August 31, 2012 - Iowa Medicaid Enterprise

More documents

Recommendations

Info

NDC Product Description Termination Date Quarter Covered 63323059710 DEFEROXAMINE INJ 500MG 12/31/9999 20121 67979050140 DELATESTRYL INJ 200MG/ML 12/31/9999 20121 42023011001 DELESTROGEN INJ 10MG/ML 12/31/9999 20121 42023011101 DELESTROGEN INJ 20MG/ML 12/31/9999 20121 42023011201 DELESTROGEN INJ 40MG/ML 12/31/9999 20121 49908012380 DELOS LIQ 3.5% 12/31/9999 20121 49908012145 DELOS LOT 3.5% 12/31/9999 20121 53014046343 DELSYM LIQ 30MG/5ML 12/31/9999 20121 53014046348 DELSYM LIQ 30MG/5ML 12/31/9999 20121 53014046356 DELSYM LIQ 30MG/5ML 12/31/9999 20121 53014046361 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824017163 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824017165 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824017265 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824017563 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824017565 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824017663 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824027263 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824027663 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824027665 DELSYM LIQ 30MG/5ML 12/31/9999 20121 63824018464 DELSYM CHILD LIQ CGH/COLD 12/31/9999 20121 63824018264 DELSYM NIGHT LIQ CGH/COLD 12/31/9999 20121 63824018364 DELSYM NIGHT LIQ MULTI-S 12/31/9999 20121 00037500101 DEMADEX TAB 100MG 12/31/9999 20121 00037501001 DEMADEX TAB 10MG 12/31/9999 20121 00004026401 DEMADEX TAB 20MG 06/30/2012 20121 00037502001 DEMADEX TAB 20MG 12/31/9999 20121 00037500501 DEMADEX TAB 5MG 12/31/9999 20121 51552127801 DEMECARIUM POW BROMIDE 12/31/9999 20121 51552127802 DEMECARIUM POW BROMIDE 12/31/9999 20121 51552127804 DEMECARIUM POW BROMIDE 12/31/9999 20121 00115211101 DEMECLOCYCL TAB 150MG 12/31/9999 20121 00555070102 DEMECLOCYCL TAB 150MG 12/31/9999 20121 00904618060 DEMECLOCYCL TAB 150MG 07/31/2012 20121 61748011501 DEMECLOCYCL TAB 150MG 12/31/9999 20121 62584015901 DEMECLOCYCL TAB 150MG 12/31/9999 20121 65162055410 DEMECLOCYCL TAB 150MG 12/31/9999 20121 00115212214 DEMECLOCYCL TAB 300MG 12/31/9999 20121 00555070284 DEMECLOCYCL TAB 300MG 12/31/9999 20121 00904618196 DEMECLOCYCL TAB 300MG 12/31/9999 20121 61748011348 DEMECLOCYCL TAB 300MG 12/31/9999 20121 62584016365 DEMECLOCYCL TAB 300MG 12/31/9999 20121 65162055548 DEMECLOCYCL TAB 300MG 12/31/9999 20121 00409125502 DEMEROL INJ 100/2ML 12/31/9999 20121 00409118069 DEMEROL INJ 100MG/ML 12/31/9999 20121 00409120120 DEMEROL INJ 100MG/ML 12/31/9999 20121 00409125601 DEMEROL INJ 100MG/ML 12/31/9999 20121 00409120301 DEMEROL INJ 25MG/0.5 12/31/9999 20121 00409117630 DEMEROL INJ 25MG/ML 12/31/9999 20121 00409117830 DEMEROL INJ 50MG/ML 12/31/9999 20121 00409118130 DEMEROL INJ 50MG/ML 12/31/9999 20121 00409125301 DEMEROL INJ 50MG/ML 12/31/9999 20121 00409125401 DEMEROL INJ 75MG/1.5 12/31/9999 20121 00409117930 DEMEROL INJ 75MG/ML 12/31/9999 20121 00024033704 DEMEROL TAB 100MG 12/31/9999 20121 00024033504 DEMEROL TAB 50MG 12/31/9999 20121 25010030515 DEMSER CAP 250MG 12/31/9999 20121 00472091716 DENATURED SOL ALCOHOL 12/31/9999 20121 51552008506 DENATURED SOL ALCOHOL 12/31/9999 20121 51552008508 DENATURED SOL ALCOHOL 12/31/9999 20121 00067602415 DENAVIR CRE 1% 10/31/2013 20121 50816062405 DENAVIR CRE 1% 12/31/9999 20121 64980030550 DENTA 5000 CRE PLUS 12/31/9999 20121 64980030650 DENTA 5000 CRE PLUS 2PK 12/31/9999 20121 64980030760 DENTAGEL GEL 1.1% 12/31/9999 20121 00904774439 DENTURE TAB 12/31/9999 20121 51552124705 DEOXYCHOLATE POW SODIUM 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 51552124706 DEOXYCHOLATE POW SODIUM 12/31/9999 20121 51552124707 DEOXYCHOLATE POW SODIUM 12/31/9999 20121 00074156410 DEPACON INJ 100MG/ML 12/31/9999 20121 00406009201 DEPADE TAB 50MG 12/31/9999 20121 00406009203 DEPADE TAB 50MG 12/31/9999 20121 00074568113 DEPAKENE CAP 250MG 12/31/9999 20121 00074568216 DEPAKENE SYP 250/5ML 12/31/9999 20121 00074621213 DEPAKOTE TAB 125MG DR 12/31/9999 20121 00074621411 DEPAKOTE TAB 250MG DR 06/01/2012 20121 00074621413 DEPAKOTE TAB 250MG DR 12/31/9999 20121 00074621453 DEPAKOTE TAB 250MG DR 12/31/9999 20121 00074621511 DEPAKOTE TAB 500MG DR 07/01/2012 20121 00074621513 DEPAKOTE TAB 500MG DR 12/31/9999 20121 00074621553 DEPAKOTE TAB 500MG DR 12/31/9999 20121 00074382611 DEPAKOTE ER TAB 250MG 12/31/9999 20121 00074382613 DEPAKOTE ER TAB 250MG 12/31/9999 20121 00074712611 DEPAKOTE ER TAB 500MG 12/31/9999 20121 00074712613 DEPAKOTE ER TAB 500MG 12/31/9999 20121 00074712653 DEPAKOTE ER TAB 500MG 12/31/9999 20121 00074611411 DEPAKOTE SPR CAP 125MG 12/31/9999 20121 00074611413 DEPAKOTE SPR CAP 125MG 12/31/9999 20121 00037440101 DEPEN TITRA TAB 250MG 12/31/9999 20121 57665033101 DEPOCYT INJ 50MG/5ML 12/31/9999 20121 24477002004 DEPODUR INJ 10MG/ML 12/31/9999 20121 24477002005 DEPODUR INJ 15/1.5ML 12/31/9999 20121 00009027101 DEPO-ESTRADI INJ 5MG/ML 12/31/9999 20121 00009027401 DEPO-MEDROL INJ 20MG/ML 12/31/9999 20121 00009028002 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009028003 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009028051 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009028052 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009307301 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009307303 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009307322 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009307323 DEPO-MEDROL INJ 40MG/ML 12/31/9999 20121 00009030602 DEPO-MEDROL INJ 80MG/ML 12/31/9999 20121 00009030612 DEPO-MEDROL INJ 80MG/ML 12/31/9999 20121 00009347501 DEPO-MEDROL INJ 80MG/ML 12/31/9999 20121 00009347503 DEPO-MEDROL INJ 80MG/ML 12/31/9999 20121 00009347522 DEPO-MEDROL INJ 80MG/ML 12/31/9999 20121 00009347523 DEPO-MEDROL INJ 80MG/ML 12/31/9999 20121 00009074630 DEPO-PROVERA INJ 150MG/ML 12/31/9999 20121 00009074635 DEPO-PROVERA INJ 150MG/ML 12/31/9999 20121 00009737604 DEPO-PROVERA INJ 150MG/ML 04/30/2013 20121 00009737607 DEPO-PROVERA INJ 150MG/ML 12/31/9999 20121 00009062601 DEPO-PROVERA INJ 400/ML 12/31/9999 20121 00009470901 DEPO-SQ PROV INJ 104 12/31/9999 20121 00009470913 DEPO-SQ PROV INJ 104 12/31/9999 20121 00009034702 DEPO-TESTOST INJ 100MG/ML 12/31/9999 20121 00009041701 DEPO-TESTOST INJ 200MG/ML 12/31/9999 20121 00009041702 DEPO-TESTOST INJ 200MG/ML 12/31/9999 20121 00574007116 DERMABASE CRE 12/31/9999 20121 00574007140 DERMABASE CRE 12/31/9999 20121 63921040004 DERMAFIX OIN 12/31/9999 20121 63921041004 DERMAFIX SPR 12/31/9999 20121 61924023404 DERMAFUNGAL OIN 2% 12/31/9999 20121 51552085403 DERMA-G LIQ MILD 12/31/9999 20121 61924010027 DERMAGEL LIQ SANITIZE 12/31/9999 20121 25382012752 DERMAGRAN AER 12/31/9999 20121 25382012634 DERMAGRAN OIN 12/31/9999 20121 25382012636 DERMAGRAN OIN 12/31/9999 20121 25382020103 DERMAGRAN OIN HYDROPHI 12/31/9999 20121 61924021404 DERMAMED OIN 12/31/9999 20121 61924022404 DERMAMED SPR 12/31/9999 20121 61924018404 DERMAPHOR OIN 12/31/9999 20121 61924018408 DERMAPHOR OIN 12/31/9999 20121 61924018416 DERMAPHOR OIN 12/31/9999 20121
Page 1 and 2:
Rebatable Drug List for Iowa Medica
Page 3 and 4:
NDC Product Description Termination
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66: NDC Product Description Termination
Page 115: NDC Product Description Termination
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
Page 343 and 344:
Page 345 and 346:
Page 347 and 348:
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
Page 357 and 358:
Page 359 and 360:
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469:
show all

August 31, 2012 - Iowa Medicaid Enterprise

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?