August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00228270411 FLUVOXAMINE TAB 25MG 12/31/9999 20121 00378040701 FLUVOXAMINE TAB 25MG 12/31/9999 20121 00555096702 FLUVOXAMINE TAB 25MG 12/31/9999 20121 42769122200 FLUVOXAMINE TAB 25MG 12/31/2013 20121 57664035788 FLUVOXAMINE TAB 25MG 12/31/9999 20121 60505016401 FLUVOXAMINE TAB 25MG 12/31/9999 20121 62559015801 FLUVOXAMINE TAB 25MG 12/31/9999 20121 00185002701 FLUVOXAMINE TAB 50MG 12/31/9999 20121 00185002705 FLUVOXAMINE TAB 50MG 12/31/9999 20121 00228265511 FLUVOXAMINE TAB 50MG 12/31/9999 20121 00378041201 FLUVOXAMINE TAB 50MG 12/31/9999 20121 00555096802 FLUVOXAMINE TAB 50MG 12/31/9999 20121 42769122500 FLUVOXAMINE TAB 50MG 03/31/2014 20121 51079099201 FLUVOXAMINE TAB 50MG 12/31/9999 20121 51079099220 FLUVOXAMINE TAB 50MG 12/31/9999 20121 57664036113 FLUVOXAMINE TAB 50MG 12/31/9999 20121 57664036188 FLUVOXAMINE TAB 50MG 12/31/9999 20121 60505016501 FLUVOXAMINE TAB 50MG 12/31/9999 20121 62559015901 FLUVOXAMINE TAB 50MG 12/31/9999 20121 00023031604 FML OIN 0.1% OP 12/31/9999 20121 11980022805 FML FORTE SUS 0.25% OP 12/31/9999 20121 11980022810 FML FORTE SUS 0.25% OP 12/31/9999 20121 11980021105 FML LIQUIFLM SUS 0.1% OP 12/31/9999 20121 11980021110 FML LIQUIFLM SUS 0.1% OP 12/31/9999 20121 11980021115 FML LIQUIFLM SUS 0.1% OP 12/31/9999 20121 00603018621 FOAM ANTACID CHW 80-20MG 09/30/2013 20121 24385012678 FOAM ANTACID CHW 80-20MG 12/31/9999 20121 24385039740 FOAM ANTACID SUS 12/31/9999 20121 00078038205 FOCALIN TAB 10MG 12/31/9999 20121 00078038005 FOCALIN TAB 2.5MG 12/31/9999 20121 00078038105 FOCALIN TAB 5MG 12/31/9999 20121 00078043105 FOCALIN XR CAP 10MG 12/31/9999 20121 00078049305 FOCALIN XR CAP 15MG 12/31/9999 20121 00078043205 FOCALIN XR CAP 20MG 12/31/9999 20121 00078060805 FOCALIN XR CAP 25MG 12/31/9999 20121 00078043305 FOCALIN XR CAP 30MG 12/31/9999 20121 00078060905 FOCALIN XR CAP 35MG 12/31/9999 20121 00078043405 FOCALIN XR CAP 40MG 12/31/9999 20121 00078043005 FOCALIN XR CAP 5MG 12/31/9999 20121 42192031190 FOLAST TAB 12/31/9999 20121 51991007733 FOLBECAL TAB 12/31/9999 20121 51991008490 FOLBEE TAB 12/31/9999 20121 51991008290 FOLBEE PLUS TAB 12/31/9999 20121 51991052890 FOLBEE PLUS TAB CZ 12/31/9999 20121 51991038490 FOLBIC TAB 12/31/9999 20121 68308035230 FOLCAL DHA CAP 12/31/9999 20121 68308016930 FOLCAPS CAP OMEGA 3 08/31/2012 20121 68308026930 FOLCAPS CAP OMEGA 3 12/31/9999 20121 68308032410 FOLCAPS TAB 12/31/9999 20121 00245015560 FOLGARD OS TAB 12/31/9999 20121 00245019111 FOLGARD RX TAB 12/31/9999 20121 63323018410 FOLIC ACID INJ 5MG/ML 12/31/9999 20121 00143124801 FOLIC ACID TAB 1MG 12/31/9999 20121 00143124810 FOLIC ACID TAB 1MG 12/31/9999 20121 00143971701 FOLIC ACID TAB 1MG 12/31/9999 20121 00143971710 FOLIC ACID TAB 1MG 12/31/9999 20121 00591521601 FOLIC ACID TAB 1MG 12/31/9999 20121 00591521610 FOLIC ACID TAB 1MG 12/31/9999 20121 00603316202 FOLIC ACID TAB 1MG 12/31/9999 20121 00603316221 FOLIC ACID TAB 1MG 12/31/9999 20121 00603316230 FOLIC ACID TAB 1MG 12/31/9999 20121 00603316232 FOLIC ACID TAB 1MG 12/31/9999 20121 00603371432 FOLIC ACID TAB 1MG 12/31/9999 20121 00904620180 FOLIC ACID TAB 1MG 12/31/9999 20121 10267012001 FOLIC ACID TAB 1MG 12/31/9999 20121 10267012004 FOLIC ACID TAB 1MG 12/31/9999 20121 15338017000 FOLIC ACID TAB 1MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 51079010501 FOLIC ACID TAB 1MG 12/31/9999 20121 51079010517 FOLIC ACID TAB 1MG 12/31/9999 20121 51079010519 FOLIC ACID TAB 1MG 12/31/9999 20121 51079010520 FOLIC ACID TAB 1MG 12/31/9999 20121 51991020110 FOLIC ACID TAB 1MG 12/31/9999 20121 59746001210 FOLIC ACID TAB 1MG 12/31/9999 20121 62584089701 FOLIC ACID TAB 1MG 12/31/9999 20121 63739053701 FOLIC ACID TAB 1MG 12/31/9999 20121 63739053710 FOLIC ACID TAB 1MG 12/31/9999 20121 64125012701 FOLIC ACID TAB 1MG 12/31/9999 20121 64125012710 FOLIC ACID TAB 1MG 12/31/9999 20121 65162036110 FOLIC ACID TAB 1MG 12/31/9999 20121 65162036111 FOLIC ACID TAB 1MG 12/31/9999 20121 00536384401 FOLIC ACID TAB 400MCG 12/31/9999 20121 00536384301 FOLIC ACID TAB 800MCG 12/31/9999 20121 64980010503 FOLITAB TAB 12/31/9999 20121 13811054030 FOLIVANE-EC PAK CA DHA 12/31/9999 20121 13811053890 FOLIVANE-F CAP 12/31/9999 20121 13811053530 FOLIVANE-OB CAP 12/31/9999 20121 13811053990 FOLIVANE-PLS CAP 12/31/9999 20121 13811054430 FOLIVANE-PRX CAP DHA NF 12/31/9999 20121 00052030902 FOLLISTIM AQ INJ 150UNIT 12/31/9999 20121 00052031301 FOLLISTIM AQ INJ 300UNIT 12/31/9999 20121 00052031601 FOLLISTIM AQ INJ 600UNIT 12/31/9999 20121 00052030802 FOLLISTIM AQ INJ 75UNIT 12/31/9999 20121 00052032601 FOLLISTIM AQ INJ 900UNIT 12/31/9999 20121 48818000101 FOLOTYN INJ 20MG/ML 12/31/9999 20121 48818000102 FOLOTYN INJ 40MG/2ML 12/31/9999 20121 68220001890 FOLPACE RX TAB 12/31/9999 20121 51991025201 FOLPLEX 2.2 TAB 12/31/9999 20121 68308032560 FOLTABS 800 TAB 12/31/9999 20121 50991032301 FOLTRATE TAB 12/31/9999 20121 00185538001 FOLTRIN CAP 12/31/9999 20121 00185538010 FOLTRIN CAP 12/31/9999 20121 00185538076 FOLTRIN CAP 08/31/2012 20121 00185538088 FOLTRIN CAP 08/31/2012 20121 00781318273 FOMEPIZOLE INJ 1.5GM 12/31/9999 20121 00781318284 FOMEPIZOLE INJ 1.5GM 12/31/9999 20121 10139091015 FOMEPIZOLE INJ 1.5GM 12/31/9999 20121 67457021102 FOMEPIZOLE INJ 1.5GM 12/31/9999 20121 39822071001 FOMEPIZOLE INJ 1GM/ML 12/31/9999 20121 55111068102 FONDAPARINUX SOL 10/0.8 12/31/9999 20121 55111068110 FONDAPARINUX SOL 10/0.8 12/31/9999 20121 60505608104 FONDAPARINUX SOL 10/0.8 12/31/9999 20121 55111067802 FONDAPARINUX SOL 2.5/0.5 12/31/9999 20121 55111067810 FONDAPARINUX SOL 2.5/0.5 12/31/9999 20121 60505607804 FONDAPARINUX SOL 2.5/0.5 12/31/9999 20121 55111067902 FONDAPARINUX SOL 5.0/0.4 12/31/9999 20121 55111067910 FONDAPARINUX SOL 5.0/0.4 12/31/9999 20121 60505607904 FONDAPARINUX SOL 5.0/0.4 12/31/9999 20121 55111068002 FONDAPARINUX SOL 7.5/0.6 12/31/9999 20121 55111068010 FONDAPARINUX SOL 7.5/0.6 12/31/9999 20121 60505608004 FONDAPARINUX SOL 7.5/0.6 12/31/9999 20121 00085140101 FORADIL CAP AEROLIZE 12/31/9999 20121 00085140201 FORADIL CAP AEROLIZE 12/31/9999 20121 10019036040 FORANE SOL 12/31/9999 20121 10019036060 FORANE SOL 12/31/9999 20121 11701000505 FORDUSTIN POW 12/31/9999 20121 11701000516 FORDUSTIN POW 12/31/9999 20121 49908016790 FORMALDEHYDE SOL 10% 12/31/9999 20121 51552042706 FORMALDEHYDE SOL 10% 12/31/9999 20121 51552020504 FORMALDEHYDE SOL 37% 12/31/9999 20121 51552020506 FORMALDEHYDE SOL 37% 12/31/9999 20121 51552020508 FORMALDEHYDE SOL 37% 12/31/9999 20121 00904792960 FORMULA B TAB PLUS 12/31/9999 20121 00904004920 FORMULA EM SOL 12/31/9999 20121 00713060434 FORMULATION CRE R 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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