August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 52152031305 HYDROXYZ HCL TAB 50MG 12/31/9999 20121 67405057710 HYDROXYZ HCL TAB 50MG 12/31/9999 20121 67405057750 HYDROXYZ HCL TAB 50MG 12/31/9999 20121 68084025501 HYDROXYZ HCL TAB 50MG 12/31/9999 20121 68462036201 HYDROXYZ HCL TAB 50MG 12/31/9999 20121 68462036205 HYDROXYZ HCL TAB 50MG 12/31/9999 20121 00555032402 HYDROXYZ PAM CAP 100MG 12/31/9999 20121 00185061301 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 00185061305 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 00555032302 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 00555032304 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 00591080001 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 00591080005 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 51079007701 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 51079007720 HYDROXYZ PAM CAP 25MG 12/31/9999 20121 00185061501 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 00185061505 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 00555030202 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 00555030204 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 00591080101 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 00591080105 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 51079007801 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 51079007820 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 62584074101 HYDROXYZ PAM CAP 50MG 12/31/9999 20121 00095007375 HYLASE WOUND GEL 12/31/9999 20121 18657010201 HYLENEX INJ 150 UNIT 12/31/9999 20121 18657010204 HYLENEX INJ 150 UNIT 12/31/9999 20121 24486060510 HYOMAX TAB 0.125MG 07/31/2012 20121 24486060310 HYOMAX-FT TAB 0.125MG 07/31/2012 20121 24486060110 HYOMAX-SL SUB 0.125MG 10/31/2013 20121 60258080215 HYOSCYAMINE DRO 0.125/ML 12/31/9999 20121 60258080116 HYOSCYAMINE ELX 0.125/5 12/31/9999 20121 00574025001 HYOSCYAMINE SUB 0.125MG 12/31/9999 20121 00904512060 HYOSCYAMINE SUB 0.125MG 12/31/2012 20121 10267273401 HYOSCYAMINE SUB 0.125MG 12/31/9999 20121 13811010210 HYOSCYAMINE SUB 0.125MG 12/31/9999 20121 43199001101 HYOSCYAMINE SUB 0.125MG 12/31/9999 20121 51991065601 HYOSCYAMINE SUB 0.125MG 12/31/9999 20121 76439030910 HYOSCYAMINE SUB 0.125MG 12/31/9999 20121 00574024601 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 00574024701 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 10267162101 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 13811010110 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 13811010310 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 43199001201 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 43199001301 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 51991032501 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 76439030710 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 76439030810 HYOSCYAMINE TAB 0.125MG 12/31/9999 20121 54838050615 HYOSYNE DRO 0.125/ML 12/31/9999 20121 54838051180 HYOSYNE ELX 0.125/5 12/31/9999 20121 58980015010 HYPERCARE SOL 20% 12/31/9999 20121 58980015011 HYPERCARE SOL 20% 12/31/9999 20121 58980015020 HYPERCARE SOL 20% 12/31/9999 20121 58980015022 HYPERCARE SOL 20% 12/31/9999 20121 13533063602 HYPERHEP B INJ S/D 12/31/9999 20121 13533063603 HYPERHEP B INJ S/D 12/31/9999 20121 13533063605 HYPERHEP B INJ S/D 12/31/9999 20121 00264194320 HYPERLYTE-CR INJ 12/31/9999 20121 13533061802 HYPERRAB S/D INJ 150/ML 12/31/9999 20121 13533061810 HYPERRAB S/D INJ 150/ML 12/31/9999 20121 13533063102 HYPERRHO S/D INJ 300MCG 12/31/9999 20121 13533063106 HYPERRHO S/D INJ 50MCG 12/31/9999 20121 68405802736 HYPERTENEVID PAK 12.5MG 12/31/9999 20121 68405803736 HYPERTENIPIN PAK 2.5MG 12/31/9999 20121 68405100702 HYPERTENSA CAP 12/31/9999 20121 68405100703 HYPERTENSA CAP 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 68405801736 HYPERTENSOLO PAK 12/31/9999 20121 13533063402 HYPERTET S/D INJ 250/ML 12/31/9999 20121 00078051924 HYPOTEARS SOL 1-1% 12/31/9999 20121 00078051982 HYPOTEARS SOL 1-1% 12/31/9999 20121 58768013030 HYPOTEARS SOL 1-1% 07/31/2012 20121 51552104106 HYPROMELLOSE POW 100CPS 12/31/9999 20121 00006074531 HYZAAR TAB 100-12.5 12/31/9999 20121 00006074554 HYZAAR TAB 100-12.5 12/31/9999 20121 00006074582 HYZAAR TAB 100-12.5 12/31/9999 20121 00006074728 HYZAAR TAB 100-25 12/31/9999 20121 00006074731 HYZAAR TAB 100-25 12/31/9999 20121 00006074754 HYZAAR TAB 100-25 12/31/9999 20121 00006074781 HYZAAR TAB 100-25 12/31/9999 20121 00006074782 HYZAAR TAB 100-25 12/31/9999 20121 00006071731 HYZAAR TAB 50-12.5 12/31/9999 20121 00006071754 HYZAAR TAB 50-12.5 12/31/9999 20121 00006071782 HYZAAR TAB 50-12.5 12/31/9999 20121 00006071786 HYZAAR TAB 50-12.5 12/31/9999 20121 00378521553 IBANDRONATE TAB 150MG 12/31/9999 20121 60505279500 IBANDRONATE TAB 150MG 12/31/9999 20121 00591366405 IBU TAB 600MG 07/31/2012 20121 63868033632 IBU/DIPHENHY CAP 200-25MG 12/31/9999 20121 50991057901 IBUDONE TAB 10-200MG 12/31/9999 20121 50991057801 IBUDONE TAB 5-200MG 12/31/9999 20121 37205064605 IBU-DROPS DRO 40MG/ML 12/31/9999 20121 37205043610 IBU-DROPS DRO 50/1.25 12/31/9999 20121 00536360330 IBUPROFEN CAP 200MG 12/31/9999 20121 24385049941 IBUPROFEN CAP 200MG 12/31/9999 20121 24385049958 IBUPROFEN CAP 200MG 12/31/9999 20121 37205032858 IBUPROFEN CAP 200MG 12/31/9999 20121 62011001601 IBUPROFEN CAP 200MG 12/31/9999 20121 00113005705 IBUPROFEN DRO 50/1.25 12/31/9999 20121 24385055010 IBUPROFEN DRO 50/1.25 12/31/9999 20121 36800005705 IBUPROFEN DRO 50/1.25 12/31/9999 20121 36800025510 IBUPROFEN DRO 50/1.25 12/31/9999 20121 49348037469 IBUPROFEN DRO 50/1.25 12/31/9999 20121 49348064227 IBUPROFEN DRO 50/1.25 12/31/9999 20121 62011000401 IBUPROFEN DRO 50/1.25 12/31/9999 20121 62011001201 IBUPROFEN DRO 50/1.25 12/31/9999 20121 63868007630 IBUPROFEN DRO 50/1.25 12/31/9999 20121 00113016626 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00113062326 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00113066026 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00113089726 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00113089734 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00121477405 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00472125594 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00472127016 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00472127094 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00904530909 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00904530920 IBUPROFEN SUS 100/5ML 12/31/9999 20121 00904557720 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385000926 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385000934 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385036126 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385036134 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385037226 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385090526 IBUPROFEN SUS 100/5ML 12/31/9999 20121 24385090534 IBUPROFEN SUS 100/5ML 12/31/9999 20121 36800016626 IBUPROFEN SUS 100/5ML 12/31/9999 20121 36800066026 IBUPROFEN SUS 100/5ML 12/31/9999 20121 36800089726 IBUPROFEN SUS 100/5ML 12/31/9999 20121 37205028226 IBUPROFEN SUS 100/5ML 12/31/9999 20121 37205028326 IBUPROFEN SUS 100/5ML 12/31/9999 20121 37205064326 IBUPROFEN SUS 100/5ML 12/31/9999 20121 37205084826 IBUPROFEN SUS 100/5ML 12/31/9999 20121 45802089726 IBUPROFEN SUS 100/5ML 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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