August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00713064086 HALOBETASOL CRE 0.05% 12/31/9999 20121 45802012932 HALOBETASOL CRE 0.05% 12/31/9999 20121 45802012935 HALOBETASOL CRE 0.05% 12/31/9999 20121 51672132101 HALOBETASOL CRE 0.05% 12/31/9999 20121 51672132103 HALOBETASOL CRE 0.05% 12/31/9999 20121 00168035615 HALOBETASOL OIN 0.05% 12/31/9999 20121 00168035650 HALOBETASOL OIN 0.05% 12/31/9999 20121 00472026115 HALOBETASOL OIN 0.05% 12/31/9999 20121 00472026150 HALOBETASOL OIN 0.05% 12/31/9999 20121 00713063915 HALOBETASOL OIN 0.05% 12/31/9999 20121 00713063986 HALOBETASOL OIN 0.05% 12/31/9999 20121 45802013132 HALOBETASOL OIN 0.05% 12/31/9999 20121 45802013135 HALOBETASOL OIN 0.05% 12/31/9999 20121 51672132201 HALOBETASOL OIN 0.05% 12/31/9999 20121 51672132203 HALOBETASOL OIN 0.05% 12/31/9999 20121 10631009420 HALOG CRE 0.1% 12/31/9999 20121 10631009430 HALOG CRE 0.1% 12/31/9999 20121 10631009476 HALOG CRE 0.1% 12/31/9999 20121 10631009620 HALOG OIN 0.1% 12/31/9999 20121 10631009630 HALOG OIN 0.1% 12/31/9999 20121 68712003401 HALONATE KIT 12/31/9999 20121 68712004201 HALONATE PAC KIT 12/31/9999 20121 00703702101 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 00703702103 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 00703702301 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 10147092205 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 60505070301 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 60505602102 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 63323047101 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 63323047105 HALOPER DEC INJ 100MG/ML 12/31/9999 20121 00703701101 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 00703701103 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 00703701301 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 10147092103 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 60505070201 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 60505602002 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 63323046901 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 63323046905 HALOPER DEC INJ 50MG/ML 12/31/9999 20121 00069011301 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 00069011302 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 00703704101 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 00703704103 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 00703704501 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 10147091101 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 25021080601 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 25021082310 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 55390014701 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 55390014710 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 63323047401 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 63323047410 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 63323047491 HALOPER LAC INJ 5MG/ML 12/31/9999 20121 00093960412 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 00093960423 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 00121058104 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 00121058105 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 00603129054 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 54838050115 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 54838050140 HALOPERIDOL CON 2MG/ML 12/31/9999 20121 00378035101 HALOPERIDOL TAB 0.5MG 12/31/9999 20121 00378035110 HALOPERIDOL TAB 0.5MG 12/31/9999 20121 00781139101 HALOPERIDOL TAB 0.5MG 12/31/9999 20121 00781139113 HALOPERIDOL TAB 0.5MG 12/31/9999 20121 51079073301 HALOPERIDOL TAB 0.5MG 12/31/9999 20121 51079073320 HALOPERIDOL TAB 0.5MG 12/31/9999 20121 00378033401 HALOPERIDOL TAB 10MG 12/31/9999 20121 00406208001 HALOPERIDOL TAB 10MG 12/31/9999 20121 00781139701 HALOPERIDOL TAB 10MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00781139713 HALOPERIDOL TAB 10MG 12/31/9999 20121 51079043101 HALOPERIDOL TAB 10MG 12/31/9999 20121 51079043120 HALOPERIDOL TAB 10MG 12/31/9999 20121 68084024901 HALOPERIDOL TAB 10MG 12/31/9999 20121 68382008001 HALOPERIDOL TAB 10MG 12/31/9999 20121 00378025701 HALOPERIDOL TAB 1MG 12/31/9999 20121 00378025710 HALOPERIDOL TAB 1MG 12/31/9999 20121 00615259539 HALOPERIDOL TAB 1MG 12/31/9999 20121 00781139201 HALOPERIDOL TAB 1MG 12/31/9999 20121 00781139213 HALOPERIDOL TAB 1MG 12/31/9999 20121 00904592361 HALOPERIDOL TAB 1MG 12/31/9999 20121 51079073401 HALOPERIDOL TAB 1MG 12/31/9999 20121 51079073420 HALOPERIDOL TAB 1MG 12/31/9999 20121 00378033501 HALOPERIDOL TAB 20MG 12/31/9999 20121 00406208101 HALOPERIDOL TAB 20MG 12/31/9999 20121 00781139801 HALOPERIDOL TAB 20MG 12/31/9999 20121 68084025021 HALOPERIDOL TAB 20MG 12/31/9999 20121 68382008101 HALOPERIDOL TAB 20MG 12/31/9999 20121 00378021401 HALOPERIDOL TAB 2MG 12/31/9999 20121 00378021410 HALOPERIDOL TAB 2MG 12/31/9999 20121 00615259639 HALOPERIDOL TAB 2MG 12/31/9999 20121 00781139301 HALOPERIDOL TAB 2MG 12/31/9999 20121 00781139313 HALOPERIDOL TAB 2MG 12/31/9999 20121 00904592461 HALOPERIDOL TAB 2MG 12/31/9999 20121 51079073501 HALOPERIDOL TAB 2MG 12/31/9999 20121 51079073520 HALOPERIDOL TAB 2MG 12/31/9999 20121 00378032701 HALOPERIDOL TAB 5MG 12/31/9999 20121 00378032710 HALOPERIDOL TAB 5MG 12/31/9999 20121 00615259739 HALOPERIDOL TAB 5MG 12/31/9999 20121 00781139601 HALOPERIDOL TAB 5MG 12/31/9999 20121 00781139610 HALOPERIDOL TAB 5MG 12/31/9999 20121 00781139613 HALOPERIDOL TAB 5MG 12/31/9999 20121 00904592561 HALOPERIDOL TAB 5MG 12/31/9999 20121 51079073601 HALOPERIDOL TAB 5MG 12/31/9999 20121 51079073620 HALOPERIDOL TAB 5MG 12/31/9999 20121 51079073656 HALOPERIDOL TAB 5MG 12/31/9999 20121 51552113707 HAWTHORN BER POW 2% 12/31/9999 20121 45802019003 HC AC/ALOE CRE 0.5% 11/22/2012 20121 60258004843 HC AC/ALOE GEL 2% 12/31/9999 20121 43478027015 HC BUTYRATE CRE 0.1% 12/31/9999 20121 43478027045 HC BUTYRATE CRE 0.1% 12/31/9999 20121 51672407401 HC BUTYRATE CRE 0.1% 12/31/9999 20121 51672407406 HC BUTYRATE CRE 0.1% 12/31/9999 20121 43478027115 HC BUTYRATE OIN 0.1% 12/31/9999 20121 43478027145 HC BUTYRATE OIN 0.1% 12/31/9999 20121 51672408301 HC BUTYRATE OIN 0.1% 12/31/9999 20121 51672408306 HC BUTYRATE OIN 0.1% 12/31/9999 20121 43478027361 HC BUTYRATE SOL 0.1% 12/31/9999 20121 51672406102 HC BUTYRATE SOL 0.1% 12/31/9999 20121 51672406104 HC BUTYRATE SOL 0.1% 12/31/9999 20121 45802014464 HC PRAMOXINE CRE 1-1% 12/31/9999 20121 45802012416 HC PRAMOXINE CRE 1-2.5% 12/31/9999 20121 45802012464 HC PRAMOXINE CRE 1-2.5% 12/31/9999 20121 42192010701 HC PRAMOXINE CRE 2.5-1% 12/31/9999 20121 42192010804 HC PRAMOXINE CRE 2.5-1% 12/31/9999 20121 45802047253 HC PRAMOXINE CRE 2.5-1% 12/31/9999 20121 45802047264 HC PRAMOXINE CRE 2.5-1% 12/31/9999 20121 45802047265 HC PRAMOXINE CRE 2.5-1% 12/31/9999 20121 45802045535 HC VALERATE CRE 0.2% 12/31/9999 20121 45802045537 HC VALERATE CRE 0.2% 12/31/9999 20121 45802045542 HC VALERATE CRE 0.2% 12/31/9999 20121 51672129001 HC VALERATE CRE 0.2% 12/31/9999 20121 51672129003 HC VALERATE CRE 0.2% 12/31/9999 20121 51672129006 HC VALERATE CRE 0.2% 12/31/9999 20121 51672129201 HC VALERATE OIN 0.2% 12/31/9999 20121 51672129203 HC VALERATE OIN 0.2% 12/31/9999 20121 51672129206 HC VALERATE OIN 0.2% 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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