August 31, 2012 - Iowa Medicaid Enterprise

More documents

Recommendations

Info

NDC Product Description Termination Date Quarter Covered 00025172003 INSPRA TAB 50MG 12/31/9999 20121 00187074631 INSTA-GLUCOS GEL 40% 12/31/9999 20121 00187074633 INSTA-GLUCOS GEL 40% 12/31/9999 20121 68016080055 INSULIN SYRG MIS 0.5/28G 12/31/9999 20121 68016090055 INSULIN SYRG MIS 0.5/29G 12/31/9999 20121 68016080105 INSULIN SYRG MIS 1ML/28G 12/31/9999 20121 68016090105 INSULIN SYRG MIS 1ML/29G 12/31/9999 20121 52747071030 INTEGRA CAP 12/31/9999 20121 52747071060 INTEGRA CAP 12/31/9999 20121 52747071130 INTEGRA F CAP 12/31/9999 20121 52747071160 INTEGRA F CAP 12/31/9999 20121 52747071230 INTEGRA PLUS CAP 12/31/9999 20121 52747071260 INTEGRA PLUS CAP 12/31/9999 20121 00085113601 INTEGRILIN INJ 0.75MG/1 12/31/9999 20121 00085117701 INTEGRILIN INJ 2MG/ML 12/31/9999 20121 00085117702 INTEGRILIN INJ 2MG/ML 12/31/9999 20121 59676057001 INTELENCE TAB 100MG 12/31/9999 20121 59676057101 INTELENCE TAB 200MG 12/31/9999 20121 37205061026 INTENSE COUG LIQ RELIEVER 12/31/9999 20121 59011025630 INTERMEZZO SUB 1.75MG 12/31/9999 20121 59011025530 INTERMEZZO SUB 3.5MG 12/31/9999 20121 00338051902 INTRALIPID INJ 20% 12/31/9999 20121 00338051903 INTRALIPID INJ 20% 12/31/9999 20121 00338051904 INTRALIPID INJ 20% 12/31/9999 20121 00338051948 INTRALIPID INJ 20% 12/31/9999 20121 00338052003 INTRALIPID INJ 30% 12/31/9999 20121 00085057102 INTRON-A INJ 10MU 12/31/9999 20121 00085125401 INTRON-A INJ 10MU PEN 12/31/9999 20121 00085111001 INTRON-A INJ 18MU 12/31/9999 20121 00085116801 INTRON-A INJ 18MU 12/31/9999 20121 00085113301 INTRON-A INJ 25MU 12/31/9999 20121 00085124201 INTRON-A INJ 3MU PEN 12/31/9999 20121 00085053901 INTRON-A INJ 50MU 12/31/9999 20121 00085123501 INTRON-A INJ 5MU PEN 12/31/9999 20121 00781558436 INTROVALE TAB 12/31/9999 20121 54092051302 INTUNIV TAB 1MG 12/31/9999 20121 54092051502 INTUNIV TAB 2MG 12/31/9999 20121 54092051702 INTUNIV TAB 3MG 12/31/9999 20121 54092051902 INTUNIV TAB 4MG 12/31/9999 20121 00006384371 INVANZ INJ 1GM 12/31/9999 20121 00006384571 INVANZ INJ 1GM 12/31/9999 20121 50458055401 INVEGA TAB 1.5MG 12/31/9999 20121 50458055001 INVEGA TAB 3MG 12/31/9999 20121 50458055010 INVEGA TAB 3MG 12/31/9999 20121 50458055101 INVEGA TAB 6MG 12/31/9999 20121 50458055110 INVEGA TAB 6MG 12/31/9999 20121 50458055201 INVEGA TAB 9MG 12/31/9999 20121 50458055210 INVEGA TAB 9MG 12/31/9999 20121 50458056201 INVEGA SUST INJ 117/0.75 12/31/9999 20121 50458056301 INVEGA SUST INJ 156MG/ML 12/31/9999 20121 50458056401 INVEGA SUST INJ 234/1.5 12/31/9999 20121 50458056001 INVEGA SUST INJ 39/0.25 12/31/9999 20121 50458056101 INVEGA SUST INJ 78/0.5ML 12/31/9999 20121 00004024515 INVIRASE CAP 200MG 12/31/9999 20121 00004024451 INVIRASE TAB 500MG 12/31/9999 20121 37205027910 INVISIB ACNE CRE 10% MS 12/31/9999 20121 53329077704 INZO CRE BARRIER 12/31/9999 20121 53329077757 INZO CRE BARRIER 12/31/9999 20121 53329077796 INZO CRE BARRIER 12/31/9999 20121 51552018404 IODINE CRY RESUBLIM 12/31/9999 20121 51552018405 IODINE CRY RESUBLIM 12/31/9999 20121 51552018406 IODINE CRY RESUBLIM 12/31/9999 20121 51552019404 IODINE SOL STRONG 12/31/9999 20121 51552019406 IODINE SOL STRONG 12/31/9999 20121 51552064702 IODINE TIN STRONG 12/31/9999 20121 51552064706 IODINE TIN STRONG 12/31/9999 20121 51552023004 IODOFORM POW 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 51552023009 IODOFORM POW 12/31/9999 20121 63323001910 IODOPEN INJ 100MCG 12/31/9999 20121 51552082004 IODOQUINOL POW 12/31/9999 20121 51552082005 IODOQUINOL POW 12/31/9999 20121 00064205002 IONAX GRA 12/31/9999 20121 00064206008 IONIL SHA 12/31/9999 20121 00064207008 IONIL PLUS SHA 2% 12/31/9999 20121 00064208516 IONIL-T SHA 1% 12/31/9999 20121 00064209508 IONIL-T PLUS SHA 2% 12/31/9999 20121 00409737203 IONOSOL-MB INJ /D5W 12/31/9999 20121 00409737262 IONOSOL-MB INJ /D5W 12/31/9999 20121 00603132958 IOPHEN C-NR LIQ 100-10/5 12/31/9999 20121 00603133058 IOPHEN DM-NR LIQ 100-10/5 12/31/9999 20121 00603132858 IOPHEN-NR LIQ 100/5ML 12/31/9999 20121 00065066505 IOPIDINE SOL 0.5% OP 12/31/9999 20121 00065066510 IOPIDINE SOL 0.5% OP 12/31/9999 20121 00065066010 IOPIDINE SOL 1% OP 12/31/9999 20121 00378698962 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00378698964 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00378698966 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00378698993 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00487980101 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00487980102 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00487980125 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00487980130 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00487980160 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00591379830 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00591379860 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00591379883 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00781715729 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00781715764 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00781715786 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 16252009822 IPRATROPIUM SOL 0.02%INH 11/30/2012 20121 16252009833 IPRATROPIUM SOL 0.02%INH 11/30/2012 20121 16252009866 IPRATROPIUM SOL 0.02%INH 03/31/2013 20121 76204010025 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 76204010030 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 76204010060 IPRATROPIUM SOL 0.02%INH 12/31/9999 20121 00472075123 IPRATROPIUM SOL INHAL 12/31/9999 20121 00472075130 IPRATROPIUM SOL INHAL 12/31/9999 20121 00472075160 IPRATROPIUM SOL INHAL 12/31/9999 20121 00472075323 IPRATROPIUM SOL INHAL 12/31/9999 20121 00472075330 IPRATROPIUM SOL INHAL 12/31/9999 20121 00472075360 IPRATROPIUM SOL INHAL 12/31/9999 20121 00054004544 IPRATROPIUM SPR 0.03% 12/31/9999 20121 24208039830 IPRATROPIUM SPR 0.03% 12/31/9999 20121 60505082601 IPRATROPIUM SPR 0.03% 12/31/9999 20121 00054004641 IPRATROPIUM SPR 0.06% 12/31/9999 20121 24208039915 IPRATROPIUM SPR 0.06% 12/31/9999 20121 60505082701 IPRATROPIUM SPR 0.06% 12/31/9999 20121 00093672373 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00093672374 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00185732230 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00185732260 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00378698858 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00378698891 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00378698893 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00487020101 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00487020102 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00487020103 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00487020160 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00591343330 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 00591343360 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 16252054733 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 16252054766 IPRATROPIUM/ SOL ALBUTER 12/31/9999 20121 68669014505 IQUIX SOL 1.5% 09/30/2012 20121 00093723856 IRBESAR/HCTZ TAB 150-12.5 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:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168: NDC Product Description Termination
Page 217: NDC Product Description Termination
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?