August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00067001648 EX-LAX TAB MAX ST 12/31/9999 20121 00067001690 EX-LAX TAB MAX ST 12/31/9999 20121 00067002712 EX-LAX MILK SUS OF MAGNE 12/31/9999 20121 00067002812 EX-LAX MILK SUS OF MAGNE 12/31/9999 20121 00067002912 EX-LAX MILK SUS OF MAGNE 12/31/9999 20121 00067034724 EX-LAX ULTRA TAB 5MG EC 12/31/9999 20121 00078056912 EXTAVIA INJ 0.3MG 12/31/9999 20121 00078056961 EXTAVIA INJ 0.3MG 12/31/9999 20121 63032005100 EXTINA AER 2% 12/31/9999 20121 63032005150 EXTINA AER 2% 12/31/9999 20121 00536097085 EXTRA ACTION SYP COUGH 12/31/9999 20121 00536097097 EXTRA ACTION SYP COUGH 12/31/9999 20121 00941067905 EXTRANEAL SOL 12/31/9999 20121 00941067906 EXTRANEAL SOL 12/31/9999 20121 00941067947 EXTRANEAL SOL 12/31/9999 20121 00941067948 EXTRANEAL SOL 12/31/9999 20121 00941067952 EXTRANEAL SOL 12/31/9999 20121 00941067953 EXTRANEAL SOL 12/31/9999 20121 62011010401 EYE DROPS DRO ADV RELF 12/31/9999 20121 37205013905 EYE DROPS SOL 0.05% OP 12/31/9999 20121 37205022405 EYE DROPS SOL 0.05% OP 12/31/9999 20121 37205013805 EYE DROPS SOL A/R 12/31/9999 20121 00536090197 EYE IRRIGATI SOL OP 12/31/9999 20121 24385049464 EYE ITCH REL DRO 0.025%OP 12/31/9999 20121 37205084917 EYE ITCH REL DRO 0.025%OP 12/31/9999 20121 62011010501 EYE ITCH REL DRO 0.025%OP 12/31/9999 20121 49348016317 EYE ITCH REL SOL 0.025%OP 12/31/9999 20121 00065053001 EYE STREAM SOL OP 12/31/9999 20121 00065053004 EYE STREAM SOL OP 12/31/9999 20121 00904537720 EYE WASH SOL 12/31/9999 20121 37205002326 EYE WASH SOL 12/31/9999 20121 50383001804 EYE WASH SOL 12/31/9999 20121 61755000502 EYLEA INJ 2/0.05ML 12/31/9999 20121 00574012225 EZ CHAR SUS PELLETS 12/31/9999 20121 12830082401 EZFE 200 CAP 200MG 12/31/9999 20121 12830082430 EZFE 200 CAP 200MG 12/31/9999 20121 12830083101 EZFE FORTE CAP 12/31/9999 20121 00245018311 FA-B6-B12 TAB 12/31/9999 20121 68308032610 FABB TAB 12/31/9999 20121 58468004001 FABRAZYME INJ 35MG 12/31/9999 20121 58468004101 FABRAZYME INJ 5MG 12/31/9999 20121 10122032105 FACTIVE TAB 320MG 03/31/2015 20121 10122032107 FACTIVE TAB 320MG 03/15/2015 20121 67707032005 FACTIVE TAB 320MG 10/31/2012 20121 67707032007 FACTIVE TAB 320MG 10/31/2012 20121 00054019613 FAMCICLOVIR TAB 125MG 12/31/9999 20121 00093811756 FAMCICLOVIR TAB 125MG 12/31/9999 20121 00378449093 FAMCICLOVIR TAB 125MG 12/31/9999 20121 00591327130 FAMCICLOVIR TAB 125MG 12/31/9999 20121 00781562031 FAMCICLOVIR TAB 125MG 12/31/9999 20121 16714030001 FAMCICLOVIR TAB 125MG 12/31/2020 20121 59762270001 FAMCICLOVIR TAB 125MG 12/31/9999 20121 60505324503 FAMCICLOVIR TAB 125MG 12/31/9999 20121 65862046530 FAMCICLOVIR TAB 125MG 12/31/9999 20121 00054019713 FAMCICLOVIR TAB 250MG 12/31/9999 20121 00093811856 FAMCICLOVIR TAB 250MG 12/31/9999 20121 00378449193 FAMCICLOVIR TAB 250MG 12/31/9999 20121 00591327230 FAMCICLOVIR TAB 250MG 12/31/9999 20121 00781562131 FAMCICLOVIR TAB 250MG 12/31/9999 20121 16714030401 FAMCICLOVIR TAB 250MG 12/31/2020 20121 59762270102 FAMCICLOVIR TAB 250MG 12/31/9999 20121 60505324603 FAMCICLOVIR TAB 250MG 12/31/9999 20121 65862046630 FAMCICLOVIR TAB 250MG 12/31/9999 20121 00054019813 FAMCICLOVIR TAB 500MG 12/31/9999 20121 00093811956 FAMCICLOVIR TAB 500MG 12/31/9999 20121 00378449293 FAMCICLOVIR TAB 500MG 12/31/9999 20121 00591327330 FAMCICLOVIR TAB 500MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00781562231 FAMCICLOVIR TAB 500MG 12/31/9999 20121 16714030501 FAMCICLOVIR TAB 500MG 12/31/2020 20121 59762270301 FAMCICLOVIR TAB 500MG 12/31/9999 20121 60505324703 FAMCICLOVIR TAB 500MG 12/31/9999 20121 65862046730 FAMCICLOVIR TAB 500MG 12/31/9999 20121 10019004502 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 10019004517 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 10019004603 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 10019004604 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 10019004614 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 10019004663 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 55390002601 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 55390002701 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 55390002810 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 55390002910 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 63323073804 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 63323073820 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 63323073912 FAMOTIDINE INJ 10MG/ML 12/31/9999 20121 00069012601 FAMOTIDINE INJ 200/20ML 12/31/9999 20121 00069012602 FAMOTIDINE INJ 200/20ML 12/31/9999 20121 00338519741 FAMOTIDINE INJ 20MG/50M 12/31/9999 20121 00069012501 FAMOTIDINE INJ 40MG/4ML 12/31/9999 20121 00069012502 FAMOTIDINE INJ 40MG/4ML 12/31/9999 20121 00574014704 FAMOTIDINE SUS 40MG/5ML 12/31/9999 20121 68180015001 FAMOTIDINE SUS 40MG/5ML 12/31/9999 20121 68382044405 FAMOTIDINE SUS 40MG/5ML 12/31/9999 20121 00172266246 FAMOTIDINE TAB 10MG 12/31/9999 20121 00172266248 FAMOTIDINE TAB 10MG 12/31/9999 20121 00172266272 FAMOTIDINE TAB 10MG 12/31/9999 20121 00172572800 FAMOTIDINE TAB 20MG 12/31/9999 20121 00172572810 FAMOTIDINE TAB 20MG 12/31/9999 20121 00172572860 FAMOTIDINE TAB 20MG 12/31/9999 20121 00172572870 FAMOTIDINE TAB 20MG 12/31/9999 20121 00172572880 FAMOTIDINE TAB 20MG 12/31/9999 20121 00228267903 FAMOTIDINE TAB 20MG 12/31/9999 20121 00228267911 FAMOTIDINE TAB 20MG 12/31/9999 20121 00228267996 FAMOTIDINE TAB 20MG 12/31/9999 20121 00378302001 FAMOTIDINE TAB 20MG 12/31/9999 20121 00378302005 FAMOTIDINE TAB 20MG 12/31/9999 20121 00904555360 FAMOTIDINE TAB 20MG 12/31/9999 20121 00904555361 FAMOTIDINE TAB 20MG 12/31/9999 20121 00904555380 FAMOTIDINE TAB 20MG 12/31/9999 20121 16714036101 FAMOTIDINE TAB 20MG 12/31/2020 20121 16714036104 FAMOTIDINE TAB 20MG 12/31/2020 20121 16714036105 FAMOTIDINE TAB 20MG 12/31/2020 20121 16714036106 FAMOTIDINE TAB 20MG 12/31/2020 20121 51079096601 FAMOTIDINE TAB 20MG 12/31/9999 20121 51079096617 FAMOTIDINE TAB 20MG 12/31/9999 20121 51079096619 FAMOTIDINE TAB 20MG 12/31/9999 20121 51079096620 FAMOTIDINE TAB 20MG 12/31/9999 20121 55111011901 FAMOTIDINE TAB 20MG 12/31/9999 20121 55111011910 FAMOTIDINE TAB 20MG 12/31/9999 20121 61442012101 FAMOTIDINE TAB 20MG 12/31/9999 20121 61442012110 FAMOTIDINE TAB 20MG 12/31/9999 20121 62037095510 FAMOTIDINE TAB 20MG 08/01/2012 20121 63739048410 FAMOTIDINE TAB 20MG 12/31/9999 20121 64679093601 FAMOTIDINE TAB 20MG 12/31/9999 20121 64679093602 FAMOTIDINE TAB 20MG 12/31/9999 20121 64679093603 FAMOTIDINE TAB 20MG 12/31/9999 20121 68084017201 FAMOTIDINE TAB 20MG 12/31/9999 20121 68645014059 FAMOTIDINE TAB 20MG 12/31/9999 20121 00172572900 FAMOTIDINE TAB 40MG 12/31/9999 20121 00172572910 FAMOTIDINE TAB 40MG 12/31/9999 20121 00172572960 FAMOTIDINE TAB 40MG 12/31/9999 20121 00172572970 FAMOTIDINE TAB 40MG 12/31/9999 20121 00228264103 FAMOTIDINE TAB 40MG 12/31/9999 20121 00228264111 FAMOTIDINE TAB 40MG 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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