. ySRONYX TAB 52544096728 WATSON PHARMA, INC. yREPREXAIN TAB 52544096960 WATSON PHARMA, INC. yNEPHRO-VITE TAB RX 52544097701 WATSON PHARMA, INC. yNEPHRO-VITE TAB 54391000201 WATSON PHARMA, INC. yNEPHRO-FER TAB 350MG 54391001308 WATSON PHARMA, INC. yNEPHRO-FER TAB 350MG 54391001309 WATSON PHARMA, INC. yCALCI-CHEW CHW CHERRY 54391002502 WATSON PHARMA, INC. yNEPHRO-CALCI TAB 1500MG 54391002603 WATSON PHARMA, INC. yCALCI-MIX CAP POWDER 54391002703 WATSON PHARMA, INC. yL-CARNITINE CAP 250MG 54391005009 WATSON PHARMA, INC. yCALCI-CHEW CHW LEMON 54391022502 WATSON PHARMA, INC. yCALCI-CHEW CHW ORANGE 54391032502 WATSON PHARMA, INC. yCORDRAN 24X3 TAP 4MCG/CM 55515001424 WATSON PHARMA, INC. yCORDRAN 80X3 TAP 4MCG/CM 55515001480 WATSON PHARMA, INC. yCORDRAN OIN 0.05% 55515002615 WATSON PHARMA, INC. yCORDRAN OIN 0.05% 55515002630 WATSON PHARMA, INC. yCORDRAN OIN 0.05% 55515002660 WATSON PHARMA, INC. yCORDRAN LOT 0.05% 55515005215 WATSON PHARMA, INC. yCORDRAN LOT 0.05% 55515005260 WATSON PHARMA, INC. yCONDYLOX SOL 0.5% 55515010101 WATSON PHARMA, INC. yCONDYLOX GEL 0.5% 55515010201 WATSON PHARMA, INC. yMONODOX CAP 50MG 55515026006 WATSON PHARMA, INC. yCORMAX OIN 0.05% 55515041015 WATSON PHARMA, INC. yCORMAX OIN 0.05% 55515041045 WATSON PHARMA, INC. yCORMAX CRE 0.05% 55515042015 WATSON PHARMA, INC. yCORMAX CRE 0.05% 55515042030 WATSON PHARMA, INC. yCORMAX CRE 0.05% 55515042045 WATSON PHARMA, INC. yCORMAX SOL 0.05% 55515043025 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CORMAX SOL 0.05% 55515043050 WATSON PHARMA, INC. yENTEX PSE CAP 120-400 62022013201 WATSON PHARMA, INC. yENTEX LIQ 7.5-100 62022030516 WATSON PHARMA, INC. yENTEX LA CAP 30-400MG 62022033301 WATSON PHARMA, INC. yENTEX ER CAP 10-300MG 62022033401 WATSON PHARMA, INC. yFORTAMET TAB 500MG 62022057460 WATSON PHARMA, INC. yFORTAMET TAB 1000MG 62022057560 WATSON PHARMA, INC. yALTOPREV TAB 20MG ER 62022062830 WATSON PHARMA, INC. yALTOPREV TAB 40MG ER 62022062930 WATSON PHARMA, INC. yALTOPREV TAB 60MG ER 62022063030 WATSON PHARMA, INC. yANEXSIA TAB 5-325MG 62022081701 WATSON PHARMA, INC. yANEXSIA TAB 7.5-325 62022081801 WATSON PHARMA, INC. yENTEX HC LIQ 62022094116 WATSON PHARMA, INC. yBENAZEPRIL TAB 5MG 62037051601 WATSON PHARMA, INC. yBENAZEPRIL TAB 20MG 62037051801 WATSON PHARMA, INC. yKETOPROFEN CAP 200MG ER 62037052001 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-30MG 62037052201 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-30MG 62037052210 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-60MG 62037052301 WATSON PHARMA, INC. yAPAP/CODEINE TAB 300-60MG 62037052305 WATSON PHARMA, INC. yHYDROCOD/IBU TAB 7.5-200 62037052401 WATSON PHARMA, INC. yHYDROCOD/IBU TAB 7.5-200 62037052405 WATSON PHARMA, INC. yCILOSTAZOL TAB 50MG 62037054060 WATSON PHARMA, INC. yCILOSTAZOL TAB 100MG 62037054160 WATSON PHARMA, INC. yDILTIA XT CAP 120MG/24 62037054801 WATSON PHARMA, INC. yDILTIA XT CAP 120MG/24 62037054810 WATSON PHARMA, INC. yDILTIA XT CAP 180MG/24 62037054901 WATSON PHARMA, INC. yDILTIA XT CAP 180MG/24 62037054910 WATSON PHARMA, INC. yDILTIA XT CAP 240MG/24 62037055001 WATSON PHARMA, INC. yDILTIA XT CAP 240MG/24 62037055010 WATSON PHARMA, INC. yHYDROCO/APAP TAB 10/660MG 62037056701 WATSON PHARMA, INC. yMETFORMIN TAB 500MG ER 62037057101 WATSON PHARMA, INC. yMETFORMIN TAB 500MG ER 62037057110 WATSON PHARMA, INC. yMETFORMIN TAB 750MG ER 62037057701 WATSON PHARMA, INC. yMETFORMIN TAB 750MG ER 62037057710 WATSON PHARMA, INC. yCARTIA XT CAP 120/24HR 62037059705 WATSON PHARMA, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CARTIA XT CAP 120/24HR 62037059790 WATSON PHARMA, INC. yCARTIA XT CAP 180/24HR 62037059805 WATSON PHARMA, INC. yCARTIA XT CAP 180/24HR 62037059890 WATSON PHARMA, INC. yCARTIA XT CAP 240/24HR 62037059905 WATSON PHARMA, INC. yCARTIA XT CAP 240/24HR 62037059990 WATSON PHARMA, INC. yCARTIA XT CAP 300/24HR 62037060005 WATSON PHARMA, INC. yCARTIA XT CAP 300/24HR 62037060090 WATSON PHARMA, INC. yMETFORMIN TAB 500MG 62037067401 WATSON PHARMA, INC. yMETFORMIN TAB 500MG 62037067410 WATSON PHARMA, INC. yMETFORMIN TAB 850MG 62037067501 WATSON PHARMA, INC. yMETFORMIN TAB 850MG 62037067510 WATSON PHARMA, INC. yMETFORMIN TAB 1000MG 62037067601 WATSON PHARMA, INC. yMETFORMIN TAB 1000MG 62037067610 WATSON PHARMA, INC. yTAZTIA XT CAP 120MG/24 62037069630 WATSON PHARMA, INC. yTAZTIA XT CAP 120MG/24 62037069690 WATSON PHARMA, INC. yTAZTIA XT CAP 180MG/24 62037069730 WATSON PHARMA, INC. yTAZTIA XT CAP 180MG/24 62037069790 WATSON PHARMA, INC. yTAZTIA XT CAP 240MG/24 62037069830 WATSON PHARMA, INC. yTAZTIA XT CAP 240MG/24 62037069890 WATSON PHARMA, INC. yTAZTIA XT CAP 300MG/24 62037069930 WATSON PHARMA, INC. yTAZTIA XT CAP 300MG/24 62037069990 WATSON PHARMA, INC. yTAZTIA XT CAP 360MG/24 62037070030 WATSON PHARMA, INC. yTAZTIA XT CAP 360MG/24 62037070090 WATSON PHARMA, INC. yPOT CHLORIDE TAB 20MEQ CR 62037072001 WATSON PHARMA, INC. yPOT CHLORIDE TAB 20MEQ CR 62037072005 WATSON PHARMA, INC. yPOT CHLORIDE TAB 20MEQ CR 62037072010 WATSON PHARMA, INC. yMIRTAZAPINE TAB 15MG 62037075310 WATSON PHARMA, INC. yMIRTAZAPINE TAB 15MG 62037075330 WATSON PHARMA, INC. yMIRTAZAPINE TAB 30MG 62037075410 WATSON PHARMA, INC. yMIRTAZAPINE TAB 30MG 62037075430 WATSON PHARMA, INC. yMIRTAZAPINE TAB 45MG 62037075530 WATSON PHARMA, INC. yBENAZEP/HCTZ TAB 5-6.25 62037075601 WATSON PHARMA, INC. yLOVASTATIN TAB 10MG 62037079101 WATSON PHARMA, INC. yLOVASTATIN TAB 20MG 62037079201 WATSON PHARMA, INC. yLOVASTATIN TAB 40MG 62037079301 WATSON PHARMA, INC. yALBUTEROL AER 90MCG 62037079444 WATSON PHARMA, INC. y

Page 752: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

752 of 774

NAPROXEN SOD TAB 500MG CR 62037082675 WATSON PHARMA, INC. yGEN ENTEX LA CAP 30-400MG 62037082701 WATSON PHARMA, INC. yPAROXETINE TAB 10MG 62037084530 WATSON PHARMA, INC. yPAROXETINE TAB 20MG 62037084601 WATSON PHARMA, INC. yPAROXETINE TAB 20MG 62037084610 WATSON PHARMA, INC. yPAROXETINE TAB 20MG 62037084630 WATSON PHARMA, INC. yPAROXETINE TAB 30MG 62037084730 WATSON PHARMA, INC. yPAROXETINE TAB 40MG 62037084830 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 2.5MG 62037087130 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 5MG 62037087201 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 5MG 62037087205 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 10MG 62037087301 WATSON PHARMA, INC. yGLIPIZIDE ER TAB 10MG 62037087305 WATSON PHARMA, INC. yFOSINOPRIL TAB 10MG 62037093590 WATSON PHARMA, INC. yFOSINOPRIL TAB 20MG 62037093690 WATSON PHARMA, INC. yFOSINOPRIL TAB 40MG 62037093790 WATSON PHARMA, INC. yFAMOTIDINE TAB 20MG 62037095501 WATSON PHARMA, INC. yFAMOTIDINE TAB 20MG 62037095510 WATSON PHARMA, INC. yFAMOTIDINE TAB 40MG 62037095601 WATSON PHARMA, INC. yFAMOTIDINE TAB 40MG 62037095610 WATSON PHARMA, INC. yPOT CHLORIDE TAB 20MEQ ER 62037099901 WATSON PHARMA, INC. yPOT CHLORIDE TAB 20MEQ ER 62037099905 WATSON PHARMA, INC. yPOT CHLORIDE TAB 20MEQ ER 62037099910 WATSON PHARMA, INC. yOMNIHIST TAB L.A. 59196000201 WE PHARMACEUTICALS, INC. yAH-CHEW CHW 59196000301 WE PHARMACEUTICALS, INC. yULTRABROM PD CAP 6-60MGCR 59196000401 WE PHARMACEUTICALS, INC. yD-FEDA II TAB 60-600CR 59196000501 WE PHARMACEUTICALS, INC. yULTRABROM CAP 12-120CR 59196000601 WE PHARMACEUTICALS, INC. yAH-CHEW D CHW 10MG 59196000701 WE PHARMACEUTICALS, INC. yPREDNISOLONE SYP 15MG/5ML 59196001024 WE PHARMACEUTICALS, INC. yPREDNISOLONE SYP 15MG/5ML 59196001048 WE PHARMACEUTICALS, INC. yPRED SOD PHO LIQ 6.7/5ML 59196001104 WE PHARMACEUTICALS, INC. yPREDNISOLONE SOL SOD PHOS 59196001224 WE PHARMACEUTICALS, INC. yAH-CHEW SUS 59196001504 WE PHARMACEUTICALS, INC. yAH-CHEW D SUS 10MG/5ML 59196001704 WE PHARMACEUTICALS, INC. yOMNIHIST II TAB LA 59196003201 WE PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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AH-CHEW II CHW 59196003301 WE PHARMACEUTICALS, INC. ySINUVENT PE TAB 15-600MG 59196003501 WE PHARMACEUTICALS, INC. ySINUTUSS DM TAB CR 59196004501 WE PHARMACEUTICALS, INC. yWE MIST LA TAB 59196006001 WE PHARMACEUTICALS, INC. yWE MIST II TAB LA 59196006501 WE PHARMACEUTICALS, INC. yWE ALLERGY SYP 59196007016 WE PHARMACEUTICALS, INC. yAMINOPHYLLIN TAB 100MG 00143102001 WEST-WARD PHARMACEUTICAL CORP yAMINOPHYLLIN TAB 100MG 00143102010 WEST-WARD PHARMACEUTICAL CORP yAMINOPHYLLIN TAB 200MG 00143102501 WEST-WARD PHARMACEUTICAL CORP yAMINOPHYLLIN TAB 200MG 00143102510 WEST-WARD PHARMACEUTICAL CORP yBUT/APAP/CAF TAB 00143111501 WEST-WARD PHARMACEUTICAL CORP yBUT/APAP/CAF TAB 00143111505 WEST-WARD PHARMACEUTICAL CORP yBELLA ALK/PB TAB 16.2MG 00143114010 WEST-WARD PHARMACEUTICAL CORP yBELLA ALK/PB TAB 16.2MG 00143114051 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 12.5MG 00143117101 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 12.5MG 00143117110 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 25MG 00143117201 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 25MG 00143117210 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 50MG 00143117301 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 50MG 00143117310 WEST-WARD PHARMACEUTICAL CORP yCAPTOPRIL TAB 100MG 00143117401 WEST-WARD PHARMACEUTICAL CORP yCARISOPRODOL TAB 350MG 00143117601 WEST-WARD PHARMACEUTICAL CORP yCARISOPRODOL TAB 350MG 00143117605 WEST-WARD PHARMACEUTICAL CORP yCARISOPRODOL TAB 350MG 00143117610 WEST-WARD PHARMACEUTICAL CORP yCHLOROQUINE TAB 250MG 00143119550 WEST-WARD PHARMACEUTICAL CORP yCOLCHICINE TAB 0.6MG 00143120101 WEST-WARD PHARMACEUTICAL CORP yCOLCHICINE TAB 0.6MG 00143120110 WEST-WARD PHARMACEUTICAL CORP yCOLCHICINE TAB 0.6MG 00143120125 WEST-WARD PHARMACEUTICAL CORP yCORTISONE AC TAB 25MG 00143120201 WEST-WARD PHARMACEUTICAL CORP yCHLOROTHIAZ TAB 250MG 00143120901 WEST-WARD PHARMACEUTICAL CORP yCHLOROTHIAZ TAB 500MG 00143121001 WEST-WARD PHARMACEUTICAL CORP yDICYCLOMINE TAB 20MG 00143122701 WEST-WARD PHARMACEUTICAL CORP yDICYCLOMINE TAB 20MG 00143122710 WEST-WARD PHARMACEUTICAL CORP yFOLIC ACID TAB 1MG 00143124801 WEST-WARD PHARMACEUTICAL CORP yFOLIC ACID TAB 1MG 00143124809 WEST-WARD PHARMACEUTICAL CORP yFOLIC ACID TAB 1MG 00143124810 WEST-WARD PHARMACEUTICAL CORP y

Page 754: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCORT TAB 20MG 00143125401 WEST-WARD PHARMACEUTICAL CORP yISONIAZID TAB 100MG 00143126001 WEST-WARD PHARMACEUTICAL CORP yISONIAZID TAB 100MG 00143126010 WEST-WARD PHARMACEUTICAL CORP yISONIAZID TAB 300MG 00143126101 WEST-WARD PHARMACEUTICAL CORP yISONIAZID TAB 300MG 00143126110 WEST-WARD PHARMACEUTICAL CORP yLISINOP/HCTZ TAB 10-12.5 00143126201 WEST-WARD PHARMACEUTICAL CORP yLISINOP/HCTZ TAB 10-12.5 00143126210 WEST-WARD PHARMACEUTICAL CORP yLISINOP/HCTZ TAB 20-12.5 00143126301 WEST-WARD PHARMACEUTICAL CORP yLISINOP/HCTZ TAB 20-12.5 00143126310 WEST-WARD PHARMACEUTICAL CORP yLISINOP/HCTZ TAB 20-25MG 00143126401 WEST-WARD PHARMACEUTICAL CORP yLISINOP/HCTZ TAB 20-25MG 00143126410 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 2.5MG 00143126501 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 2.5MG 00143126510 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 5MG 00143126601 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 5MG 00143126610 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 10MG 00143126701 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 10MG 00143126710 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 20MG 00143126801 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 20MG 00143126810 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 40MG 00143127001 WEST-WARD PHARMACEUTICAL CORP yLISINOPRIL TAB 40MG 00143127010 WEST-WARD PHARMACEUTICAL CORP yLITHIUM CARB TAB 450MG ER 00143127701 WEST-WARD PHARMACEUTICAL CORP yMETHOCARBAM TAB 500MG 00143129001 WEST-WARD PHARMACEUTICAL CORP yMETHOCARBAM TAB 500MG 00143129005 WEST-WARD PHARMACEUTICAL CORP yMETHOCARBAM TAB 750MG 00143129201 WEST-WARD PHARMACEUTICAL CORP yMETHOCARBAM TAB 750MG 00143129205 WEST-WARD PHARMACEUTICAL CORP yISOSORB MONO TAB 20MG 00143133301 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN TAB 250MG 00143134601 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN TAB 250MG 00143134605 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN TAB 375MG 00143134701 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN TAB 375MG 00143134705 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN TAB 500MG 00143134801 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN TAB 500MG 00143134805 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 2.5MG 00143142501 WEST-WARD PHARMACEUTICAL CORP yPHENOBARB TAB 15MG 00143144510 WEST-WARD PHARMACEUTICAL CORP yPHENOBARB TAB 30MG 00143145010 WEST-WARD PHARMACEUTICAL CORP y

Page 755: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PHENOBARB TAB 60MG 00143145510 WEST-WARD PHARMACEUTICAL CORP yPHENOBARBITA TAB 100MG 00143145801 WEST-WARD PHARMACEUTICAL CORP yPHENOBARBITA TAB 100MG 00143145810 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 10MG 00143147301 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 10MG 00143147310 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 5MG 00143147501 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 5MG 00143147510 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 20MG 00143147701 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 20MG 00143147705 WEST-WARD PHARMACEUTICAL CORP yPREDNISONE TAB 20MG 00143147710 WEST-WARD PHARMACEUTICAL CORP yPROPYLTHIOUR TAB 50MG 00143148001 WEST-WARD PHARMACEUTICAL CORP yPROPYLTHIOUR TAB 50MG 00143148010 WEST-WARD PHARMACEUTICAL CORP yPRIMIDONE TAB 50MG 00143148201 WEST-WARD PHARMACEUTICAL CORP yPRIMIDONE TAB 50MG 00143148205 WEST-WARD PHARMACEUTICAL CORP yPRIMIDONE TAB 250MG 00143148401 WEST-WARD PHARMACEUTICAL CORP yPRIMIDONE TAB 250MG 00143148410 WEST-WARD PHARMACEUTICAL CORP yTRIHEXYPHEN TAB 5MG 00143176301 WEST-WARD PHARMACEUTICAL CORP yTRIHEXYPHEN TAB 5MG 00143176310 WEST-WARD PHARMACEUTICAL CORP yTRIHEXYPHEN TAB 2MG 00143176401 WEST-WARD PHARMACEUTICAL CORP yTRIHEXYPHEN TAB 2MG 00143176410 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN SUB 2.5MG 00143176501 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN SUB 5MG 00143176701 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 5MG 00143176901 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 5MG 00143176910 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 10MG 00143177101 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 10MG 00143177110 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 10MG 00143177125 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 20MG 00143177201 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 20MG 00143177210 WEST-WARD PHARMACEUTICAL CORP yISOSORB DIN TAB 20MG 00143177225 WEST-WARD PHARMACEUTICAL CORP yBUT/ASA/CAFF TAB 00143178501 WEST-WARD PHARMACEUTICAL CORP yBUT/ASA/CAFF TAB 00143178510 WEST-WARD PHARMACEUTICAL CORP yBUT/APAP/CAF TAB 00143178701 WEST-WARD PHARMACEUTICAL CORP yBUT/APAP/CAF TAB 00143178705 WEST-WARD PHARMACEUTICAL CORP yWEST-DECON M TAB 4-40-20 00143197901 WEST-WARD PHARMACEUTICAL CORP yDOXYCYCL HYC TAB 100MG 00143211205 WEST-WARD PHARMACEUTICAL CORP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DOXYCYCL HYC TAB 100MG 00143211250 WEST-WARD PHARMACEUTICAL CORP yERGOTAM/CAFF TAB 1/100 00143212001 WEST-WARD PHARMACEUTICAL CORP yCHLOROQUINE TAB 500MG 00143212522 WEST-WARD PHARMACEUTICAL CORP yISOSORB MONO TAB 30MG ER 00143223001 WEST-WARD PHARMACEUTICAL CORP yISOSORB MONO TAB 60MG ER 00143226001 WEST-WARD PHARMACEUTICAL CORP yBUT/APAP/CAF CAP CODEINE 00143300001 WEST-WARD PHARMACEUTICAL CORP yDICYCLOMINE CAP 10MG 00143312601 WEST-WARD PHARMACEUTICAL CORP yDICYCLOMINE CAP 10MG 00143312610 WEST-WARD PHARMACEUTICAL CORP yDOXYCYCL HYC CAP 50MG 00143314150 WEST-WARD PHARMACEUTICAL CORP yDOXYCYCL HYC CAP 100MG 00143314205 WEST-WARD PHARMACEUTICAL CORP yDOXYCYCL HYC CAP 100MG 00143314250 WEST-WARD PHARMACEUTICAL CORP yEPHEDRINE SU CAP 25MG 00143314501 WEST-WARD PHARMACEUTICAL CORP yLITHIUM CARB CAP 150MG 00143318801 WEST-WARD PHARMACEUTICAL CORP yLITHIUM CARB CAP 300MG 00143318901 WEST-WARD PHARMACEUTICAL CORP yLITHIUM CARB CAP 300MG 00143318910 WEST-WARD PHARMACEUTICAL CORP yFLURAZEPAM CAP 15MG 00143336701 WEST-WARD PHARMACEUTICAL CORP yFLURAZEPAM CAP 15MG 00143336705 WEST-WARD PHARMACEUTICAL CORP yFLURAZEPAM CAP 30MG 00143337001 WEST-WARD PHARMACEUTICAL CORP yFLURAZEPAM CAP 30MG 00143337005 WEST-WARD PHARMACEUTICAL CORP yONDANSETRON INJ 2MG/ML 00143989001 WEST-WARD PHARMACEUTICAL CORP yCEPHALEXIN CAP 500MG 00143989701 WEST-WARD PHARMACEUTICAL CORP yCEPHALEXIN CAP 500MG 00143989705 WEST-WARD PHARMACEUTICAL CORP yCEPHALEXIN CAP 250MG 00143989801 WEST-WARD PHARMACEUTICAL CORP yCEPHALEXIN CAP 250MG 00143989805 WEST-WARD PHARMACEUTICAL CORP yFLUCONAZOLE/ INJ NACL 200 00143989906 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN SOD TAB 550MG 00143990801 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN SOD TAB 550MG 00143990805 WEST-WARD PHARMACEUTICAL CORP yNAPROXEN SOD TAB 275MG 00143991601 WEST-WARD PHARMACEUTICAL CORP yGLYBURID MCR TAB 1.5MG 00143991801 WEST-WARD PHARMACEUTICAL CORP yGLYBURID MCR TAB 3MG 00143991901 WEST-WARD PHARMACEUTICAL CORP yGLYBURID MCR TAB 3MG 00143991905 WEST-WARD PHARMACEUTICAL CORP yGLYBURID MCR TAB 6MG 00143992001 WEST-WARD PHARMACEUTICAL CORP yGLYBURID MCR TAB 6MG 00143992005 WEST-WARD PHARMACEUTICAL CORP yGLYBURID MCR TAB 6MG 00143992010 WEST-WARD PHARMACEUTICAL CORP yCEFAZOLIN INJ 500MG 00143992390 WEST-WARD PHARMACEUTICAL CORP yCEFAZOLIN INJ 1GM 00143992490 WEST-WARD PHARMACEUTICAL CORP y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CIPROFLOXACN TAB 250MG 00143992701 WEST-WARD PHARMACEUTICAL CORP yCIPROFLOXACN TAB 500MG 00143992801 WEST-WARD PHARMACEUTICAL CORP yCIPROFLOXACN TAB 750MG 00143992950 WEST-WARD PHARMACEUTICAL CORP yCEFOTAXIME INJ 500MG 00143993003 WEST-WARD PHARMACEUTICAL CORP yCEFOTAXIME INJ 10GM 00143993591 WEST-WARD PHARMACEUTICAL CORP yAMOXICILLIN TAB 875MG 00143995101 WEST-WARD PHARMACEUTICAL CORP yCEFUROXIME INJ 7.5GM 00143997691 WEST-WARD PHARMACEUTICAL CORP yCEFUROXIME INJ 1.5GM 00143997790 WEST-WARD PHARMACEUTICAL CORP yCEFUROXIME INJ 750MG 00143997990 WEST-WARD PHARMACEUTICAL CORP yAMOCLAN SUS 200/5ML 00143998101 WEST-WARD PHARMACEUTICAL CORP yAMOCLAN SUS 200/5ML 00143998150 WEST-WARD PHARMACEUTICAL CORP yAMOCLAN SUS 200/5ML 00143998175 WEST-WARD PHARMACEUTICAL CORP yAMOCLAN SUS 400/5ML 00143998201 WEST-WARD PHARMACEUTICAL CORP yAMOCLAN SUS 400/5ML 00143998250 WEST-WARD PHARMACEUTICAL CORP yAMOCLAN SUS 400/5ML 00143998275 WEST-WARD PHARMACEUTICAL CORP yEPINEPHRINE INJ 1MG/ML 00143998490 WEST-WARD PHARMACEUTICAL CORP yDOVONEX CRE 0.005% 00072026003 WESTWOOD-SQUIBB PHARMACEUTICALS yDOVONEX CRE 0.005% 00072026006 WESTWOOD-SQUIBB PHARMACEUTICALS yDOVONEX CRE 0.005% 00072026012 WESTWOOD-SQUIBB PHARMACEUTICALS yDOVONEX SOL 0.005% 00072116006 WESTWOOD-SQUIBB PHARMACEUTICALS yULTRAVATE CRE 0.05% 00072140015 WESTWOOD-SQUIBB PHARMACEUTICALS yULTRAVATE CRE 0.05% 00072140045 WESTWOOD-SQUIBB PHARMACEUTICALS yULTRAVATE CRE 0.05% 00072140050 WESTWOOD-SQUIBB PHARMACEUTICALS yULTRAVATE OIN 0.05% 00072145015 WESTWOOD-SQUIBB PHARMACEUTICALS yULTRAVATE OIN 0.05% 00072145045 WESTWOOD-SQUIBB PHARMACEUTICALS yULTRAVATE OIN 0.05% 00072145050 WESTWOOD-SQUIBB PHARMACEUTICALS yEURAX CRE 10% 00072210360 WESTWOOD-SQUIBB PHARMACEUTICALS yEURAX LOT 10% 00072220316 WESTWOOD-SQUIBB PHARMACEUTICALS yEURAX LOT 10% 00072220360 WESTWOOD-SQUIBB PHARMACEUTICALS yLOWILA BAR 00072230001 WESTWOOD-SQUIBB PHARMACEUTICALS yDOVONEX OIN 0.005% 00072254006 WESTWOOD-SQUIBB PHARMACEUTICALS yDOVONEX OIN 0.005% 00072254012 WESTWOOD-SQUIBB PHARMACEUTICALS ySEBULEX SHA 00072260007 WESTWOOD-SQUIBB PHARMACEUTICALS ySEBULEX SHA 00072270007 WESTWOOD-SQUIBB PHARMACEUTICALS ySEBULEX SHA 00072270008 WESTWOOD-SQUIBB PHARMACEUTICALS yBALNETAR EMU 2.5% 00072420008 WESTWOOD-SQUIBB PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SEBUTONE SHA 0.5% 00072500007 WESTWOOD-SQUIBB PHARMACEUTICALS yLAC-HYDRIN LOT 12% 00072571208 WESTWOOD-SQUIBB PHARMACEUTICALS yLAC-HYDRIN LOT 12% 00072571214 WESTWOOD-SQUIBB PHARMACEUTICALS yLAC-HYDRIN CRE 12% 00072573028 WESTWOOD-SQUIBB PHARMACEUTICALS yLAC-HYDRIN CRE 12% 00072573038 WESTWOOD-SQUIBB PHARMACEUTICALS yLAC-HYDRIN LOT FIVE 00072576004 WESTWOOD-SQUIBB PHARMACEUTICALS yLAC-HYDRIN LOT FIVE 00072576008 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-E GEL 2.5% 00072600345 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-E GEL 5% 00072610345 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X GEL 2.5% 00072630001 WESTWOOD-SQUIBB PHARMACEUTICALS yKERALYT GEL 6% 00072650001 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X GEL 5% 00072662101 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X GEL 5% 00072662103 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X GEL 10% 00072672101 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X GEL 10% 00072672103 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X LIQ WASH 5% 00072690505 WESTWOOD-SQUIBB PHARMACEUTICALS yDESQUAM-X LIQ WASH 10% 00072700005 WESTWOOD-SQUIBB PHARMACEUTICALS yHALOTEX CRE 1% 00072713002 WESTWOOD-SQUIBB PHARMACEUTICALS yHALOTEX CRE 1% 00072713015 WESTWOOD-SQUIBB PHARMACEUTICALS yHALOTEX SOL 1% 00072720030 WESTWOOD-SQUIBB PHARMACEUTICALS yTACARYL TAB 8MG 00072740001 WESTWOOD-SQUIBB PHARMACEUTICALS yWESTCORT OIN 0.2% 00072780015 WESTWOOD-SQUIBB PHARMACEUTICALS yWESTCORT OIN 0.2% 00072780045 WESTWOOD-SQUIBB PHARMACEUTICALS yWESTCORT OIN 0.2% 00072780060 WESTWOOD-SQUIBB PHARMACEUTICALS yWESTCORT CRE 0.2% 00072810015 WESTWOOD-SQUIBB PHARMACEUTICALS yWESTCORT CRE 0.2% 00072810045 WESTWOOD-SQUIBB PHARMACEUTICALS yWESTCORT CRE 0.2% 00072810060 WESTWOOD-SQUIBB PHARMACEUTICALS yEXELDERM CRE 1% 00072820015 WESTWOOD-SQUIBB PHARMACEUTICALS yEXELDERM CRE 1% 00072820030 WESTWOOD-SQUIBB PHARMACEUTICALS yEXELDERM CRE 1% 00072820060 WESTWOOD-SQUIBB PHARMACEUTICALS yEXELDERM SOL 1% 00072840030 WESTWOOD-SQUIBB PHARMACEUTICALS yMAXIVATE CRE 0.05% 00072941015 WESTWOOD-SQUIBB PHARMACEUTICALS yMAXIVATE OIN 0.05% 00072945015 WESTWOOD-SQUIBB PHARMACEUTICALS yORUDIS KT TAB 12.5MG 00573013030 WHITEHALL-ROBINS yORUDIS KT TAB 12.5MG 00573013040 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015005 WHITEHALL-ROBINS y

Page 759: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ADVIL TAB 200MG 00573015006 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015008 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015018 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015020 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015030 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015032 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015035 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015040 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015043 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015046 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015048 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015049 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015153 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015175 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015176 WHITEHALL-ROBINS yADVIL TAB 200MG 00573015485 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016020 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016030 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016035 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016040 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016043 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016045 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016046 WHITEHALL-ROBINS yADVIL PM TAB 200-38MG 00573016430 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016508 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016520 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016530 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016540 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016543 WHITEHALL-ROBINS yADVIL TAB 200MG 00573016546 WHITEHALL-ROBINS yADVIL MIGRAI CAP 200MG 00573016820 WHITEHALL-ROBINS yADVIL MIGRAI CAP 200MG 00573016830 WHITEHALL-ROBINS yADVIL MIGRAI CAP 200MG 00573016840 WHITEHALL-ROBINS yADVIL CAP 200MG 00573016920 WHITEHALL-ROBINS yADVIL CAP 200MG 00573016930 WHITEHALL-ROBINS yCHILD ADVIL SUS 100/5ML 00573017020 WHITEHALL-ROBINS y

Page 760: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

760 of 774

CHILD ADVIL SUS 100/5ML 00573017030 WHITEHALL-ROBINS yCHILD ADVIL SUS 100/5ML 00573017040 WHITEHALL-ROBINS yCHILD ADVIL SUS 100/5ML 00573017120 WHITEHALL-ROBINS yCHILD ADVIL SUS 100/5ML 00573017130 WHITEHALL-ROBINS yCHILD ADVIL DRO 40MG/ML 00573017320 WHITEHALL-ROBINS yCHILD ADVIL SUS 100/5ML 00573017430 WHITEHALL-ROBINS yADVIL JR TAB 100MG 00573017510 WHITEHALL-ROBINS yCHILD ADVIL CHW 50MG 00573017610 WHITEHALL-ROBINS yCHILD ADVIL CHW 50MG 00573017710 WHITEHALL-ROBINS yADVIL JR STR CHW 100MG 00573017910 WHITEHALL-ROBINS yADVIL COLD/ TAB SINUS 00573018010 WHITEHALL-ROBINS yADVIL COLD/ TAB SINUS 00573018020 WHITEHALL-ROBINS yADVIL COLD/ TAB SINUS 00573018021 WHITEHALL-ROBINS yADVIL COLD/ TAB SINUS 00573018085 WHITEHALL-ROBINS yADVIL COLD/ TAB SINUS 00573018510 WHITEHALL-ROBINS yADVIL COLD/ TAB SINUS 00573018520 WHITEHALL-ROBINS yADVIL ALLERG TAB SINUS 00573018805 WHITEHALL-ROBINS yADVIL ALLERG TAB SINUS 00573018810 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020005 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020006 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020025 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020035 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020045 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020065 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020095 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020274 WHITEHALL-ROBINS yANACIN TAB 400-32MG 00573020640 WHITEHALL-ROBINS yANACIN TAB MAX STR 00573021110 WHITEHALL-ROBINS yANACIN TAB MAX STR 00573021120 WHITEHALL-ROBINS yANACIN TAB MAX STR 00573021140 WHITEHALL-ROBINS yANBESOL LIQ 20% 00573021541 WHITEHALL-ROBINS yBABY ANBESOL GEL 7.5% 00573021615 WHITEHALL-ROBINS yANBESOL LIQ 00573022110 WHITEHALL-ROBINS yANBESOL GEL 20%MX ST 00573022510 WHITEHALL-ROBINS yANBESOL LIQ 20% 00573022810 WHITEHALL-ROBINS yANBESOL LIQ 20% 00573022825 WHITEHALL-ROBINS y

Page 761: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ANBESOL COLD OIN SORE 00573024610 WHITEHALL-ROBINS yARTH PAIN FO TAB MAX STR 00573027110 WHITEHALL-ROBINS yARTH PAIN FO TAB MAX STR 00573027120 WHITEHALL-ROBINS yARTH PAIN FO TAB MAX STR 00573027130 WHITEHALL-ROBINS yANACIN AF TAB 500MG 00573031005 WHITEHALL-ROBINS yANACIN AF TAB 500MG 00573031010 WHITEHALL-ROBINS yANACIN AF TAB 500MG 00573031020 WHITEHALL-ROBINS yANACIN AF TAB 500MG 00573031030 WHITEHALL-ROBINS yANACIN AF TAB 500MG 00573034030 WHITEHALL-ROBINS yANACIN AF TAB 500MG 00573034040 WHITEHALL-ROBINS yPREPARATION PAD H 00573055610 WHITEHALL-ROBINS yDENOREX MED SHA /COND XS 00573081110 WHITEHALL-ROBINS yDENOREX MED SHA /COND XS 00573081120 WHITEHALL-ROBINS yDENOREX MEDI SHA EX-STR 00573081610 WHITEHALL-ROBINS yDENOREX MEDI SHA EX-STR 00573081620 WHITEHALL-ROBINS yDENOREX MED/ SHA COND 00573082610 WHITEHALL-ROBINS yDENOREX MED/ SHA COND 00573082620 WHITEHALL-ROBINS yDENOREX MEDI SHA 00573083610 WHITEHALL-ROBINS yDENOREX MEDI SHA 00573083620 WHITEHALL-ROBINS yDENOREX FORM SHA ADVANCED 00573083710 WHITEHALL-ROBINS yDENOREX FORM SHA ADVANCED 00573083720 WHITEHALL-ROBINS yDRISTAN COLD TAB NO-DROWS 00573112020 WHITEHALL-ROBINS yDRISTAN COLD TAB NO-DROWS 00573112021 WHITEHALL-ROBINS yDRISTAN COLD TAB NO-DROWS 00573112030 WHITEHALL-ROBINS yDRISTAN COLD TAB NO-DROWS 00573112031 WHITEHALL-ROBINS yDRISTAN COLD TAB NO-DROWS 00573112040 WHITEHALL-ROBINS yDRISTAN SPR 0.05% 00573119120 WHITEHALL-ROBINS yDRISTAN SPR 0.05% 00573119130 WHITEHALL-ROBINS yDRISTAN SOL 00573120020 WHITEHALL-ROBINS yDRISTAN SOL 00573120030 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123810 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123820 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123821 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123827 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123831 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123840 WHITEHALL-ROBINS y

Page 762: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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DRISTAN COLD TAB MULT-SYM 00573123841 WHITEHALL-ROBINS yDRISTAN COLD TAB MULT-SYM 00573123851 WHITEHALL-ROBINS yDRISTAN COLD CAP COUGH 00573124410 WHITEHALL-ROBINS yDRISTAN TAB SINUS 00573126510 WHITEHALL-ROBINS yDRISTAN TAB SINUS 00573126520 WHITEHALL-ROBINS yAXID AR TAB 75MG 00573240040 WHITEHALL-ROBINS yAXID AR TAB 75MG 00573240045 WHITEHALL-ROBINS yALAVERT TAB NON-DROW 00573262006 WHITEHALL-ROBINS yALAVERT TAB NON-DROW 00573262012 WHITEHALL-ROBINS yALAVERT TAB NON-DROW 00573262024 WHITEHALL-ROBINS yALAVERT TAB NON-DROW 00573262048 WHITEHALL-ROBINS yALAVERT TAB 10MG 00573264515 WHITEHALL-ROBINS yALAVERT TAB 10MG 00573264530 WHITEHALL-ROBINS yALAVERT ALGY TAB -SINUS 00573266012 WHITEHALL-ROBINS yALAVERT ALGY TAB -SINUS 00573266024 WHITEHALL-ROBINS yALAVERT SYP 00573270020 WHITEHALL-ROBINS yPREP H HC CRE 1% 00573283010 WHITEHALL-ROBINS yPREPARATIO H GEL 00573284020 WHITEHALL-ROBINS yPREPARATION CRE H 00573286710 WHITEHALL-ROBINS yPREPARATION CRE H 00573286720 WHITEHALL-ROBINS yPREPARATION CRE H 00573286810 WHITEHALL-ROBINS yPREPARATION CRE H 00573286820 WHITEHALL-ROBINS yPREPARATION OIN H 00573287110 WHITEHALL-ROBINS yPREPARATION OIN H 00573287120 WHITEHALL-ROBINS yPREPARATION SUP H 00573288310 WHITEHALL-ROBINS yPREPARATION SUP H 00573288320 WHITEHALL-ROBINS yPREPARATION SUP H 00573288330 WHITEHALL-ROBINS yPRIMATENE AER 0.22MG/A 00573291020 WHITEHALL-ROBINS yPRIMATENE AER 0.22MG/A 00573291030 WHITEHALL-ROBINS yPRIMATENE AER 0.22MG/A 00573291040 WHITEHALL-ROBINS yPRIMATENE TAB 12.5-200 00573295205 WHITEHALL-ROBINS yPRIMATENE TAB 12.5-200 00573295210 WHITEHALL-ROBINS yPRIMATENE TAB 12.5-200 00573295220 WHITEHALL-ROBINS yRIOPAN PLUS SUS 540-40MG 00573321020 WHITEHALL-ROBINS yRIOPAN PLUS2 SUS 00573322020 WHITEHALL-ROBINS yRIOPAN PLUS SUS D/S CHRY 00573322220 WHITEHALL-ROBINS y

Page 763: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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METFORMIN TAB 500MG 64679052804 WOCKHARDT AMERICAS, INC. yMETFORMIN TAB 500MG 64679052805 WOCKHARDT AMERICAS, INC. yMETFORMIN TAB 850MG 64679052904 WOCKHARDT AMERICAS, INC. yMETFORMIN TAB 850MG 64679052905 WOCKHARDT AMERICAS, INC. yMETFORMIN TAB 1000MG 64679053004 WOCKHARDT AMERICAS, INC. yMETFORMIN TAB 1000MG 64679053005 WOCKHARDT AMERICAS, INC. yMIRTAZAPINE TAB 15MG 64679055901 WOCKHARDT AMERICAS, INC. yMIRTAZAPINE TAB 30MG 64679056001 WOCKHARDT AMERICAS, INC. yMIRTAZAPINE TAB 45MG 64679056101 WOCKHARDT AMERICAS, INC. yONDANSETRON INJ 2MG/ML 64679072601 WOCKHARDT AMERICAS, INC. yONDANSETRON INJ 2MG/ML 64679072701 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 12.5MG 64679090201 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 12.5MG 64679090202 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 25MG 64679090301 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 25MG 64679090302 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 50MG 64679090401 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 50MG 64679090402 WOCKHARDT AMERICAS, INC. yCAPTOPRIL TAB 100MG 64679090501 WOCKHARDT AMERICAS, INC. yRANITIDINE TAB 150MG 64679090601 WOCKHARDT AMERICAS, INC. yRANITIDINE TAB 150MG 64679090603 WOCKHARDT AMERICAS, INC. yRANITIDINE TAB 150MG 64679090606 WOCKHARDT AMERICAS, INC. yRANITIDINE TAB 300MG 64679090701 WOCKHARDT AMERICAS, INC. yRANITIDINE TAB 300MG 64679090702 WOCKHARDT AMERICAS, INC. yRANITIDINE TAB 300MG 64679090704 WOCKHARDT AMERICAS, INC. yCEFUROXIME TAB 250MG 64679092101 WOCKHARDT AMERICAS, INC. yCEFUROXIME TAB 250MG 64679092102 WOCKHARDT AMERICAS, INC. yCEFUROXIME TAB 500MG 64679092201 WOCKHARDT AMERICAS, INC. yCEFUROXIME TAB 500MG 64679092202 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 2.5MG 64679092302 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 2.5MG 64679092303 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 5MG 64679092402 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 5MG 64679092403 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 10MG 64679092502 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 10MG 64679092503 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 20MG 64679092602 WOCKHARDT AMERICAS, INC. yENALAPRIL TAB 20MG 64679092603 WOCKHARDT AMERICAS, INC. y

Page 764: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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FAMOTIDINE TAB 20MG 64679093601 WOCKHARDT AMERICAS, INC. yFAMOTIDINE TAB 20MG 64679093602 WOCKHARDT AMERICAS, INC. yFAMOTIDINE TAB 20MG 64679093603 WOCKHARDT AMERICAS, INC. yFAMOTIDINE TAB 40MG 64679093701 WOCKHARDT AMERICAS, INC. yFAMOTIDINE TAB 40MG 64679093702 WOCKHARDT AMERICAS, INC. yFAMOTIDINE TAB 40MG 64679093703 WOCKHARDT AMERICAS, INC. yZONISAMIDE CAP 25MG 64679094501 WOCKHARDT AMERICAS, INC. yZONISAMIDE CAP 50MG 64679094601 WOCKHARDT AMERICAS, INC. yCLARITHROMYC TAB 500MG 64679094901 WOCKHARDT AMERICAS, INC. yCLARITHROMYC TAB 250MG 64679095401 WOCKHARDT AMERICAS, INC. yBETHANECHOL TAB 5MG 64679096501 WOCKHARDT AMERICAS, INC. yBETHANECHOL TAB 10MG 64679096601 WOCKHARDT AMERICAS, INC. yBETHANECHOL TAB 25MG 64679096701 WOCKHARDT AMERICAS, INC. yBETHANECHOL TAB 50MG 64679096801 WOCKHARDT AMERICAS, INC. yCITALOPRAM TAB 10MG 64679096914 WOCKHARDT AMERICAS, INC. yCITALOPRAM TAB 20MG 64679097014 WOCKHARDT AMERICAS, INC. yCITALOPRAM TAB 40MG 64679097114 WOCKHARDT AMERICAS, INC. yCEFOTAXIME INJ 1GM 64679098601 WOCKHARDT AMERICAS, INC. yCEFOTAXIME INJ 1GM 64679098602 WOCKHARDT AMERICAS, INC. yCEFOTAXIME INJ 1GM 64679098603 WOCKHARDT AMERICAS, INC. yCEFOTAXIME INJ 1GM 64679098604 WOCKHARDT AMERICAS, INC. yZONISAMIDE CAP 100MG 64679099001 WOCKHARDT AMERICAS, INC. yBETAVENT LIQ 20-100MG 66992012016 WRASER PHARMACEUTICALS yBETATAN SUS 66992012504 WRASER PHARMACEUTICALS yVAZOL LIQ 2MG/5ML 66992013016 WRASER PHARMACEUTICALS yVAZOL-D LIQ 2-7.5/5 66992013516 WRASER PHARMACEUTICALS yVAZOL-D LIQ 66992013616 WRASER PHARMACEUTICALS yLUSONEX TAB 20-800MG 66992014010 WRASER PHARMACEUTICALS yLUSONEX TAB 66992014210 WRASER PHARMACEUTICALS yLUSONEX PLUS TAB 66992014410 WRASER PHARMACEUTICALS yLUSONAL LIQ 66992014516 WRASER PHARMACEUTICALS yLUSONAL LIQ 66992014616 WRASER PHARMACEUTICALS yFLUTUSS HC LIQ 66992015016 WRASER PHARMACEUTICALS yFLUTUSS HC LIQ 66992015116 WRASER PHARMACEUTICALS yFLUTUSS XP LIQ 5-150MG 66992015516 WRASER PHARMACEUTICALS yLEVACET TAB 66992016050 WRASER PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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NUOX GEL 6-3% 66992017043 WRASER PHARMACEUTICALS yNUZON GEL 2% 66992018043 WRASER PHARMACEUTICALS yUNIVERT TAB 32MG 66992019010 WRASER PHARMACEUTICALS yVAZOTAN SUS 66992022004 WRASER PHARMACEUTICALS yVAZOBID SUS 6-10MG/5 66992023004 WRASER PHARMACEUTICALS yPHENERGAN TAB 25MG 00008002702 WYETH LABORATORIES yOVRAL TAB -21 00008005602 WYETH LABORATORIES yOVRETTE 28 TAB 0.075MG 00008006201 WYETH LABORATORIES yOVRETTE 28 TAB 0.075MG 00008006202 WYETH LABORATORIES yPHENERGAN INJ 25MG/ML 00008006301 WYETH LABORATORIES yATIVAN TAB 1MG 00008006402 WYETH LABORATORIES yATIVAN TAB 1MG 00008006403 WYETH LABORATORIES yATIVAN TAB 1MG 00008006405 WYETH LABORATORIES yATIVAN TAB 1MG 00008006407 WYETH LABORATORIES yATIVAN TAB 2MG 00008006502 WYETH LABORATORIES yATIVAN TAB 2MG 00008006503 WYETH LABORATORIES yATIVAN TAB 2MG 00008006505 WYETH LABORATORIES yATIVAN TAB 2MG 00008006507 WYETH LABORATORIES yNORDETTE-21 TAB 00008007501 WYETH LABORATORIES yNORDETTE-21 TAB 00008007502 WYETH LABORATORIES yLO/OVRAL TAB -21 00008007802 WYETH LABORATORIES yATIVAN TAB 0.5MG 00008008101 WYETH LABORATORIES yATIVAN TAB 0.5MG 00008008102 WYETH LABORATORIES yATIVAN TAB 0.5MG 00008008103 WYETH LABORATORIES yATIVAN TAB 0.5MG 00008008105 WYETH LABORATORIES yEQUAGESIC TAB 200-325 00008009102 WYETH LABORATORIES yWYDASE INJ 150U 00008012101 WYETH LABORATORIES yWYDASE INJ 1500U 00008014901 WYETH LABORATORIES yPHENOBARB INJ 130MG/ML 00008030401 WYETH LABORATORIES yMEPERIDINE TAB 50MG 00008030802 WYETH LABORATORIES yANTIVENIN CR KIT POLYVAL 00008033204 WYETH LABORATORIES yANTIVENIN MI KIT 00008040703 WYETH LABORATORIES yPHENERGAN/ SYP CODEINE 00008055001 WYETH LABORATORIES yATIVAN INJ 4MG/ML 00008057013 WYETH LABORATORIES yATIVAN INJ 4MG/ML 00008057015 WYETH LABORATORIES yATIVAN INJ 2MG/ML 00008058104 WYETH LABORATORIES y

Page 766: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ATIVAN INJ 2MG/ML 00008058105 WYETH LABORATORIES yATIVAN INJ 2MG/ML 00008058107 WYETH LABORATORIES yATIVAN INJ 2MG/ML 00008058113 WYETH LABORATORIES yATIVAN INJ 2MG/ML 00008058115 WYETH LABORATORIES yWYANOIDS REL SUP FACTOR 00008065902 WYETH LABORATORIES yORUVAIL CAP 200MG ER 00008069001 WYETH LABORATORIES yEFFEXOR TAB 25MG 00008070101 WYETH LABORATORIES yEFFEXOR TAB 25MG 00008070107 WYETH LABORATORIES yEFFEXOR TAB 25MG 00008070108 WYETH LABORATORIES yEFFEXOR TAB 50MG 00008070301 WYETH LABORATORIES yEFFEXOR TAB 50MG 00008070307 WYETH LABORATORIES yEFFEXOR TAB 50MG 00008070308 WYETH LABORATORIES yEFFEXOR TAB 75MG 00008070401 WYETH LABORATORIES yEFFEXOR TAB 75MG 00008070407 WYETH LABORATORIES yEFFEXOR TAB 75MG 00008070408 WYETH LABORATORIES yEFFEXOR TAB 100MG 00008070501 WYETH LABORATORIES yEFFEXOR TAB 100MG 00008070507 WYETH LABORATORIES yEFFEXOR TAB 100MG 00008070508 WYETH LABORATORIES yPHENERGAN INJ 50MG/ML 00008074601 WYETH LABORATORIES yUNIPEN INJ 1GM 00008075102 WYETH LABORATORIES yUNIPEN INJ 2GM 00008075103 WYETH LABORATORIES yUNIPEN INJ 1GM 00008075115 WYETH LABORATORIES yUNIPEN INJ 10GM 00008075118 WYETH LABORATORIES yCOLLYRIUM SOL OP 00008076901 WYETH LABORATORIES yISMO TAB 20MG 00008077101 WYETH LABORATORIES yEFFEXOR TAB 37.5MG 00008078101 WYETH LABORATORIES yEFFEXOR TAB 37.5MG 00008078107 WYETH LABORATORIES yEFFEXOR TAB 37.5MG 00008078108 WYETH LABORATORIES yEFFEXOR XR CAP 75MG 00008083301 WYETH LABORATORIES yEFFEXOR XR CAP 75MG 00008083303 WYETH LABORATORIES yEFFEXOR XR CAP 75MG 00008083320 WYETH LABORATORIES yEFFEXOR XR CAP 75MG 00008083321 WYETH LABORATORIES yEFFEXOR XR CAP 75MG 00008083322 WYETH LABORATORIES yEFFEXOR XR CAP 150MG 00008083601 WYETH LABORATORIES yEFFEXOR XR CAP 150MG 00008083603 WYETH LABORATORIES yEFFEXOR XR CAP 150MG 00008083620 WYETH LABORATORIES y

Page 767: [XLS]dhs.iowa.govdhs.iowa.gov/sites/default/files/RebatableDrugList.xls · Web viewSheet2 64679092503 64679092602 64679092603 64679093601 64679093602 64679093603 64679093701 64679093702

Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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EFFEXOR XR CAP 150MG 00008083621 WYETH LABORATORIES yEFFEXOR XR CAP 150MG 00008083622 WYETH LABORATORIES yEFFEXOR XR CAP 37.5MG 00008083701 WYETH LABORATORIES yEFFEXOR XR CAP 37.5MG 00008083703 WYETH LABORATORIES yEFFEXOR XR CAP 37.5MG 00008083720 WYETH LABORATORIES yEFFEXOR XR CAP 37.5MG 00008083721 WYETH LABORATORIES yEFFEXOR XR CAP 37.5MG 00008083722 WYETH LABORATORIES yPROTONIX TAB 40MG 00008084181 WYETH LABORATORIES yPROTONIX TAB 40MG 00008084199 WYETH LABORATORIES yPROTONIX TAB 20MG 00008084381 WYETH LABORATORIES yCRINONE GEL 8% VAG 00008090802 WYETH LABORATORIES yPROTONIX INJ 40MG 00008092302 WYETH LABORATORIES yPROTONIX INJ 40MG 00008092351 WYETH LABORATORIES yPROTONIX INJ 40MG 00008092355 WYETH LABORATORIES ySONATA CAP 5MG 00008092581 WYETH LABORATORIES ySONATA CAP 10MG 00008092681 WYETH LABORATORIES yRAPAMUNE SOL 1MG/ML 00008103004 WYETH LABORATORIES yRAPAMUNE SOL 1MG/ML 00008103006 WYETH LABORATORIES yRAPAMUNE TAB 1MG 00008103105 WYETH LABORATORIES yRAPAMUNE TAB 1MG 00008103110 WYETH LABORATORIES yRAPAMUNE TAB 2MG 00008103205 WYETH LABORATORIES yRAPAMUNE TAB 1MG 00008104105 WYETH LABORATORIES yRAPAMUNE TAB 1MG 00008104110 WYETH LABORATORIES yRAPAMUNE TAB 2MG 00008104205 WYETH LABORATORIES yOVRAL TAB -28 00008251101 WYETH LABORATORIES yLO/OVRAL-28 TAB 00008251401 WYETH LABORATORIES yLO/OVRAL-28 TAB 00008251402 WYETH LABORATORIES yLO/OVRAL-28 TAB 00008251403 WYETH LABORATORIES yNORDETTE-28 TAB 00008253301 WYETH LABORATORIES yTRIPHASIL 28 TAB 00008253601 WYETH LABORATORIES yTRIPHASIL 28 TAB 00008253603 WYETH LABORATORIES yTRIPHASIL 28 TAB 00008253605 WYETH LABORATORIES yALESSE TAB -28 00008257601 WYETH LABORATORIES yALESSE TAB -28 00008257602 WYETH LABORATORIES yTRECATOR TAB 250MG 00008411701 WYETH LABORATORIES yISORDIL TAB 5MG 00008415201 WYETH LABORATORIES y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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CORDARONE TAB 200MG 00008418804 WYETH LABORATORIES ySYNALGOS DC CAP 00008419101 WYETH LABORATORIES ySYNALGOS DC CAP 00008419102 WYETH LABORATORIES yISORDIL TAB 40MG 00008419201 WYETH LABORATORIES yCEROSE-DM SOL 00008420401 WYETH LABORATORIES yMYLOTARG SOL 5MG 00008451001 WYETH LABORATORIES yTYGACIL INJ 50MG 00008536002 WYETH LABORATORIES yPOLY-RX POW 39822010001 X-GEN PHARMACEUTICALS yLIOTHYRONINE INJ 10MCG/ML 39822015101 X-GEN PHARMACEUTICALS yBACI-RX POW 5MU 39822020005 X-GEN PHARMACEUTICALS yBACIIM INJ 50000UNT 39822027702 X-GEN PHARMACEUTICALS yBACIIM INJ 50000UNT 39822027705 X-GEN PHARMACEUTICALS yBACIIM INJ 50000UNT 39822027707 X-GEN PHARMACEUTICALS yBACIIM INJ 50000UNT 39822027709 X-GEN PHARMACEUTICALS yNEO-RX POW 39822030001 X-GEN PHARMACEUTICALS yNEO-RX POW 39822030002 X-GEN PHARMACEUTICALS yNEO-RX POW 39822030005 X-GEN PHARMACEUTICALS yNEO-FRADIN SOL 125/5ML 39822033005 X-GEN PHARMACEUTICALS yCOLISTIMETH INJ 150MG 39822061501 X-GEN PHARMACEUTICALS ySTREPTOMYCIN INJ 1GM 39822070601 X-GEN PHARMACEUTICALS ySTREPTOMYCIN INJ 1GM 39822070602 X-GEN PHARMACEUTICALS yERYTHRO-RX POW 39822080005 X-GEN PHARMACEUTICALS yNYSTAT-RX POW 500MU 39822090002 X-GEN PHARMACEUTICALS yNYSTAT-RX POW 150MU 39822090003 X-GEN PHARMACEUTICALS yNYSTAT-RX POW 2BU 39822090004 X-GEN PHARMACEUTICALS yNYSTAT-RX POW 50MU 39822090005 X-GEN PHARMACEUTICALS yNYSTAT-RX POW 1BU 39822090007 X-GEN PHARMACEUTICALS yAMPHOTERICIN INJ 50MG 39822105505 X-GEN PHARMACEUTICALS yAMPHOTERICIN INJ 50MG 39822105507 X-GEN PHARMACEUTICALS yNEO/POLY GU SOL 40/ML IR 39822120102 X-GEN PHARMACEUTICALS yNEO/POLY GU SOL 40/ML IR 39822120105 X-GEN PHARMACEUTICALS yNEO/POLY GU SOL 40/ML IR 39822122001 X-GEN PHARMACEUTICALS yHYDROCORT POW 39822500001 X-GEN PHARMACEUTICALS yHYDROCORT POW 39822500003 X-GEN PHARMACEUTICALS yHYDROCORT POW 39822500005 X-GEN PHARMACEUTICALS yHYDROCORT POW 39822500007 X-GEN PHARMACEUTICALS y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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HYDROCORT AC POW 39822509001 X-GEN PHARMACEUTICALS yHYDROCORT AC POW 39822509003 X-GEN PHARMACEUTICALS yHYDROCORT AC POW 39822509005 X-GEN PHARMACEUTICALS yTRIAMCINOLON POW ACETONID 39822530005 X-GEN PHARMACEUTICALS yPROGESTERONE POW MICRONIZ 39822600001 X-GEN PHARMACEUTICALS yPROGESTERONE POW MICRONIZ 39822600003 X-GEN PHARMACEUTICALS yPROGESTERONE POW MICRONIZ 39822600005 X-GEN PHARMACEUTICALS yPROGESTERONE POW MICRONIZ 39822600007 X-GEN PHARMACEUTICALS yPROGESTERONE POW 39822610001 X-GEN PHARMACEUTICALS yPROGESTERONE POW 39822610003 X-GEN PHARMACEUTICALS yPROGESTERONE POW 39822610005 X-GEN PHARMACEUTICALS yPROGESTERONE POW 39822610007 X-GEN PHARMACEUTICALS yAMMONIA AROM INH 0.33ML 39822990001 X-GEN PHARMACEUTICALS yAMMONIA AROM INH 0.33ML 39822990002 X-GEN PHARMACEUTICALS yAMMONIA AROM INH 0.33ML 39822990007 X-GEN PHARMACEUTICALS yAMYL NITRITE INH 0.3ML 39822995002 X-GEN PHARMACEUTICALS yAMICAR TAB 500MG 66479002182 XANODYNE PHARMACEUTICAL, INC. yAMICAR TAB 1000MG 66479002282 XANODYNE PHARMACEUTICAL, INC. yAMICAR SYP 25% 66479002356 XANODYNE PHARMACEUTICAL, INC. yAZATHIOPRINE TAB 50MG 66479030110 XANODYNE PHARMACEUTICAL, INC. yDARVON CAP 65MG 66479051010 XANODYNE PHARMACEUTICAL, INC. yDARVON-N TAB 100MG 66479051210 XANODYNE PHARMACEUTICAL, INC. yDARVOCET TAB A500 66479051310 XANODYNE PHARMACEUTICAL, INC. yDURACLON INJ 66479052001 XANODYNE PHARMACEUTICAL, INC. yDURACLON INJ 66479052101 XANODYNE PHARMACEUTICAL, INC. yORAMORPH SR TAB 15MG 66479054010 XANODYNE PHARMACEUTICAL, INC. yORAMORPH SR TAB 15MG 66479054025 XANODYNE PHARMACEUTICAL, INC. yORAMORPH SR TAB 60MG 66479054210 XANODYNE PHARMACEUTICAL, INC. yORAMORPH SR TAB 60MG 66479054225 XANODYNE PHARMACEUTICAL, INC. yORAMORPH SR TAB 100MG 66479054325 XANODYNE PHARMACEUTICAL, INC. yROXANOL SOL 20MG/ML 66479056003 XANODYNE PHARMACEUTICAL, INC. yROXANOL SOL 20MG/ML 66479056012 XANODYNE PHARMACEUTICAL, INC. yHYCET SOL 7.5-325 66479057416 XANODYNE PHARMACEUTICAL, INC. yROXICODONE TAB 5MG 66479058010 XANODYNE PHARMACEUTICAL, INC. yROXICODONE TAB 15MG 66479058110 XANODYNE PHARMACEUTICAL, INC. yROXICODONE TAB 30MG 66479058210 XANODYNE PHARMACEUTICAL, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ROXICODONE SOL 5MG/5ML 66479058305 XANODYNE PHARMACEUTICAL, INC. yROXICODONE SOL 5MG/5ML 66479058350 XANODYNE PHARMACEUTICAL, INC. yDEXALONE CAP 30MG 66479073292 XANODYNE PHARMACEUTICAL, INC. yDEXALONE CAP 30MG 66479073294 XANODYNE PHARMACEUTICAL, INC. yDUET CHW 66479083090 XANODYNE PHARMACEUTICAL, INC. yDUET DHA MIS 66479084530 XANODYNE PHARMACEUTICAL, INC. yDUET TAB 66479084801 XANODYNE PHARMACEUTICAL, INC. yDUET DHA EC MIS 66479085030 XANODYNE PHARMACEUTICAL, INC. yCHLORHEX GLU SOL 0.12% 00116200116 XTTRIUM LABORATORIES, INC. ySTREPTASE INJ 250000 00053177001 ZLB BEHRING ySTIMATE SOL 1.5MG/ML 00053245300 ZLB BEHRING yZEMAIRA SOL 1000MG 00053720102 ZLB BEHRING yGAMMAR-P IV INJ 1 GM 00053748601 ZLB BEHRING yGAMMAR-P IV INJ 2.5 GM 00053748602 ZLB BEHRING yGAMMAR-P IV INJ 5 GM 00053748605 ZLB BEHRING yGAMMAR-P IV INJ 10 GM 00053748610 ZLB BEHRING yVIVAGLOBIN SOL 160MG/ML 00053759603 ZLB BEHRING yVIVAGLOBIN SOL 160MG/ML 00053759610 ZLB BEHRING yVIVAGLOBIN SOL 160MG/ML 00053759615 ZLB BEHRING yVIVAGLOBIN SOL 160MG/ML 00053759620 ZLB BEHRING yVIVAGLOBIN SOL 160MG/ML 00053759625 ZLB BEHRING yHUMATE-P SOL 600UNIT 00053761505 ZLB BEHRING yHUMATE-P SOL 1200UNIT 00053761510 ZLB BEHRING yHUMATE-P SOL 2400UNIT 00053761520 ZLB BEHRING yHUMATE-P INJ 500UNIT 00053762005 ZLB BEHRING yHUMATE-P INJ 1000UNIT 00053762010 ZLB BEHRING yHUMATE-P INJ 2000UNIT 00053762020 ZLB BEHRING yMONOCLATE-P INJ 250UNIT 00053765601 ZLB BEHRING yMONOCLATE-P INJ 500UNIT 00053765602 ZLB BEHRING yMONOCLATE-P INJ 1000UNIT 00053765604 ZLB BEHRING yMONOCLATE-P INJ 1500UNIT 00053765605 ZLB BEHRING yMONONINE INJ 250UNIT 00053766801 ZLB BEHRING yMONONINE INJ 500UNIT 00053766802 ZLB BEHRING yMONONINE INJ 1000UNIT 00053766804 ZLB BEHRING yALBUMINAR-5 INJ 5% 00053767001 ZLB BEHRING yALBUMINAR-5 INJ 5% 00053767002 ZLB BEHRING y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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ALBUMINAR-5 INJ 5% 00053767003 ZLB BEHRING yALBUMINAR-5 INJ 5% 00053767006 ZLB BEHRING yALBUMINAR-5 INJ 5% 00053767031 ZLB BEHRING yALBUMINAR-5 INJ 5% 00053767032 ZLB BEHRING yALBUMINAR-25 INJ 25% 00053768001 ZLB BEHRING yALBUMINAR-25 INJ 25% 00053768002 ZLB BEHRING yALBUMINAR-25 INJ 25% 00053768003 ZLB BEHRING yALBUMINAR-25 INJ 25% 00053768032 ZLB BEHRING yALBUMINAR-25 INJ 25% 00053768033 ZLB BEHRING yHELIXATE FS SOL 250UNIT 00053813001 ZLB BEHRING yHELIXATE FS SOL 500UNIT 00053813002 ZLB BEHRING yHELIXATE FS SOL 1000UNIT 00053813004 ZLB BEHRING yALBUMIN HUM INJ 25% 44206025105 ZLB BEHRING LLC yALBUMIN HUM INJ 25% 44206025110 ZLB BEHRING LLC yRHOPHYLAC INJ 1500/2ML 44206030001 ZLB BEHRING LLC yRHOPHYLAC INJ 1500/2ML 44206030010 ZLB BEHRING LLC yALBURX INJ 5% 44206031025 ZLB BEHRING LLC yALBURX INJ 5% 44206031050 ZLB BEHRING LLC yCARIMUNE NF INJ 3GM 44206041603 ZLB BEHRING LLC yCARIMUNE NF INJ 6GM 44206041706 ZLB BEHRING LLC yCARIMUNE NF INJ 12GM 44206041812 ZLB BEHRING LLC yZ-COF LAX TAB 30-835MG 65224011001 ZYBER PHARMACEUTICALS, INC. yPEDIATEX LIQ 65224014816 ZYBER PHARMACEUTICALS, INC. yPEDIATEX LIQ 65224015016 ZYBER PHARMACEUTICALS, INC. yPEDIATEX HC LIQ 65224016516 ZYBER PHARMACEUTICALS, INC. yPEDIATEX-D LIQ 65224029316 ZYBER PHARMACEUTICALS, INC. yPEDIATEX-D LIQ 65224029516 ZYBER PHARMACEUTICALS, INC. yPEDIATEX-D LIQ 2-15MG/5 65224032116 ZYBER PHARMACEUTICALS, INC. yZ-COF HC LIQ 65224040816 ZYBER PHARMACEUTICALS, INC. yZ-COF HC LIQ 65224041016 ZYBER PHARMACEUTICALS, INC. yPEDIATEX DM LIQ 65224044316 ZYBER PHARMACEUTICALS, INC. yPEDIATEX DM LIQ 65224044516 ZYBER PHARMACEUTICALS, INC. yPEDIATEX 12 SUS 65224050116 ZYBER PHARMACEUTICALS, INC. yPEDIATEX 12 SUS 65224050316 ZYBER PHARMACEUTICALS, INC. yPEDIATEX 12D SUS 65224051116 ZYBER PHARMACEUTICALS, INC. yPEDIATEX 12D SUS 65224051216 ZYBER PHARMACEUTICALS, INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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PEDIATEX SUS 12DM 65224052216 ZYBER PHARMACEUTICALS, INC. yPEDIATEX SUS 12DM 65224052316 ZYBER PHARMACEUTICALS, INC. yALDEX-CT CHW 12.5-5MG 65224054501 ZYBER PHARMACEUTICALS, INC. yALDEX D SUS 65224055016 ZYBER PHARMACEUTICALS, INC. yALDEX DM SUS 65224055516 ZYBER PHARMACEUTICALS, INC. yZ-COF HCX LIQ 65224061016 ZYBER PHARMACEUTICALS, INC. yZ-COF 12DM SUS 65224061516 ZYBER PHARMACEUTICALS, INC. yZ-COF DM LIQ 65224061716 ZYBER PHARMACEUTICALS, INC. yZ-COF DM LIQ 65224061916 ZYBER PHARMACEUTICALS, INC. yALDEX G TAB 25-835MG 65224064001 ZYBER PHARMACEUTICALS, INC. yATENOLOL TAB 25MG 68382002201 ZYDUS PHARMACEUTICALS (USA) INC. yATENOLOL TAB 25MG 68382002210 ZYDUS PHARMACEUTICALS (USA) INC. yATENOLOL TAB 50MG 68382002301 ZYDUS PHARMACEUTICALS (USA) INC. yATENOLOL TAB 50MG 68382002310 ZYDUS PHARMACEUTICALS (USA) INC. yATENOLOL TAB 100MG 68382002401 ZYDUS PHARMACEUTICALS (USA) INC. yATENOLOL TAB 100MG 68382002410 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 500MG 68382002801 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 500MG 68382002805 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 500MG 68382002810 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 850MG 68382002901 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 850MG 68382002905 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 850MG 68382002910 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 1000MG 68382003001 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 1000MG 68382003005 ZYDUS PHARMACEUTICALS (USA) INC. yMETFORMIN TAB 1000MG 68382003010 ZYDUS PHARMACEUTICALS (USA) INC. yPROMETHAZINE TAB 12.5MG 68382004001 ZYDUS PHARMACEUTICALS (USA) INC. yPROMETHAZINE TAB 25MG 68382004101 ZYDUS PHARMACEUTICALS (USA) INC. yPROMETHAZINE TAB 50MG 68382004201 ZYDUS PHARMACEUTICALS (USA) INC. yRIBAVIRIN TAB 200MG 68382004603 ZYDUS PHARMACEUTICALS (USA) INC. yMELOXICAM TAB 7.5MG 68382005001 ZYDUS PHARMACEUTICALS (USA) INC. yMELOXICAM TAB 7.5MG 68382005005 ZYDUS PHARMACEUTICALS (USA) INC. yMELOXICAM TAB 15MG 68382005101 ZYDUS PHARMACEUTICALS (USA) INC. yMELOXICAM TAB 15MG 68382005105 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 1MG 68382005201 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 1MG 68382005210 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 2MG 68382005301 ZYDUS PHARMACEUTICALS (USA) INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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WARFARIN TAB 2MG 68382005310 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 3MG 68382005401 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 3MG 68382005410 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 4MG 68382005501 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 4MG 68382005510 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 5MG 68382005601 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 5MG 68382005610 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 6MG 68382005701 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 7.5MG 68382005801 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 10MG 68382005901 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 2.5MG 68382006401 ZYDUS PHARMACEUTICALS (USA) INC. yWARFARIN TAB 2.5MG 68382006410 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 5MG 68382006505 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 5MG 68382006506 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 5MG 68382006510 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 5MG 68382006514 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 5MG 68382006516 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 10MG 68382006605 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 10MG 68382006606 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 10MG 68382006610 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 10MG 68382006614 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 10MG 68382006616 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 10MG 68382006624 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 20MG 68382006705 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 20MG 68382006706 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 20MG 68382006710 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 20MG 68382006714 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 20MG 68382006716 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 20MG 68382006724 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 40MG 68382006805 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 40MG 68382006806 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 40MG 68382006810 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 40MG 68382006814 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 40MG 68382006816 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 40MG 68382006840 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 80MG 68382006905 ZYDUS PHARMACEUTICALS (USA) INC. y

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Rebatable Drug List for Iowa MedicaidInitial List March 1, 2007

Please use control F as a search function for the drug names, NDC number or labelerThis list will be updated quarterly

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SIMVASTATIN TAB 80MG 68382006906 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 80MG 68382006910 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 80MG 68382006914 ZYDUS PHARMACEUTICALS (USA) INC. ySIMVASTATIN TAB 80MG 68382006916 ZYDUS PHARMACEUTICALS (USA) INC. yGEMFIBROZIL TAB 600MG 68382010005 ZYDUS PHARMACEUTICALS (USA) INC. yGEMFIBROZIL TAB 600MG 68382010014 ZYDUS PHARMACEUTICALS (USA) INC. yRIBAVIRIN CAP 200MG 68382026007 ZYDUS PHARMACEUTICALS (USA) INC. yRIBAVIRIN CAP 200MG 68382026009 ZYDUS PHARMACEUTICALS (USA) INC. yRIBAVIRIN CAP 200MG 68382026012 ZYDUS PHARMACEUTICALS (USA) INC. y