August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00078042957 GENTEAL GEL 0.3% 12/31/9999 20121 00078042997 GENTEAL GEL 0.3% 12/31/9999 20121 00078051716 GENTEAL MILD DRO 0.2% 12/31/9999 20121 00078051724 GENTEAL MILD DRO 0.2% 12/31/9999 20121 00078047397 GENTEAL PM OIN 12/31/9999 20121 49614013163 GENTLE LAXAT TAB 5MG EC 12/31/9999 20121 15127000230 GENTLE LAXAT TAB 5MG WMN 12/31/9999 20121 11701001826 GENTLE RAIN LIQ ANTIBACT 12/31/9999 20121 00049396041 GEODON CAP 20MG 12/31/9999 20121 00049396060 GEODON CAP 20MG 12/31/9999 20121 00049397041 GEODON CAP 40MG 12/31/9999 20121 00049397060 GEODON CAP 40MG 12/31/9999 20121 00049398041 GEODON CAP 60MG 12/31/9999 20121 00049398060 GEODON CAP 60MG 12/31/9999 20121 00049399041 GEODON CAP 80MG 12/31/9999 20121 00049399060 GEODON CAP 80MG 12/31/9999 20121 00049392083 GEODON INJ 20MG 12/31/9999 20121 54838000780 GERIATON LIQ 12/31/9999 20121 50383012016 GERI-TONIC LIQ 12/31/9999 20121 18860025330 GESTICARE PAK DHA 12/31/9999 20121 00121077504 GG/CODEINE SOL 100-10/5 12/31/9999 20121 00121077516 GG/CODEINE SOL 100-10/5 12/31/9999 20121 00121177505 GG/CODEINE SOL 100-10/5 12/31/9999 20121 00121177510 GG/CODEINE SOL 100-10/5 12/31/9999 20121 64376043516 GG/CODEINE SOL 100-10/5 12/31/9999 20121 00093542328 GIANVI TAB 3-0.02MG 12/31/9999 20121 00093542358 GIANVI TAB 3-0.02MG 12/31/9999 20121 00603760817 GILDESS FE TAB 1.5/30 12/31/9999 20121 00603760917 GILDESS FE TAB 1/20 12/31/9999 20121 00078060751 GILENYA CAP 0.5MG 12/31/9999 20121 51552121207 GINGER ROOT POW 12/31/9999 20121 51552067204 GINKGO BILOB POW 12/31/9999 20121 51552067205 GINKGO BILOB POW 12/31/9999 20121 00944288401 GLASSIA INJ 12/31/9999 20121 00078040134 GLEEVEC TAB 100MG 12/31/9999 20121 00078043815 GLEEVEC TAB 400MG 12/31/9999 20121 58063010001 GLIADEL WAF 7.7MG 12/31/9999 20121 62856017708 GLIADEL WAF 7.7MG 12/31/9999 20121 00093725401 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 00378401101 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 00603374421 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 00603374428 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 16729000101 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 45802077078 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 54458096810 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 55111032001 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 55111032005 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 61442011501 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 63304042501 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 66993016202 GLIMEPIRIDE TAB 1MG 12/31/9999 20121 00093725501 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 00378401201 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 00603374521 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 00603374528 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 00781504601 GLIMEPIRIDE TAB 2MG 05/31/2012 20121 16729000201 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 45802082278 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 51079042501 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 51079042520 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 54458096710 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 55111032101 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 55111032105 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 61442011601 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 63304042601 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 66993016302 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 68084032601 GLIMEPIRIDE TAB 2MG 12/31/9999 20121 00093725601 GLIMEPIRIDE TAB 4MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00093725652 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 00378401301 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 00603374621 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 00603374628 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 00781504701 GLIMEPIRIDE TAB 4MG 05/31/2012 20121 16729000301 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 45802094778 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 51079042601 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 51079042620 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 54458096610 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 55111032201 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 55111032205 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 61442011701 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 63304042701 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 66993016402 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 68084032701 GLIMEPIRIDE TAB 4MG 12/31/9999 20121 00093745501 GLIP/METFORM TAB 2.5-250M 12/31/9999 20121 00378313101 GLIP/METFORM TAB 2.5-250M 12/31/9999 20121 00591397101 GLIP/METFORM TAB 2.5-250M 12/31/9999 20121 23155011501 GLIP/METFORM TAB 2.5-250M 12/31/9999 20121 57664072788 GLIP/METFORM TAB 2.5-250M 12/31/9999 20121 00093745601 GLIP/METFORM TAB 2.5-500M 12/31/9999 20121 00378313201 GLIP/METFORM TAB 2.5-500M 12/31/9999 20121 00591397201 GLIP/METFORM TAB 2.5-500M 12/31/9999 20121 23155011601 GLIP/METFORM TAB 2.5-500M 12/31/9999 20121 57664072588 GLIP/METFORM TAB 2.5-500M 12/31/9999 20121 00093745701 GLIP/METFORM TAB 5-500MG 12/31/9999 20121 00378313301 GLIP/METFORM TAB 5-500MG 12/31/9999 20121 00591397301 GLIP/METFORM TAB 5-500MG 12/31/9999 20121 23155011701 GLIP/METFORM TAB 5-500MG 12/31/9999 20121 57664072488 GLIP/METFORM TAB 5-500MG 12/31/9999 20121 51552106402 GLIPIZIDE POW 12/31/9999 20121 00172365000 GLIPIZIDE TAB 10MG 12/31/9999 20121 00172365010 GLIPIZIDE TAB 10MG 12/31/9999 20121 00172365060 GLIPIZIDE TAB 10MG 12/31/9999 20121 00172365070 GLIPIZIDE TAB 10MG 12/31/9999 20121 00378111001 GLIPIZIDE TAB 10MG 12/31/9999 20121 00378111005 GLIPIZIDE TAB 10MG 12/31/9999 20121 00591046101 GLIPIZIDE TAB 10MG 12/31/9999 20121 00591046105 GLIPIZIDE TAB 10MG 12/31/9999 20121 00591046110 GLIPIZIDE TAB 10MG 12/31/9999 20121 00781145301 GLIPIZIDE TAB 10MG 12/31/9999 20121 00781145310 GLIPIZIDE TAB 10MG 12/31/9999 20121 00904612361 GLIPIZIDE TAB 10MG 12/31/9999 20121 16729014000 GLIPIZIDE TAB 10MG 12/31/9999 20121 16729014016 GLIPIZIDE TAB 10MG 12/31/9999 20121 51079081101 GLIPIZIDE TAB 10MG 12/31/9999 20121 51079081117 GLIPIZIDE TAB 10MG 12/31/9999 20121 51079081119 GLIPIZIDE TAB 10MG 12/31/9999 20121 51079081120 GLIPIZIDE TAB 10MG 12/31/9999 20121 57664039913 GLIPIZIDE TAB 10MG 12/31/9999 20121 57664039918 GLIPIZIDE TAB 10MG 12/31/9999 20121 57664039988 GLIPIZIDE TAB 10MG 12/31/9999 20121 60505014200 GLIPIZIDE TAB 10MG 12/31/9999 20121 60505014201 GLIPIZIDE TAB 10MG 12/31/9999 20121 60505014202 GLIPIZIDE TAB 10MG 12/31/9999 20121 60505014204 GLIPIZIDE TAB 10MG 12/31/9999 20121 68645015159 GLIPIZIDE TAB 10MG 12/31/9999 20121 00172364900 GLIPIZIDE TAB 5MG 12/31/9999 20121 00172364910 GLIPIZIDE TAB 5MG 12/31/9999 20121 00172364960 GLIPIZIDE TAB 5MG 12/31/9999 20121 00378110501 GLIPIZIDE TAB 5MG 12/31/9999 20121 00378110505 GLIPIZIDE TAB 5MG 12/31/9999 20121 00591046001 GLIPIZIDE TAB 5MG 12/31/9999 20121 00591046005 GLIPIZIDE TAB 5MG 12/31/9999 20121 00591046010 GLIPIZIDE TAB 5MG 12/31/9999 20121 00781145201 GLIPIZIDE TAB 5MG 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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