August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00781145210 GLIPIZIDE TAB 5MG 12/31/9999 20121 00904612461 GLIPIZIDE TAB 5MG 12/31/9999 20121 16729013900 GLIPIZIDE TAB 5MG 12/31/9999 20121 16729013916 GLIPIZIDE TAB 5MG 12/31/9999 20121 51079081001 GLIPIZIDE TAB 5MG 12/31/9999 20121 51079081017 GLIPIZIDE TAB 5MG 12/31/9999 20121 51079081019 GLIPIZIDE TAB 5MG 12/31/9999 20121 51079081020 GLIPIZIDE TAB 5MG 12/31/9999 20121 57664039813 GLIPIZIDE TAB 5MG 12/31/9999 20121 57664039818 GLIPIZIDE TAB 5MG 12/31/9999 20121 57664039888 GLIPIZIDE TAB 5MG 12/31/9999 20121 60505014100 GLIPIZIDE TAB 5MG 12/31/9999 20121 60505014101 GLIPIZIDE TAB 5MG 12/31/9999 20121 60505014102 GLIPIZIDE TAB 5MG 12/31/9999 20121 60505014108 GLIPIZIDE TAB 5MG 12/31/9999 20121 68645015054 GLIPIZIDE TAB 5MG 12/31/9999 20121 00228290010 GLIPIZIDE ER TAB 10MG 04/30/2013 20121 00228290050 GLIPIZIDE ER TAB 10MG 05/31/2013 20121 00228290096 GLIPIZIDE ER TAB 10MG 12/31/9999 20121 00591084501 GLIPIZIDE ER TAB 10MG 12/31/9999 20121 00591084510 GLIPIZIDE ER TAB 10MG 12/31/9999 20121 00591084515 GLIPIZIDE ER TAB 10MG 12/31/9999 20121 68084011201 GLIPIZIDE ER TAB 10MG 12/31/9999 20121 00228289803 GLIPIZIDE ER TAB 2.5MG 12/31/9999 20121 00591090030 GLIPIZIDE ER TAB 2.5MG 12/31/9999 20121 68084029521 GLIPIZIDE ER TAB 2.5MG 12/31/9999 20121 00228289910 GLIPIZIDE ER TAB 5MG 12/31/9999 20121 00228289950 GLIPIZIDE ER TAB 5MG 12/31/9999 20121 00591084401 GLIPIZIDE ER TAB 5MG 12/31/9999 20121 00591084410 GLIPIZIDE ER TAB 5MG 12/31/9999 20121 00591084415 GLIPIZIDE ER TAB 5MG 12/31/9999 20121 68084011101 GLIPIZIDE ER TAB 5MG 12/31/9999 20121 59762503301 GLIPIZIDE XL TAB 10MG 12/31/9999 20121 59762503302 GLIPIZIDE XL TAB 10MG 12/31/9999 20121 59762503101 GLIPIZIDE XL TAB 2.5MG 12/31/9999 20121 59762503201 GLIPIZIDE XL TAB 5MG 12/31/9999 20121 59762503202 GLIPIZIDE XL TAB 5MG 12/31/9999 20121 55390000401 GLUCAGEN INJ 1MG 12/31/9999 20121 55390000410 GLUCAGEN INJ 1MG 12/31/9999 20121 00169706515 GLUCAGEN INJ HYPOKIT 12/31/9999 20121 00002803101 GLUCAGON KIT 1MG 12/31/9999 20121 51552076004 GLUCONOLACTO POW 12/31/9999 20121 00087607111 GLUCOPHAGE TAB 1000MG 12/31/9999 20121 00087606005 GLUCOPHAGE TAB 500MG 12/31/9999 20121 00087606010 GLUCOPHAGE TAB 500MG 12/31/9999 20121 00087607005 GLUCOPHAGE TAB 850MG 12/31/9999 20121 00087606313 GLUCOPHAGE TAB XR 500MG 12/31/9999 20121 00087606413 GLUCOPHAGE TAB XR 750MG 12/31/9999 20121 51991003206 GLUCOS/CHOND CAP 250-200 12/31/9999 20121 51991010906 GLUCOSAMINE CAP 500MG 12/31/9999 20121 38779095604 GLUCOSAMINE POW ACETYL-D 12/31/9999 20121 00904589615 GLUCOSE CHW 4GM 12/31/9999 20121 00049412066 GLUCOTROL TAB 10MG 12/31/9999 20121 00049411066 GLUCOTROL TAB 5MG 12/31/9999 20121 00049156066 GLUCOTROL XL TAB 10MG 12/31/9999 20121 00049156073 GLUCOTROL XL TAB 10MG 12/31/9999 20121 00049162030 GLUCOTROL XL TAB 2.5MG 12/31/9999 20121 00049155066 GLUCOTROL XL TAB 5MG 12/31/9999 20121 00049155073 GLUCOTROL XL TAB 5MG 12/31/9999 20121 00087607311 GLUCOVANCE TAB 2.5-500 12/31/9999 20121 00087607411 GLUCOVANCE TAB 5-500MG 12/31/9999 20121 13913000316 GLUMETZA TAB 1000MG 12/31/9999 20121 13913000213 GLUMETZA TAB 500MG 12/31/9999 20121 51552019705 GLUTARALDEHY SOL 25% 12/31/9999 20121 51552019707 GLUTARALDEHY SOL 25% 12/31/9999 20121 51552055404 GLUTATHIONE CRY 12/31/9999 20121 00574195906 GLUTOL SOL 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00574006915 GLUTOSE 15 GEL 40% 12/31/9999 20121 00574006930 GLUTOSE 15 GEL 40% 12/31/9999 20121 00574007015 GLUTOSE 15 GEL 40% 12/31/9999 20121 00574007030 GLUTOSE 15 GEL 40% 12/31/9999 20121 00574006945 GLUTOSE 45 GEL 40% 12/31/9999 20121 00093571001 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00093571005 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00093571019 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00093571083 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00093571093 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00228275111 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00228275150 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 65862008001 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 65862008005 GLYB/METFORM TAB 1.25-250 12/31/9999 20121 00093571101 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 00093571105 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 00093571119 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 00093571193 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 00228275211 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 00228275250 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 59762233106 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 59762233108 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 65862008101 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 65862008105 GLYB/METFORM TAB 2.5-500 12/31/9999 20121 00093571201 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 00093571205 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 00093571219 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 00093571293 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 00228275311 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 00228275350 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 45963075302 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 59762233206 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 59762233208 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 65862008201 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 65862008205 GLYB/METFORM TAB 5-500MG 12/31/9999 20121 00093803401 GLYBURID MCR TAB 1.5MG 12/31/9999 20121 00143991801 GLYBURID MCR TAB 1.5MG 12/31/9999 20121 00378111301 GLYBURID MCR TAB 1.5MG 12/31/9999 20121 67253046010 GLYBURID MCR TAB 1.5MG 12/31/9999 20121 67253046050 GLYBURID MCR TAB 1.5MG 12/31/9999 20121 00093803501 GLYBURID MCR TAB 3MG 12/31/9999 20121 00093803505 GLYBURID MCR TAB 3MG 12/31/9999 20121 00143991901 GLYBURID MCR TAB 3MG 12/31/9999 20121 00143991905 GLYBURID MCR TAB 3MG 12/31/9999 20121 00378112501 GLYBURID MCR TAB 3MG 12/31/9999 20121 00378112510 GLYBURID MCR TAB 3MG 12/31/9999 20121 52152013402 GLYBURID MCR TAB 3MG 12/31/9999 20121 52152013404 GLYBURID MCR TAB 3MG 12/31/9999 20121 52152013405 GLYBURID MCR TAB 3MG 12/31/9999 20121 67253046110 GLYBURID MCR TAB 3MG 12/31/9999 20121 67253046111 GLYBURID MCR TAB 3MG 12/31/9999 20121 67253046150 GLYBURID MCR TAB 3MG 12/31/9999 20121 00093803601 GLYBURID MCR TAB 6MG 12/31/9999 20121 00143992001 GLYBURID MCR TAB 6MG 12/31/9999 20121 00143992005 GLYBURID MCR TAB 6MG 12/31/9999 20121 00143992010 GLYBURID MCR TAB 6MG 12/31/9999 20121 00378114201 GLYBURID MCR TAB 6MG 12/31/9999 20121 52152013502 GLYBURID MCR TAB 6MG 12/31/9999 20121 52152013504 GLYBURID MCR TAB 6MG 12/31/9999 20121 52152013505 GLYBURID MCR TAB 6MG 12/31/9999 20121 67253046210 GLYBURID MCR TAB 6MG 12/31/9999 20121 67253046211 GLYBURID MCR TAB 6MG 12/31/9999 20121 67253046250 GLYBURID MCR TAB 6MG 12/31/9999 20121 00093834201 GLYBURIDE TAB 1.25MG 12/31/9999 20121 00093947753 GLYBURIDE TAB 1.25MG 12/31/9999 20121 00904613760 GLYBURIDE TAB 1.25MG 12/31/9999 20121 23155005601 GLYBURIDE TAB 1.25MG 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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