August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00603389021 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 00603389022 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 00603389028 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 00603389032 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 50268040315 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 51079077701 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 51079077721 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 53746010901 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 53746010905 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 53746010910 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 57664012613 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 57664012688 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 63739038410 HYDROCO/APAP TAB 5-325MG 02/28/2013 20121 63739053210 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 68084036801 HYDROCO/APAP TAB 5-325MG 12/31/9999 20121 00406035701 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00406035705 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00406035762 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00406035791 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00591034901 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00591034905 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388102 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388104 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388112 HYDROCO/APAP TAB 5-500MG 07/31/2013 20121 00603388116 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388119 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388120 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388121 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388122 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388128 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00603388132 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 00904344061 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 46672005210 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 46672005250 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 51079078096 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 51079078099 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 53746011101 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 53746011105 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 53746011110 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 62584073801 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 63739045501 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 63739045510 HYDROCO/APAP TAB 5-500MG 12/31/9999 20121 10914055101 HYDROCO/APAP TAB 7.5-300 12/31/9999 20121 64376064901 HYDROCO/APAP TAB 7.5-300 12/31/9999 20121 00406036601 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00406036605 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00406036662 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00591320301 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00603389102 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00603389121 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00603389122 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00603389128 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00603389132 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 51079077801 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 51079077821 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 57664017013 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 57664017088 HYDROCO/APAP TAB 7.5-325 12/31/9999 20121 00406035801 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00406035805 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00406035862 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00591038501 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00591038505 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00603388202 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00603388204 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00603388212 HYDROCO/APAP TAB 7.5-500 04/30/2013 20121 00603388216 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00603388220 HYDROCO/APAP TAB 7.5-500 01/31/2013 20121
NDC Product Description Termination Date Quarter Covered 00603388221 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00603388222 HYDROCO/APAP TAB 7.5-500 04/30/2013 20121 00603388228 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00603388232 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 53746011201 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 53746011205 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 53746011210 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 63739014110 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 68084014501 HYDROCO/APAP TAB 7.5-500 12/31/9999 20121 00406035901 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 00406035905 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 00591050201 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 00591050205 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 00603388421 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 00603388428 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 53746011301 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 53746011305 HYDROCO/APAP TAB 7.5-650 12/31/9999 20121 00406036001 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00406036005 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00591038701 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00591038705 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00603388302 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00603388320 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00603388321 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00603388322 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00603388328 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00603388332 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00904763261 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 53746011801 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 53746011805 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 53746011810 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 63739013110 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 68084014401 HYDROCO/APAP TAB 7.5-750 12/31/9999 20121 00121481105 HYDROCOD/HOM SYP 5-1.5/5 12/31/9999 20121 50383004316 HYDROCOD/HOM SYP 5-1.5/5 12/31/9999 20121 60432045516 HYDROCOD/HOM SYP 5-1.5/5 12/31/9999 20121 00093516101 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 00603389721 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 00603389728 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 53746014501 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 62037052401 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 62037052405 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 68084022701 HYDROCOD/IBU TAB 7.5-200 12/31/9999 20121 43386035001 HYDROCODONE/ TAB HOMATROP 12/31/9999 20121 43386035003 HYDROCODONE/ TAB HOMATROP 12/31/9999 20121 00168001431 HYDROCORT CRE 0.5% 12/31/9999 20121 24385019003 HYDROCORT CRE 0.5% 12/31/9999 20121 49348002172 HYDROCORT CRE 0.5% 12/31/9999 20121 00168001516 HYDROCORT CRE 1% 12/31/9999 20121 00168001531 HYDROCORT CRE 1% 12/31/9999 20121 00168015408 HYDROCORT CRE 1% 12/31/9999 20121 00168015431 HYDROCORT CRE 1% 12/31/9999 20121 00472032126 HYDROCORT CRE 1% 12/31/9999 20121 00472034356 HYDROCORT CRE 1% 12/31/9999 20121 00603053550 HYDROCORT CRE 1% 12/31/9999 20121 00904762331 HYDROCORT CRE 1% 12/31/9999 20121 37205016210 HYDROCORT CRE 1% 12/31/9999 20121 45802043802 HYDROCORT CRE 1% 08/03/2014 20121 45802043803 HYDROCORT CRE 1% 12/31/9999 20121 45802043805 HYDROCORT CRE 1% 12/31/9999 20121 45802043870 HYDROCORT CRE 1% 12/31/9999 20121 51672201301 HYDROCORT CRE 1% 12/31/9999 20121 51672201302 HYDROCORT CRE 1% 12/31/9999 20121 51672201309 HYDROCORT CRE 1% 12/31/9999 20121 51672206302 HYDROCORT CRE 1% 12/31/9999 20121 51672206902 HYDROCORT CRE 1% 12/31/9999 20121 51672300402 HYDROCORT CRE 1% 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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