August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00603703939 HC/ACET ACID SOL OTIC 12/31/9999 20121 45963041261 HC/ACET ACID SOL OTIC 12/31/9999 20121 50383090110 HC/ACET ACID SOL OTIC 12/31/9999 20121 51672300701 HC/ACET ACID SOL OTIC 12/31/9999 20121 51672201001 HC/ALOE CRE 0.5% 12/31/9999 20121 51672201002 HC/ALOE CRE 0.5% 12/31/9999 20121 00113043078 HEADACHE TAB FORMULA 03/14/2013 20121 00113035571 HEADACHE TAB PM 12/31/9999 20121 36800035571 HEADACHE TAB PM 12/31/9999 20121 36800043078 HEADACHE FOR TAB ADDED ST 12/31/9999 20121 37205070378 HEADACHE FOR TAB ADDED ST 12/31/9999 20121 63868015901 HEADACHE REL TAB PM 12/31/9999 20121 46122009372 HEALTHY EYES CAP SUPERVIS 12/31/9999 20121 68084043098 HEALTHYLAX POW 12/31/9999 20121 63868099601 HEARTBRN ANT CHW 160-105 12/31/9999 20121 36800004702 HEARTBURN TAB 150MG 12/31/9999 20121 36800004771 HEARTBURN TAB 150MG 12/31/9999 20121 24385011165 HEARTBURN TAB 200MG 01/21/2013 20121 36800027139 HEARTBURN TAB REL 75MG 12/31/9999 20121 36800027172 HEARTBURN TAB REL 75MG 12/31/9999 20121 00113002239 HEARTBURN TAB RELIEF 01/21/2013 20121 00904552952 HEARTBURN TAB RELIEF 12/31/9999 20121 00904552987 HEARTBURN TAB RELIEF 12/31/9999 20121 00904578017 HEARTBURN TAB RELIEF 12/31/9999 20121 00904578051 HEARTBURN TAB RELIEF 12/31/9999 20121 36800002239 HEARTBURN TAB RELIEF 12/31/9999 20121 68462030329 HEATHER TAB 0.35MG 12/31/9999 20121 00078061605 HECORIA CAP 0.5MG 12/31/9999 20121 00078061705 HECORIA CAP 1MG 12/31/9999 20121 00078061805 HECORIA CAP 5MG 12/31/9999 20121 58468012001 HECTOROL CAP 0.5MCG 12/31/9999 20121 58468012401 HECTOROL CAP 1MCG 12/31/9999 20121 58468012101 HECTOROL CAP 2.5MCG 12/31/9999 20121 58468012601 HECTOROL INJ 2MCG/ML 12/31/9999 20121 58468012301 HECTOROL INJ 4MCG/2ML 12/31/9999 20121 65483049514 HELIDAC MIS 12/31/9999 20121 00053813302 HELIXATE FS INJ 1000UNIT 12/31/9999 20121 00053813402 HELIXATE FS INJ 2000UNIT 12/31/9999 20121 00053813102 HELIXATE FS INJ 250UNIT 12/31/9999 20121 00053813502 HELIXATE FS INJ 3000UNIT 12/31/9999 20121 00053813202 HELIXATE FS INJ 500UNIT 12/31/9999 20121 00009085605 HEMABATE INJ 250MCG 12/31/9999 20121 00009085608 HEMABATE INJ 250MCG 12/31/9999 20121 60258018101 HEMATINIC/FA TAB 06/30/2012 20121 63044063119 HEMATOGEN CAP 12/31/9999 20121 63044063321 HEMATOGEN CAP FORTE 12/31/9999 20121 63044063217 HEMATOGEN FA CAP 12/31/9999 20121 52747080030 HEMOCYTE PLS CAP 12/31/9999 20121 52747080060 HEMOCYTE PLS CAP 12/31/9999 20121 52747030630 HEMOCYTE-F TAB 12/31/9999 20121 52747030670 HEMOCYTE-F TAB 12/31/9999 20121 00944293001 HEMOFIL M INJ 220-400 12/31/9999 20121 00944293101 HEMOFIL M INJ 401-800 12/31/9999 20121 00944293301 HEMOFIL M SOL 501-2000 12/31/9999 20121 00944293201 HEMOFIL M SOL 801-1500 12/31/9999 20121 37205071516 HEMORRHOID SUP 12/31/9999 20121 00113094424 HEMORRHOIDAL CRE 12/31/9999 20121 37205057224 HEMORRHOIDAL CRE 12/31/9999 20121 24385042106 HEMORRHOIDAL GEL COOLING 12/31/9999 20121 00113040016 HEMORRHOIDAL OIN 12/31/9999 20121 00603052052 HEMORRHOIDAL OIN 12/31/9999 20121 24385038746 HEMORRHOIDAL OIN 12/31/9999 20121 36800040016 HEMORRHOIDAL OIN 12/31/9999 20121 49614038716 HEMORRHOIDAL OIN 12/31/9999 20121 63868020102 HEMORRHOIDAL OIN 12/31/9999 20121 00113039453 HEMORRHOIDAL SUP 12/31/9999 20121 00113039462 HEMORRHOIDAL SUP 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00536138912 HEMORRHOIDAL SUP 12/31/9999 20121 00603052411 HEMORRHOIDAL SUP 12/31/9999 20121 24385031553 HEMORRHOIDAL SUP 12/31/9999 20121 36800039453 HEMORRHOIDAL SUP 12/31/9999 20121 36800039462 HEMORRHOIDAL SUP 12/31/9999 20121 63868020812 HEMORRHOIDAL SUP 12/31/9999 20121 00472051112 HEMORRHOIDAL SUP -HC 25MG 12/31/9999 20121 00472051124 HEMORRHOIDAL SUP -HC 25MG 12/31/9999 20121 00603812711 HEMORRHOIDAL SUP -HC 25MG 12/31/2012 20121 00603812718 HEMORRHOIDAL SUP -HC 25MG 09/30/2012 20121 00904512437 HEM-PREP CRE 12/31/9999 20121 00904530424 HEM-PREP SUP 12/31/9999 20121 00245011212 HEMRIL-30 SUP 30MG 12/31/9999 20121 00245011224 HEMRIL-30 SUP 30MG 12/31/9999 20121 00409779362 HEP SOD/D5W INJ 100/ML 12/31/9999 20121 00264956710 HEP SOD/D5W INJ 20000UNT 12/31/9999 20121 00409776003 HEP SOD/D5W INJ 20000UNT 12/31/9999 20121 00264957710 HEP SOD/D5W INJ 25000UNT 12/31/9999 20121 00264958720 HEP SOD/D5W INJ 25000UNT 12/31/9999 20121 00409776103 HEP SOD/D5W INJ 25000UNT 12/31/9999 20121 00409779462 HEP SOD/D5W INJ 50UNT/ML 12/31/9999 20121 00264987210 HEP SOD/NACL INJ 1000UNIT 12/31/9999 20121 00338043103 HEP SOD/NACL INJ 1000UNIT 12/31/9999 20121 00409765162 HEP SOD/NACL INJ 12500UNT 12/31/9999 20121 00338043304 HEP SOD/NACL INJ 2000UNIT 12/31/9999 20121 00409765062 HEP SOD/NACL INJ 25000UNT 12/31/9999 20121 00409765103 HEP SOD/NACL INJ 25000UNT 12/31/9999 20121 00409762003 HEP SOD/NACL INJ 2UNIT/ML 12/31/9999 20121 00409762059 HEP SOD/NACL INJ 2UNIT/ML 12/31/9999 20121 53270005101 HEPAGAM B INJ 12/31/9999 20121 53270005201 HEPAGAM B INJ 12/31/9999 20121 53270005301 HEPAGAM B INJ 12/31/9999 20121 53270005401 HEPAGAM B INJ 12/31/9999 20121 00409115270 HEPARIN LOCK INJ 100/ML 12/31/9999 20121 00409115278 HEPARIN LOCK INJ 100/ML 12/31/9999 20121 00409128131 HEPARIN LOCK INJ 100/ML 12/31/9999 20121 00409128132 HEPARIN LOCK INJ 100/ML 12/31/9999 20121 00409128133 HEPARIN LOCK INJ 100/ML 12/31/9999 20121 00409128135 HEPARIN LOCK INJ 100/ML 12/31/9999 20121 00409115170 HEPARIN LOCK INJ 10UNT/ML 12/31/9999 20121 00409115178 HEPARIN LOCK INJ 10UNT/ML 12/31/9999 20121 00409128031 HEPARIN LOCK INJ 10UNT/ML 12/31/9999 20121 00409128032 HEPARIN LOCK INJ 10UNT/ML 12/31/9999 20121 00409128033 HEPARIN LOCK INJ 10UNT/ML 12/31/9999 20121 00409128035 HEPARIN LOCK INJ 10UNT/ML 12/31/9999 20121 00069004301 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00069004302 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00069005801 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00069005802 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00409272001 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00409272002 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00409272003 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00641039112 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00641245055 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 25021040001 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 25021040010 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 25021040030 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 25021040102 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 63323027602 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 63323054001 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 63323054011 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 63323054031 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 63323054057 HEPARIN SOD INJ 1000/ML 12/31/9999 20121 00069006201 HEPARIN SOD INJ 10000/ML 12/31/9999 20121 00069006202 HEPARIN SOD INJ 10000/ML 12/31/9999 20121 00409272101 HEPARIN SOD INJ 10000/ML 12/31/9999 20121 00641041012 HEPARIN SOD INJ 10000/ML 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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