August 31, 2012 - Iowa Medicaid Enterprise

More documents

Recommendations

Info

NDC Product Description Termination Date Quarter Covered 44087903001 GONAL-F INJ 450UNIT 12/31/9999 20121 44087111301 GONAL-F RFF INJ 300 12/31/9999 20121 44087111201 GONAL-F RFF INJ 450 12/31/9999 20121 44087900501 GONAL-F RFF INJ 75UNIT 12/31/9999 20121 44087900506 GONAL-F RFF INJ 75UNIT 12/31/9999 20121 44087111401 GONAL-F RFF INJ 900 12/31/9999 20121 00135046201 GOODYS POW EX ST 12/31/9999 20121 00135046202 GOODYS POW EX ST 12/31/9999 20121 10158000101 GOODYS POW EX ST 12/31/9999 20121 10158000102 GOODYS POW EX ST 12/31/9999 20121 10158000103 GOODYS POW EX ST 12/31/9999 20121 10158000104 GOODYS POW EX ST 12/31/9999 20121 10158000407 GOODYS TAB EX ST 12/31/9999 20121 10158099925 GOODYS BODY POW PAIN 12/31/9999 20121 10158099926 GOODYS BODY POW PAIN 12/31/9999 20121 10158000308 GOODYS PM POW 38-500MG 12/31/9999 20121 10158000309 GOODYS PM POW 38-500MG 12/31/9999 20121 13913000413 GRALISE TAB 300MG 12/31/9999 20121 13913000519 GRALISE TAB 600MG 12/31/9999 20121 13913000616 GRALISE STAR MIS 300/600 12/31/9999 20121 00703789101 GRANISETRON INJ 0.1MG/ML 12/31/9999 20121 17478054701 GRANISETRON INJ 0.1MG/ML 12/31/9999 20121 25021077801 GRANISETRON INJ 0.1MG/ML 12/31/9999 20121 60505076402 GRANISETRON INJ 0.1MG/ML 12/31/9999 20121 63323031701 GRANISETRON INJ 0.1MG/ML 12/31/9999 20121 00143974410 GRANISETRON INJ 1MG/ML 12/31/9999 20121 00703797101 GRANISETRON INJ 1MG/ML 12/31/9999 20121 00703797103 GRANISETRON INJ 1MG/ML 12/31/9999 20121 00703797301 GRANISETRON INJ 1MG/ML 12/31/9999 20121 17478054601 GRANISETRON INJ 1MG/ML 03/31/2013 20121 17478054602 GRANISETRON INJ 1MG/ML 12/31/9999 20121 25021077901 GRANISETRON INJ 1MG/ML 12/31/9999 20121 63323031801 GRANISETRON INJ 1MG/ML 12/31/9999 20121 64679066103 GRANISETRON INJ 1MG/ML 12/31/9999 20121 66758003501 GRANISETRON INJ 1MG/ML 12/31/9999 20121 00143974505 GRANISETRON INJ 4MG/4ML 12/31/9999 20121 17478054605 GRANISETRON INJ 4MG/4ML 12/31/9999 20121 25021078104 GRANISETRON INJ 4MG/4ML 12/31/9999 20121 63323031904 GRANISETRON INJ 4MG/4ML 12/31/9999 20121 64679066102 GRANISETRON INJ 4MG/4ML 12/31/9999 20121 66758003601 GRANISETRON INJ 4MG/4ML 12/31/9999 20121 00054014308 GRANISETRON TAB 1MG 12/31/9999 20121 00054014387 GRANISETRON TAB 1MG 12/31/9999 20121 00093748512 GRANISETRON TAB 1MG 12/31/9999 20121 00093748519 GRANISETRON TAB 1MG 12/31/9999 20121 00093748520 GRANISETRON TAB 1MG 12/31/9999 20121 00378100394 GRANISETRON TAB 1MG 12/31/9999 20121 16714022101 GRANISETRON TAB 1MG 12/31/2020 20121 16714022130 GRANISETRON TAB 1MG 12/31/2020 20121 16714022132 GRANISETRON TAB 1MG 12/31/2020 20121 51079047201 GRANISETRON TAB 1MG 11/30/2012 20121 51079047205 GRANISETRON TAB 1MG 11/30/2012 20121 51672413806 GRANISETRON TAB 1MG 12/31/9999 20121 51991073520 GRANISETRON TAB 1MG 12/31/9999 20121 51991073532 GRANISETRON TAB 1MG 12/31/9999 20121 67877018402 GRANISETRON TAB 1MG 12/31/9999 20121 67877018420 GRANISETRON TAB 1MG 12/31/9999 20121 52547080130 GRANISOL SOL 2MG/10ML 12/31/9999 20121 51079062181 GRANULEX AER 12/31/9999 20121 51079062182 GRANULEX AER 12/31/9999 20121 51552016503 GRAPE LIQ FLAVOR 12/31/9999 20121 51552083106 GRAPE SYP 12/31/9999 20121 51552130304 GRAPE SEED OIL 12/31/9999 20121 51552098607 GRAPE SEED POW 95% 12/31/9999 20121 51552015104 GREEN SOAP TIN 12/31/9999 20121 51552015106 GREEN SOAP TIN 12/31/9999 20121 51552015108 GREEN SOAP TIN 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00062021460 GRIFULVIN V TAB 500MG 12/31/9999 20121 00093710212 GRISEOFULVIN SUS 125/5ML 12/31/9999 20121 00472001304 GRISEOFULVIN SUS 125/5ML 12/31/9999 20121 00603917154 GRISEOFULVIN SUS 125/5ML 12/31/9999 20121 45802096826 GRISEOFULVIN SUS 125/5ML 12/31/9999 20121 00884076304 GRIS-PEG TAB 125MG 12/31/9999 20121 00884077304 GRIS-PEG TAB 250MG 12/31/9999 20121 51552017605 GUAIACOL SOL 12/31/9999 20121 50383008704 GUAIATUSSIN SYP AC 12/31/9999 20121 50383008716 GUAIATUSSIN SYP AC 12/31/9999 20121 00121074404 GUAIFENESIN SOL 100/5ML 12/31/9999 20121 00121074408 GUAIFENESIN SOL 100/5ML 12/31/9999 20121 00121074416 GUAIFENESIN SOL 100/5ML 12/31/9999 20121 00121174405 GUAIFENESIN SOL 100/5ML 12/31/9999 20121 00121174410 GUAIFENESIN SOL 100/5ML 12/31/9999 20121 00121174415 GUAIFENESIN SOL 100/5ML 12/31/9999 20121 16571030116 GUAIFENESIN SOL DAC 12/31/9999 20121 16571030216 GUAIFENESIN SYP AC 12/31/9999 20121 00121063804 GUAIFENESIN SYP DM 12/31/9999 20121 00121063805 GUAIFENESIN SYP DM 12/31/9999 20121 00121063808 GUAIFENESIN SYP DM 12/31/9999 20121 00121063810 GUAIFENESIN SYP DM 12/31/9999 20121 00121063816 GUAIFENESIN SYP DM 12/31/9999 20121 00904515460 GUAIFENESIN TAB 200MG 12/31/9999 20121 45802049878 GUAIFENESIN TAB 600MG ER 12/31/9999 20121 00172422660 GUANABENZ TAB 4MG 08/31/2012 20121 00172422760 GUANABENZ TAB 8MG 10/31/2012 20121 00378116001 GUANFACINE TAB 1MG 12/31/9999 20121 00591044401 GUANFACINE TAB 1MG 12/31/9999 20121 00904618360 GUANFACINE TAB 1MG 12/31/9999 20121 52152011802 GUANFACINE TAB 1MG 12/31/9999 20121 52152011804 GUANFACINE TAB 1MG 12/31/9999 20121 65162071110 GUANFACINE TAB 1MG 12/31/9999 20121 00378119001 GUANFACINE TAB 2MG 12/31/9999 20121 00591045301 GUANFACINE TAB 2MG 12/31/9999 20121 00904618460 GUANFACINE TAB 2MG 12/31/9999 20121 52152011902 GUANFACINE TAB 2MG 12/31/9999 20121 52152011904 GUANFACINE TAB 2MG 12/31/9999 20121 65162071310 GUANFACINE TAB 2MG 12/31/9999 20121 00085049201 GUANIDINE TAB 125MG 12/31/9999 20121 00472041904 GUIATUSS SYP 100/5ML 12/31/9999 20121 00472041916 GUIATUSS SYP 100/5ML 12/31/9999 20121 00472041994 GUIATUSS SYP 100/5ML 12/31/9999 20121 00472041998 GUIATUSS SYP 100/5ML 12/31/9999 20121 00472041594 GUIATUSS SYP CF 12/31/9999 20121 00472001204 GUIATUSS AC SYP 100-10/5 12/31/9999 20121 00472001216 GUIATUSS AC SYP 100-10/5 12/31/9999 20121 00472001228 GUIATUSS AC SYP 100-10/5 12/31/9999 20121 00472042094 GUIATUSS CF SYP 12/31/9999 20121 00472001116 GUIATUSS DAC SOL 12/31/9999 20121 00472103104 GUIATUSS DM SYP 100-10/5 12/31/9999 20121 00472103116 GUIATUSS DM SYP 100-10/5 12/31/9999 20121 00472103128 GUIATUSS DM SYP 100-10/5 12/31/9999 20121 00472103194 GUIATUSS DM SYP 100-10/5 12/31/9999 20121 00472103198 GUIATUSS DM SYP 100-10/5 12/31/9999 20121 00472042194 GUIATUSS PE SYP 30-100/5 12/31/9999 20121 64011000108 GYNAZOLE-1 CRE 2% 12/31/9999 20121 62107000984 H.E.A.R. SOL 6.5% OT 12/31/9999 20121 00113079830 HAIR REGROWT SOL 5% MEN 12/31/9999 20121 62856038901 HALAVEN INJ 1MG/2ML 12/31/9999 20121 00009001755 HALCION TAB 0.25MG 12/31/9999 20121 00009001759 HALCION TAB 0.25MG 12/31/9999 20121 50458025501 HALDOL INJ 5MG/ML 12/31/9999 20121 50458025414 HALDOL DECAN INJ 100MG/ML 12/31/9999 20121 50458025303 HALDOL DECAN INJ 50MG/ML 12/31/9999 20121 52268052302 HALFLYTELY KIT FLAV PKS 12/31/9999 20121 00713064015 HALOBETASOL CRE 0.05% 12/31/9999 20121
Page 1 and 2:
Rebatable Drug List for Iowa Medica
Page 3 and 4:
NDC Product Description Termination
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142: NDC Product Description Termination
Page 191: NDC Product Description Termination
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
Page 343 and 344:
Page 345 and 346:
Page 347 and 348:
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
Page 357 and 358:
Page 359 and 360:
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469:
show all

August 31, 2012 - Iowa Medicaid Enterprise

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?