August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 51079052056 FINASTERIDE TAB 5MG 12/31/9999 20121 52152050002 FINASTERIDE TAB 5MG 12/31/9999 20121 52152050008 FINASTERIDE TAB 5MG 12/31/9999 20121 52152050030 FINASTERIDE TAB 5MG 12/31/9999 20121 55111017230 FINASTERIDE TAB 5MG 12/31/9999 20121 55111017290 FINASTERIDE TAB 5MG 12/31/9999 20121 55111055430 FINASTERIDE TAB 5MG 06/30/2012 20121 59762085002 FINASTERIDE TAB 5MG 12/31/9999 20121 59762085003 FINASTERIDE TAB 5MG 12/31/9999 20121 59762085007 FINASTERIDE TAB 5MG 12/31/9999 20121 65862014901 FINASTERIDE TAB 5MG 12/31/9999 20121 65862014930 FINASTERIDE TAB 5MG 12/31/9999 20121 65862014990 FINASTERIDE TAB 5MG 12/31/9999 20121 68084024701 FINASTERIDE TAB 5MG 12/31/9999 20121 52544095701 FIORICET TAB 12/31/9999 20121 52544095705 FIORICET TAB 12/31/9999 20121 52544095801 FIORICET/COD CAP 12/31/9999 20121 52544095501 FIORINAL CAP 12/31/9999 20121 52544095601 FIORINAL/COD CAP 30MG 12/31/9999 20121 54092070202 FIRAZYR INJ 30MG/3ML 12/31/9999 20121 54092070203 FIRAZYR INJ 30MG/3ML 12/31/9999 20121 55566840101 FIRMAGON INJ 120MG 12/31/9999 20121 55566830101 FIRMAGON INJ 80MG 12/31/9999 20121 51879021002 FIRST AID GEL 0.2-2.5% 12/31/9999 20121 00025194250 FLAGYL CAP 375MG 12/31/9999 20121 00025183131 FLAGYL TAB 250MG 12/31/9999 20121 00025183150 FLAGYL TAB 250MG 12/31/9999 20121 00025183155 FLAGYL TAB 250MG 12/31/9999 20121 00025182131 FLAGYL TAB 500MG 12/31/9999 20121 00025182150 FLAGYL TAB 500MG 12/31/9999 20121 00025196130 FLAGYL ER TAB 750MG 12/31/9999 20121 00065009605 FLAREX SUS 0.1% OP 12/31/9999 20121 00115181101 FLAVOXATE TAB 100MG 12/31/9999 20121 00574011501 FLAVOXATE TAB 100MG 12/31/9999 20121 42806005801 FLAVOXATE TAB 100MG 12/31/9999 20121 51224015450 FLAVOXATE TAB 100MG 12/31/9999 20121 24385093378 FLAXSEED OIL CAP 1000MG 12/31/9999 20121 61953000501 FLEBOGAMMA INJ 10% 12/31/9999 20121 61953000502 FLEBOGAMMA INJ 10% 12/31/9999 20121 61953000503 FLEBOGAMMA INJ 10% 12/31/9999 20121 61953000401 FLEBOGAMMA INJ DIF 5% 12/31/9999 20121 61953000402 FLEBOGAMMA INJ DIF 5% 12/31/9999 20121 61953000403 FLEBOGAMMA INJ DIF 5% 12/31/9999 20121 61953000404 FLEBOGAMMA INJ DIF 5% 12/31/9999 20121 61953000405 FLEBOGAMMA INJ DIF 5% 12/31/9999 20121 00054001121 FLECAINIDE TAB 100MG 12/31/9999 20121 00054001125 FLECAINIDE TAB 100MG 12/31/9999 20121 00555086002 FLECAINIDE TAB 100MG 12/31/9999 20121 49884069501 FLECAINIDE TAB 100MG 06/30/2012 20121 63304079501 FLECAINIDE TAB 100MG 12/31/9999 20121 65162064210 FLECAINIDE TAB 100MG 12/31/9999 20121 68084054021 FLECAINIDE TAB 100MG 12/31/9999 20121 00054001221 FLECAINIDE TAB 150MG 12/31/9999 20121 00054001225 FLECAINIDE TAB 150MG 12/31/9999 20121 00555086102 FLECAINIDE TAB 150MG 12/31/9999 20121 49884069601 FLECAINIDE TAB 150MG 06/30/2012 20121 63304079601 FLECAINIDE TAB 150MG 12/31/9999 20121 65162064310 FLECAINIDE TAB 150MG 12/31/9999 20121 00054001021 FLECAINIDE TAB 50MG 12/31/9999 20121 00054001025 FLECAINIDE TAB 50MG 12/31/9999 20121 00555085902 FLECAINIDE TAB 50MG 12/31/9999 20121 49884069401 FLECAINIDE TAB 50MG 06/30/2012 20121 63304079401 FLECAINIDE TAB 50MG 12/31/9999 20121 65162064110 FLECAINIDE TAB 50MG 12/31/9999 20121 60793041130 FLECTOR DIS 1.3% 12/31/9999 20121 63857011133 FLECTOR DIS 1.3% 06/30/2012 20121 00132020140 FLEET ENE 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00132020142 FLEET ENE 12/31/9999 20121 00132020145 FLEET ENE 12/31/9999 20121 00132080199 FLEET ENE 12/31/9999 20121 00132011946 FLEET ENE ENEMA 12/31/9999 20121 00132020220 FLEET ENE PED 12/31/9999 20121 00132070336 FLEET BISACO ENE 10/30ML 12/31/9999 20121 00132070402 FLEET LAXATI TAB 5MG EC 12/31/9999 20121 00132018582 FLEET LIQUID ENE GLYCERIN 12/31/9999 20121 00132012101 FLEET NATURL ENE CLEANSNG 12/31/9999 20121 00132030140 FLEET OIL ENE 12/31/9999 20121 00944049301 FLEXBUMIN INJ 25% 12/31/9999 20121 00944049302 FLEXBUMIN INJ 25% 12/31/9999 20121 50991043601 FLEXTRA CAP 12/31/9999 20121 50991083001 FLEXTRA DS TAB 50-500MG 12/31/9999 20121 50991065001 FLEXTRA-650 TAB 12/31/9999 20121 00173051700 FLOLAN INJ 0.5MG 12/31/9999 20121 00173051900 FLOLAN INJ 1.5MG 12/31/9999 20121 00597005801 FLOMAX CAP 0.4MG 12/31/9999 20121 00173045301 FLONASE SPR 0.05% 12/31/9999 20121 51672133803 FLO-PRED SUS 12/31/9999 20121 00482400030 FLORA-Q CAP 12/31/9999 20121 00482400130 FLORA-Q 2 CAP 12/31/9999 20121 00173060200 FLOVENT DISK AER 100MCG 12/31/9999 20121 00173060202 FLOVENT DISK AER 100MCG 12/31/9999 20121 00173060100 FLOVENT DISK AER 250MCG 12/31/9999 20121 00173060102 FLOVENT DISK AER 250MCG 12/31/9999 20121 00173060002 FLOVENT DISK AER 50MCG 12/31/9999 20121 00173071920 FLOVENT HFA AER 110MCG 12/31/9999 20121 00173072020 FLOVENT HFA AER 220MCG 12/31/9999 20121 00173071820 FLOVENT HFA AER 44MCG 12/31/9999 20121 55390013501 FLOXURIDINE INJ 0.5GM 12/31/9999 20121 63323014507 FLOXURIDINE INJ 0.5GM 12/31/9999 20121 36800013391 FLU & SORE POW THROAT 12/31/9999 20121 46122003713 FLU/COLD/CGH PAK NIGHTTIM 12/31/9999 20121 00113009691 FLU/COLD/CGH POW DAYTIME 12/31/9999 20121 46122002213 FLU/COLD/CGH POW DAYTIME 12/31/9999 20121 36800055291 FLU/SEVERE POW CLD DAY 12/31/9999 20121 00054000285 FLUCONAZOLE SUS 10MG/ML 12/31/9999 20121 00093541495 FLUCONAZOLE SUS 10MG/ML 12/31/9999 20121 16714069501 FLUCONAZOLE SUS 10MG/ML 12/31/2020 20121 59762502901 FLUCONAZOLE SUS 10MG/ML 12/31/9999 20121 63304097505 FLUCONAZOLE SUS 10MG/ML 12/31/9999 20121 65862029935 FLUCONAZOLE SUS 10MG/ML 12/31/9999 20121 00054000385 FLUCONAZOLE SUS 40MG/ML 12/31/9999 20121 00093541595 FLUCONAZOLE SUS 40MG/ML 12/31/9999 20121 16714069601 FLUCONAZOLE SUS 40MG/ML 12/31/2020 20121 59762503001 FLUCONAZOLE SUS 40MG/ML 12/31/9999 20121 63304097605 FLUCONAZOLE SUS 40MG/ML 12/31/9999 20121 65862030035 FLUCONAZOLE SUS 40MG/ML 12/31/9999 20121 00172541100 FLUCONAZOLE TAB 100MG 12/31/9999 20121 00172541110 FLUCONAZOLE TAB 100MG 12/31/9999 20121 00172541146 FLUCONAZOLE TAB 100MG 12/31/9999 20121 00172541160 FLUCONAZOLE TAB 100MG 12/31/9999 20121 00378251693 FLUCONAZOLE TAB 100MG 12/31/9999 20121 59762501601 FLUCONAZOLE TAB 100MG 12/31/9999 20121 63304080401 FLUCONAZOLE TAB 100MG 12/31/9999 20121 63304080430 FLUCONAZOLE TAB 100MG 12/31/9999 20121 65862005930 FLUCONAZOLE TAB 100MG 12/31/9999 20121 68462010230 FLUCONAZOLE TAB 100MG 12/31/9999 20121 00172541211 FLUCONAZOLE TAB 150MG 12/31/9999 20121 00172541279 FLUCONAZOLE TAB 150MG 12/31/9999 20121 00378251896 FLUCONAZOLE TAB 150MG 12/31/9999 20121 59762501701 FLUCONAZOLE TAB 150MG 12/31/9999 20121 63304080512 FLUCONAZOLE TAB 150MG 12/31/9999 20121 65862006011 FLUCONAZOLE TAB 150MG 12/31/9999 20121 68462010340 FLUCONAZOLE TAB 150MG 12/31/9999 20121 00172541300 FLUCONAZOLE TAB 200MG 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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