August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00172392780 DIAZEPAM TAB 10MG 12/31/9999 20121 00228205310 DIAZEPAM TAB 10MG 12/31/9999 20121 00228205350 DIAZEPAM TAB 10MG 12/31/9999 20121 00228205396 DIAZEPAM TAB 10MG 12/31/9999 20121 00378047701 DIAZEPAM TAB 10MG 12/31/9999 20121 00378047705 DIAZEPAM TAB 10MG 12/31/9999 20121 00555016405 DIAZEPAM TAB 10MG 08/31/2013 20121 00591562001 DIAZEPAM TAB 10MG 12/31/9999 20121 00591562005 DIAZEPAM TAB 10MG 12/31/9999 20121 00591562010 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321502 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321516 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321520 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321521 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321522 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321528 DIAZEPAM TAB 10MG 12/31/9999 20121 00603321532 DIAZEPAM TAB 10MG 12/31/9999 20121 00904588161 DIAZEPAM TAB 10MG 12/31/9999 20121 51079028601 DIAZEPAM TAB 10MG 12/31/9999 20121 51079028620 DIAZEPAM TAB 10MG 12/31/9999 20121 00172392560 DIAZEPAM TAB 2MG 12/31/9999 20121 00172392570 DIAZEPAM TAB 2MG 12/31/9999 20121 00228205196 DIAZEPAM TAB 2MG 12/31/9999 20121 00378027101 DIAZEPAM TAB 2MG 12/31/9999 20121 00378027105 DIAZEPAM TAB 2MG 12/31/9999 20121 00591562101 DIAZEPAM TAB 2MG 12/31/9999 20121 00591562105 DIAZEPAM TAB 2MG 12/31/9999 20121 00591562110 DIAZEPAM TAB 2MG 12/31/9999 20121 00603321316 DIAZEPAM TAB 2MG 12/31/9999 20121 00603321320 DIAZEPAM TAB 2MG 12/31/9999 20121 00603321321 DIAZEPAM TAB 2MG 12/31/9999 20121 00603321328 DIAZEPAM TAB 2MG 12/31/9999 20121 51079028401 DIAZEPAM TAB 2MG 12/31/9999 20121 51079028420 DIAZEPAM TAB 2MG 12/31/9999 20121 00172392660 DIAZEPAM TAB 5MG 12/31/9999 20121 00172392670 DIAZEPAM TAB 5MG 12/31/9999 20121 00172392680 DIAZEPAM TAB 5MG 12/31/9999 20121 00228205210 DIAZEPAM TAB 5MG 12/31/9999 20121 00228205250 DIAZEPAM TAB 5MG 12/31/9999 20121 00378034501 DIAZEPAM TAB 5MG 12/31/9999 20121 00378034505 DIAZEPAM TAB 5MG 12/31/9999 20121 00555036305 DIAZEPAM TAB 5MG 03/31/2013 20121 00591561901 DIAZEPAM TAB 5MG 12/31/9999 20121 00591561905 DIAZEPAM TAB 5MG 12/31/9999 20121 00591561910 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321402 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321416 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321420 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321421 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321422 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321428 DIAZEPAM TAB 5MG 12/31/9999 20121 00603321432 DIAZEPAM TAB 5MG 12/31/9999 20121 00904588061 DIAZEPAM TAB 5MG 12/31/9999 20121 51079028501 DIAZEPAM TAB 5MG 12/31/9999 20121 51079028520 DIAZEPAM TAB 5MG 12/31/9999 20121 63739007310 DIAZEPAM TAB 5MG 12/31/9999 20121 68084035901 DIAZEPAM TAB 5MG 12/31/9999 20121 00168004631 DIBUCAINE OIN 1% 12/31/9999 20121 45802005003 DIBUCAINE OIN 1% 12/31/9999 20121 51552052002 DIBUCAINE POW 12/31/9999 20121 51552052004 DIBUCAINE POW 12/31/9999 20121 38779123606 DIBUT SQUART POW 12/31/9999 20121 38779123603 DIBUTYL LIQ SQUARATE 12/31/9999 20121 11528010102 DICEL CHW 2-30MG 12/31/9999 20121 11528010016 DICEL SUS 12/31/9999 20121 11528010704 DICEL CD LIQ 12/31/9999 20121 11528010716 DICEL CD LIQ 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 11528010602 DICEL DM CHW 12/31/9999 20121 11528010516 DICEL DM SUS 12/31/9999 20121 51552116004 DICHLOROACET LIQ 12/31/9999 20121 51552116009 DICHLOROACET LIQ 12/31/9999 20121 00093094801 DICLOFEN POT TAB 50MG 12/31/9999 20121 00093094805 DICLOFEN POT TAB 50MG 12/31/9999 20121 00378247401 DICLOFEN POT TAB 50MG 12/31/9999 20121 00781501701 DICLOFEN POT TAB 50MG 12/31/9999 20121 60505013500 DICLOFEN POT TAB 50MG 12/31/9999 20121 38779169804 DICLOFENAC POW SODIUM 12/31/9999 20121 38779169805 DICLOFENAC POW SODIUM 12/31/9999 20121 38779169808 DICLOFENAC POW SODIUM 12/31/9999 20121 16571010125 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 16571010150 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 17478089210 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 17478089225 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 24208045705 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 24208045725 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 61314001405 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 61314001425 DICLOFENAC SOL 0.1% OP 12/31/9999 20121 00093104101 DICLOFENAC TAB 100MG ER 12/31/9999 20121 00228271711 DICLOFENAC TAB 100MG ER 12/31/9999 20121 00378035501 DICLOFENAC TAB 100MG ER 12/31/9999 20121 00591067601 DICLOFENAC TAB 100MG ER 12/31/9999 20121 00781138101 DICLOFENAC TAB 100MG XR 12/31/9999 20121 00781178501 DICLOFENAC TAB 25MG DR 12/31/9999 20121 16571020310 DICLOFENAC TAB 25MG DR 12/31/9999 20121 00228255006 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00228255011 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00228255096 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00378628001 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00378628010 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00591033801 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00591033810 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00591033860 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00781178701 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00781178710 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00781178760 DICLOFENAC TAB 50MG DR 12/31/9999 20121 16571020206 DICLOFENAC TAB 50MG DR 12/31/9999 20121 16571020210 DICLOFENAC TAB 50MG DR 12/31/9999 20121 16571020211 DICLOFENAC TAB 50MG DR 12/31/9999 20121 51079046601 DICLOFENAC TAB 50MG DR 12/31/9999 20121 51079046620 DICLOFENAC TAB 50MG DR 12/31/9999 20121 61442010201 DICLOFENAC TAB 50MG DR 12/31/9999 20121 61442010210 DICLOFENAC TAB 50MG DR 12/31/9999 20121 61442010260 DICLOFENAC TAB 50MG DR 12/31/9999 20121 00228274306 DICLOFENAC TAB 50MG EC 12/31/9999 20121 00228274311 DICLOFENAC TAB 50MG EC 12/31/9999 20121 00228274396 DICLOFENAC TAB 50MG EC 12/31/9999 20121 00228255106 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00228255111 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00228255196 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00378628101 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00378628110 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00591033901 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00591033905 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00591033910 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00591033960 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00781178901 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00781178905 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00781178910 DICLOFENAC TAB 75MG DR 12/31/9999 20121 00781178960 DICLOFENAC TAB 75MG DR 12/31/9999 20121 16571020106 DICLOFENAC TAB 75MG DR 12/31/9999 20121 16571020110 DICLOFENAC TAB 75MG DR 12/31/9999 20121 16571020111 DICLOFENAC TAB 75MG DR 12/31/9999 20121 16571020150 DICLOFENAC TAB 75MG DR 12/31/9999 20121 51079022401 DICLOFENAC TAB 75MG DR 12/31/9999 20121
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Rebatable Drug List for Iowa Medica
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August 31, 2012 - Iowa Medicaid Enterprise

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