August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00409792255 DEXTROSE INJ 5% 12/31/9999 20121 00409792261 DEXTROSE INJ 5% 12/31/9999 20121 00409792306 DEXTROSE INJ 5% 12/31/9999 20121 00409792311 DEXTROSE INJ 5% 12/31/9999 20121 00409792313 DEXTROSE INJ 5% 12/31/9999 20121 00409792320 DEXTROSE INJ 5% 12/31/9999 20121 00409792323 DEXTROSE INJ 5% 12/31/9999 20121 00409792336 DEXTROSE INJ 5% 12/31/9999 20121 00409792337 DEXTROSE INJ 5% 12/31/9999 20121 00338055111 DEXTROSE INJ 5% PGBK 12/31/9999 20121 00338055118 DEXTROSE INJ 5% PGBK 12/31/9999 20121 00264128050 DEXTROSE INJ 50% 12/31/9999 20121 00264128055 DEXTROSE INJ 50% 12/31/9999 20121 00409490234 DEXTROSE INJ 50% 12/31/9999 20121 00409664802 DEXTROSE INJ 50% 12/31/9999 20121 00409751716 DEXTROSE INJ 50% 12/31/9999 20121 00409793619 DEXTROSE INJ 50% 12/31/9999 20121 00264129050 DEXTROSE INJ 70% 12/31/9999 20121 00264129055 DEXTROSE INJ 70% 12/31/9999 20121 00338071906 DEXTROSE INJ 70% 12/31/9999 20121 00338071913 DEXTROSE INJ 70% 12/31/9999 20121 00409712007 DEXTROSE INJ 70% 12/31/9999 20121 00409791819 DEXTROSE INJ 70% 12/31/9999 20121 51552012306 DEXTROSE POW MONOHYD 12/31/9999 20121 51552012309 DEXTROSE POW MONOHYD 12/31/9999 20121 60258053016 DEX-TUSS LIQ 300-10/5 12/31/9999 20121 60258075016 DEX-TUSS LIQ 300-10/5 12/31/9999 20121 00096072508 DHS SHA 12/31/9999 20121 00096072516 DHS SHA 12/31/9999 20121 00096072708 DHS SHA 12/31/9999 20121 00096072716 DHS SHA 12/31/9999 20121 00096072608 DHS CONDIT LIQ RINSE 12/31/9999 20121 00096073104 DHS SAL SHA 3% 12/31/9999 20121 00096072804 DHS TAR SHA 12/31/9999 20121 00096072808 DHS TAR SHA 12/31/9999 20121 00096072816 DHS TAR SHA 12/31/9999 20121 00096073008 DHS TAR GEL SHA 0.5% 12/31/9999 20121 00096072908 DHS ZINC SHA 2% 12/31/9999 20121 00096072912 DHS ZINC SHA 2% 12/31/9999 20121 00096072916 DHS ZINC SHA 2% 12/31/9999 20121 50383006104 DIABET EXPEC SYP 100/5ML 12/31/9999 20121 50383006904 DIABET TUSS SYP ALLERGY 12/31/9999 20121 00039005305 DIABETA TAB 1.25MG 12/31/9999 20121 00039005110 DIABETA TAB 2.5MG 12/31/9999 20121 00039005210 DIABETA TAB 5MG 12/31/9999 20121 00039005270 DIABETA TAB 5MG 12/31/2012 20121 61787005312 DIABETIC CAP COLD/FLU 12/31/9999 20121 61787005512 DIABETIC TUS CAP DM 12/31/9999 20121 61787006304 DIABETIC TUS LIQ 100/5ML 12/31/9999 20121 61787044604 DIABETIC TUS LIQ 200MG/5 12/31/9999 20121 61787047904 DIABETIC TUS LIQ CHILDREN 12/31/9999 20121 61787047104 DIABETIC TUS LIQ COLD/FLU 12/31/9999 20121 61787006204 DIABETIC TUS LIQ DM 12/31/9999 20121 61787006208 DIABETIC TUS LIQ DM 12/31/9999 20121 61787006316 DIABETIC TUS LIQ EX 12/31/9999 20121 61787006404 DIABETIC TUS LIQ MAX ST 12/31/9999 20121 61787006408 DIABETIC TUS LIQ MAX ST 12/31/9999 20121 61787006416 DIABETIC TUS LIQ MAX STR 12/31/9999 20121 61787066101 DIABETI-GEST CHW 420MG 12/31/9999 20121 61787005616 DIABETISWEET POW 12/31/9999 20121 61787005212 DIABTC TUSSN CAP ALLERGY 12/31/9999 20121 61787005412 DIABTC TUSSN CAP DM 12/31/9999 20121 10542001010 DIALYVITE TAB 12/31/9999 20121 10542001409 DIALYVITE TAB 3000 12/31/9999 20121 10542001109 DIALYVITE TAB 5000 12/31/9999 20121 10542000909 DIALYVITE TAB SUPREM D 12/31/9999 20121 10542001210 DIALYVITE/ TAB ZINC 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 51285075402 DIAMOX SEQUE CAP 500MG CR 12/31/9999 20121 00941040901 DIANEAL SOL LOW CALC 12/31/9999 20121 00941040905 DIANEAL SOL LOW CALC 12/31/9999 20121 00941040906 DIANEAL SOL LOW CALC 12/31/9999 20121 00941040907 DIANEAL SOL LOW CALC 12/31/9999 20121 00941040927 DIANEAL SOL LOW CALC 12/31/9999 20121 00941040928 DIANEAL SOL LOW CALC 12/31/9999 20121 00941040936 DIANEAL SOL LOW CALC 05/31/2013 20121 00941040949 DIANEAL SOL LOW CALC 01/31/2013 20121 00941045701 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045702 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045705 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045708 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045725 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045728 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045747 DIANEAL SOL LOW CALC 04/30/2013 20121 00941045749 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045901 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045902 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045905 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045908 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045925 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045928 DIANEAL SOL LOW CALC 12/31/9999 20121 00941045947 DIANEAL SOL LOW CALC 03/31/2013 20121 00941045949 DIANEAL SOL LOW CALC 12/31/9999 20121 00941041104 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041105 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041106 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041107 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041111 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041125 DIANEAL PD-2 SOL 1.5% DEX 03/31/2013 20121 00941041128 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041143 DIANEAL PD-2 SOL 1.5% DEX 09/30/2012 20121 00941041146 DIANEAL PD-2 SOL 1.5% DEX 03/31/2013 20121 00941041149 DIANEAL PD-2 SOL 1.5% DEX 12/31/9999 20121 00941041301 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041304 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041305 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041306 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041307 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041325 DIANEAL PD-2 SOL 2.5% DEX 05/31/2013 20121 00941041328 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041347 DIANEAL PD-2 SOL 2.5% DEX 03/31/2013 20121 00941041349 DIANEAL PD-2 SOL 2.5% DEX 12/31/9999 20121 00941041501 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 20121 00941041504 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 20121 00941041505 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 20121 00941041506 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 20121 00941041507 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 20121 00941041528 DIANEAL PD-2 SOL 4.25%DEX 12/31/9999 20121 00941041547 DIANEAL PD-2 SOL 4.25%DEX 06/30/2012 20121 00472180204 DIAPER RASH OIN 40% 12/31/9999 20121 00713025804 DIAPER RASH OIN 40% 12/31/9999 20121 46122001346 DIAPER RASH OIN CREAMY 12/31/9999 20121 00187065920 DIASTAT ACDL GEL 12.5-20 12/31/9999 20121 00187065820 DIASTAT ACDL GEL 5-10MG 12/31/9999 20121 66490065020 DIASTAT PED GEL 2.5M GEL 12/31/9999 20121 00054318544 DIAZEPAM CON 5MG/ML 12/31/9999 20121 00093613832 DIAZEPAM GEL 10MG 12/31/9999 20121 00093613732 DIAZEPAM GEL 2.5MG 12/31/9999 20121 00093613932 DIAZEPAM GEL 20MG 12/31/9999 20121 00409127332 DIAZEPAM INJ 5MG/ML 12/31/9999 20121 00409321312 DIAZEPAM INJ 5MG/ML 12/31/9999 20121 00054318863 DIAZEPAM SOL 1MG/ML 12/31/9999 20121 00054820716 DIAZEPAM SOL 1MG/ML 12/31/9999 20121 00172392760 DIAZEPAM TAB 10MG 12/31/9999 20121 00172392770 DIAZEPAM TAB 10MG 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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