August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00126019393 GEL-KAM GEL 0.4% 12/31/9999 20121 52544008430 GELNIQUE GEL 10% 12/31/9999 20121 52544004154 GELNIQUE GEL 3% 12/31/9999 20121 00069385810 GEMCITABINE INJ 1GM 12/31/9999 20121 00409018101 GEMCITABINE INJ 1GM 12/31/9999 20121 00409018601 GEMCITABINE INJ 1GM 12/31/9999 20121 00591356355 GEMCITABINE INJ 1GM 12/31/9999 20121 00703577801 GEMCITABINE INJ 1GM 12/31/9999 20121 00781328379 GEMCITABINE INJ 1GM 12/31/9999 20121 16729011711 GEMCITABINE INJ 1GM 12/31/9999 20121 25021020950 GEMCITABINE INJ 1GM 12/31/9999 20121 47335015440 GEMCITABINE INJ 1GM 12/31/9999 20121 55111068725 GEMCITABINE INJ 1GM 12/31/9999 20121 63323012550 GEMCITABINE INJ 1GM 12/31/9999 20121 00069385710 GEMCITABINE INJ 200MG 12/31/9999 20121 00409018301 GEMCITABINE INJ 200MG 12/31/9999 20121 00409018501 GEMCITABINE INJ 200MG 12/31/9999 20121 00591356279 GEMCITABINE INJ 200MG 12/31/9999 20121 00703577501 GEMCITABINE INJ 200MG 12/31/9999 20121 00781328275 GEMCITABINE INJ 200MG 12/31/9999 20121 16729009203 GEMCITABINE INJ 200MG 12/31/9999 20121 25021020810 GEMCITABINE INJ 200MG 12/31/9999 20121 47335015340 GEMCITABINE INJ 200MG 12/31/9999 20121 55111068607 GEMCITABINE INJ 200MG 12/31/9999 20121 63323010210 GEMCITABINE INJ 200MG 12/31/9999 20121 00069385910 GEMCITABINE INJ 2GM 12/31/9999 20121 00409018201 GEMCITABINE INJ 2GM 12/31/9999 20121 00409018701 GEMCITABINE INJ 2GM 12/31/9999 20121 16729011838 GEMCITABINE INJ 2GM 12/31/9999 20121 63323012600 GEMCITABINE INJ 2GM 12/31/9999 20121 00093067005 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00093067006 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00093067019 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00093067093 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00115991113 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00143913005 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00143913060 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00228255296 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00904537961 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00904598840 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00904598852 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00904598861 GEMFIBROZIL TAB 600MG 12/31/9999 20121 16714010102 GEMFIBROZIL TAB 600MG 12/31/2020 20121 16714010105 GEMFIBROZIL TAB 600MG 12/31/2020 20121 24658013005 GEMFIBROZIL TAB 600MG 12/31/9999 20121 24658013018 GEMFIBROZIL TAB 600MG 12/31/9999 20121 24658013060 GEMFIBROZIL TAB 600MG 12/31/9999 20121 24658026005 GEMFIBROZIL TAB 600MG 12/31/9999 20121 24658026018 GEMFIBROZIL TAB 600MG 12/31/9999 20121 24658026060 GEMFIBROZIL TAB 600MG 12/31/9999 20121 31722022501 GEMFIBROZIL TAB 600MG 12/31/9999 20121 31722022505 GEMFIBROZIL TAB 600MG 12/31/9999 20121 31722022560 GEMFIBROZIL TAB 600MG 12/31/9999 20121 51079078717 GEMFIBROZIL TAB 600MG 12/31/9999 20121 51079078719 GEMFIBROZIL TAB 600MG 12/31/9999 20121 57664011513 GEMFIBROZIL TAB 600MG 12/31/9999 20121 57664011586 GEMFIBROZIL TAB 600MG 12/31/9999 20121 60505003400 GEMFIBROZIL TAB 600MG 12/31/9999 20121 60505003401 GEMFIBROZIL TAB 600MG 12/31/9999 20121 60505003402 GEMFIBROZIL TAB 600MG 12/31/9999 20121 60505003404 GEMFIBROZIL TAB 600MG 12/31/9999 20121 60505003406 GEMFIBROZIL TAB 600MG 12/31/9999 20121 60505003408 GEMFIBROZIL TAB 600MG 12/31/9999 20121 67253074106 GEMFIBROZIL TAB 600MG 12/31/9999 20121 67253074150 GEMFIBROZIL TAB 600MG 12/31/9999 20121 68084047301 GEMFIBROZIL TAB 600MG 12/31/9999 20121 76282022505 GEMFIBROZIL TAB 600MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 76282022518 GEMFIBROZIL TAB 600MG 12/31/9999 20121 76282022560 GEMFIBROZIL TAB 600MG 12/31/9999 20121 00002750201 GEMZAR INJ 1GM 12/31/9999 20121 00002750101 GEMZAR INJ 200MG 12/31/9999 20121 43538051012 GENADUR LIQ 12/31/9999 20121 00182209201 GENAHIST CAP 25MG 06/30/2012 20121 00182147116 GENAPHED TAB PLUS 06/30/2012 20121 00182222001 GENATON CHW 07/31/2012 20121 52544020431 GENERESS FE CHW 12/31/9999 20121 60432003816 GENERLAC SOL 10GM/15 12/31/9999 20121 60432003864 GENERLAC SOL 10GM/15 12/31/9999 20121 00182151376 GENFIBER POW 50% 03/31/2013 20121 00182151378 GENFIBER POW 50% 11/30/2012 20121 00074647932 GENGRAF CAP 100MG 12/31/9999 20121 00074646332 GENGRAF CAP 25MG 12/31/9999 20121 00074726950 GENGRAF SOL 100MG/ML 12/31/9999 20121 00013264902 GENOTROPIN INJ 0.2MG 12/31/9999 20121 00013265002 GENOTROPIN INJ 0.4MG 12/31/9999 20121 00013265102 GENOTROPIN INJ 0.6MG 12/31/9999 20121 00013265202 GENOTROPIN INJ 0.8MG 12/31/9999 20121 00013265402 GENOTROPIN INJ 1.2MG 12/31/9999 20121 00013265502 GENOTROPIN INJ 1.4MG 12/31/9999 20121 00013265602 GENOTROPIN INJ 1.6MG 12/31/9999 20121 00013265702 GENOTROPIN INJ 1.8MG 12/31/9999 20121 00013264681 GENOTROPIN INJ 12MG 12/31/9999 20121 00013265302 GENOTROPIN INJ 1MG 12/31/9999 20121 00013265802 GENOTROPIN INJ 2MG 12/31/9999 20121 00013262681 GENOTROPIN INJ 5MG 12/31/9999 20121 17478028435 GENTAK OIN 0.3% OP 12/31/9999 20121 17478028310 GENTAK SOL 0.3% OP 12/31/9999 20121 00264581032 GENTAM/NACL INJ 100MG 12/31/9999 20121 00338050548 GENTAM/NACL INJ 100MG 12/31/9999 20121 00409788923 GENTAM/NACL INJ 100MG 12/31/9999 20121 00338051141 GENTAM/NACL INJ 100MG PB 12/31/9999 20121 00338050748 GENTAM/NACL INJ 120MG 12/31/9999 20121 00264581238 GENTAM/NACL INJ 60MG 12/31/9999 20121 00338050741 GENTAM/NACL INJ 60MG 12/31/9999 20121 00409787913 GENTAM/NACL INJ 60MG PB 12/31/9999 20121 00264580832 GENTAM/NACL INJ 80MG 12/31/9999 20121 00264581638 GENTAM/NACL INJ 80MG 12/31/9999 20121 00338050348 GENTAM/NACL INJ 80MG 12/31/9999 20121 00338050941 GENTAM/NACL INJ 80MG 12/31/9999 20121 00409788313 GENTAM/NACL INJ 80MG 12/31/9999 20121 00409788423 GENTAM/NACL INJ 80MG PB 12/31/9999 20121 00168007115 GENTAMICIN CRE 0.1% 12/31/9999 20121 45802005611 GENTAMICIN CRE 0.1% 12/31/9999 20121 45802005635 GENTAMICIN CRE 0.1% 12/31/9999 20121 63323017302 GENTAMICIN INJ 10MG/ML 12/31/9999 20121 63323051302 GENTAMICIN INJ 10MG/ML 12/31/9999 20121 00409120703 GENTAMICIN INJ 40MG/ML 12/31/9999 20121 63323001002 GENTAMICIN INJ 40MG/ML 12/31/9999 20121 63323001020 GENTAMICIN INJ 40MG/ML 12/31/9999 20121 00168007815 GENTAMICIN OIN 0.1% 12/31/9999 20121 45802004611 GENTAMICIN OIN 0.1% 12/31/9999 20121 45802004635 GENTAMICIN OIN 0.1% 12/31/9999 20121 48102010235 GENTAMICIN OIN 0.3% OP 12/31/9999 20121 24208058060 GENTAMICIN SOL 0.3% OP 12/31/9999 20121 24208058064 GENTAMICIN SOL 0.3% OP 12/31/9999 20121 60758018805 GENTAMICIN SOL 0.3% OP 12/31/9999 20121 61314063305 GENTAMICIN SOL 0.3% OP 12/31/9999 20121 00078051816 GENTEAL DRO OPTH 12/31/9999 20121 00078051824 GENTEAL DRO OPTH 12/31/9999 20121 58768078815 GENTEAL DRO OPTH 05/31/2012 20121 58768078825 GENTEAL DRO OPTH 05/31/2012 20121 00078042516 GENTEAL GEL 12/31/9999 20121 00078042524 GENTEAL GEL 12/31/9999 20121 00078042947 GENTEAL GEL 0.3% 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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