August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00093723898 IRBESAR/HCTZ TAB 150-12.5 12/31/9999 20121 00093723956 IRBESAR/HCTZ TAB 300-12.5 12/31/9999 20121 00093723998 IRBESAR/HCTZ TAB 300-12.5 12/31/9999 20121 00093746505 IRBESARTAN TAB 150MG 12/31/9999 20121 00093746556 IRBESARTAN TAB 150MG 12/31/9999 20121 00093746598 IRBESARTAN TAB 150MG 12/31/9999 20121 00093746605 IRBESARTAN TAB 300MG 12/31/9999 20121 00093746656 IRBESARTAN TAB 300MG 12/31/9999 20121 00093746698 IRBESARTAN TAB 300MG 12/31/9999 20121 00093746456 IRBESARTAN TAB 75MG 12/31/9999 20121 00093746498 IRBESARTAN TAB 75MG 12/31/9999 20121 00310048230 IRESSA TAB 250MG 12/31/9999 20121 00703443411 IRINOTECAN INJ 100/5ML 12/31/9999 20121 59762752902 IRINOTECAN INJ 100/5ML 01/01/2013 20121 61703034909 IRINOTECAN INJ 100/5ML 12/31/9999 20121 63323019305 IRINOTECAN INJ 100/5ML 12/31/9999 20121 66758004802 IRINOTECAN INJ 100/5ML 12/31/9999 20121 00703443211 IRINOTECAN INJ 40MG/2ML 12/31/9999 20121 61703034916 IRINOTECAN INJ 40MG/2ML 12/31/9999 20121 63323019302 IRINOTECAN INJ 40MG/2ML 12/31/9999 20121 66758004801 IRINOTECAN INJ 40MG/2ML 12/31/9999 20121 61703034936 IRINOTECAN INJ 500MG/25 12/31/9999 20121 00677159701 IRON COMPLEX CAP 150MG 05/31/2012 20121 50967012630 IROSPAN 24/6 MIS 12/31/9999 20121 11701002504 ISAGEL GEL 60% 12/31/9999 20121 11701002526 ISAGEL GEL 60% 12/31/9999 20121 11701003237 ISAGEL GEL 60% 12/31/9999 20121 00006022761 ISENTRESS TAB 400MG 12/31/9999 20121 00998030305 ISO ATROPINE SOL 1% OP 12/31/9999 20121 00998030315 ISO ATROPINE SOL 1% OP 12/31/9999 20121 00998022315 ISO CARBACHO SOL 1.5% OP 12/31/9999 20121 00998022515 ISO CARBACHO SOL 3% OP 12/31/9999 20121 00998031105 ISO HOMATROP SOL 2% OP 12/31/9999 20121 00998031505 ISO HOMATROP SOL 5% OP 12/31/9999 20121 00998033105 ISO HYOSCINE SOL 0.25% OP 12/31/9999 20121 00264771900 ISOLYTE-H INJ /D5W 12/31/9999 20121 00264772000 ISOLYTE-M INJ /D5W 12/31/9999 20121 00264773010 ISOLYTE-P INJ /D5W 12/31/9999 20121 00264770300 ISOLYTE-S INJ 12/31/9999 20121 00264770700 ISOLYTE-S INJ PH 7.4 12/31/9999 20121 00264770710 ISOLYTE-S INJ PH 7.4 12/31/9999 20121 44183044001 ISOMETH/APAP CAP DICHLOR 12/31/9999 20121 62584013901 ISOMETH/APAP CAP DICHLOR 12/31/9999 20121 50967062050 ISOMETH/CAFF TAB /APAP 12/31/9999 20121 61748001760 ISONARIF CAP 12/31/9999 20121 00781305670 ISONIAZID INJ 100MG/ML 12/31/9999 20121 51552086005 ISONIAZID POW 12/31/9999 20121 46287000901 ISONIAZID SYP 50MG/5ML 12/31/9999 20121 00143126001 ISONIAZID TAB 100MG 12/31/9999 20121 00143126010 ISONIAZID TAB 100MG 12/31/9999 20121 00185435101 ISONIAZID TAB 100MG 12/31/9999 20121 00185435110 ISONIAZID TAB 100MG 12/31/9999 20121 00185435130 ISONIAZID TAB 100MG 12/31/9999 20121 00555006602 ISONIAZID TAB 100MG 12/31/9999 20121 00555006605 ISONIAZID TAB 100MG 12/31/9999 20121 61748001601 ISONIAZID TAB 100MG 12/31/9999 20121 00143126101 ISONIAZID TAB 300MG 12/31/9999 20121 00143126110 ISONIAZID TAB 300MG 12/31/9999 20121 00143126130 ISONIAZID TAB 300MG 12/31/9999 20121 00185435001 ISONIAZID TAB 300MG 12/31/9999 20121 00185435010 ISONIAZID TAB 300MG 12/31/9999 20121 00185435030 ISONIAZID TAB 300MG 12/31/9999 20121 00555007101 ISONIAZID TAB 300MG 12/31/9999 20121 00555007102 ISONIAZID TAB 300MG 12/31/9999 20121 00555007105 ISONIAZID TAB 300MG 12/31/9999 20121 00904620360 ISONIAZID TAB 300MG 12/31/9999 20121 51079008301 ISONIAZID TAB 300MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 51079008320 ISONIAZID TAB 300MG 12/31/9999 20121 61748001301 ISONIAZID TAB 300MG 12/31/9999 20121 61748001310 ISONIAZID TAB 300MG 12/31/9999 20121 61748001330 ISONIAZID TAB 300MG 12/31/9999 20121 51552046606 ISOP ALCOHOL SOL 50% 12/31/9999 20121 24385024916 ISOP ALCOHOL SOL 70% 12/31/9999 20121 49348003038 ISOP ALCOHOL SOL 70% 12/31/9999 20121 49348003040 ISOP ALCOHOL SOL 70% 12/31/9999 20121 51552040406 ISOP ALCOHOL SOL 70% 12/31/9999 20121 51552040408 ISOP ALCOHOL SOL 70% 12/31/9999 20121 62011010701 ISOP ALCOHOL SOL 70% 12/31/9999 20121 00904604516 ISOP ALCOHOL SOL 70% RUB 12/31/9999 20121 00574006710 ISOP ALCOHOL SOL 70% WG 12/31/9999 20121 00574006716 ISOP ALCOHOL SOL 70% WG 12/31/9999 20121 49348000438 ISOP ALCOHOL SOL 91% 12/31/9999 20121 51552042008 ISOP ALCOHOL SOL 91% 12/31/9999 20121 00574006610 ISOP ALCOHOL SOL 99% 12/31/9999 20121 00574006616 ISOP ALCOHOL SOL 99% 12/31/9999 20121 38779081001 ISOP ALCOHOL SOL 99% 12/31/9999 20121 38779081008 ISOP ALCOHOL SOL 99% 12/31/9999 20121 49348000538 ISOP ALCOHOL SOL 99% 12/31/9999 20121 51552004706 ISOP ALCOHOL SOL 99% 12/31/9999 20121 51552004708 ISOP ALCOHOL SOL 99% 12/31/9999 20121 51552061206 ISOPROPYL SOL MYRISTAT 12/31/9999 20121 51552061208 ISOPROPYL SOL MYRISTAT 12/31/9999 20121 00998020315 ISOPTO CARP SOL 1% OP 12/31/9999 20121 00998020415 ISOPTO CARP SOL 2% OP 12/31/9999 20121 00998020615 ISOPTO CARP SOL 4% OP 12/31/9999 20121 00998040815 ISOPTO TEARS SOL 0.5% OP 12/31/9999 20121 64455019201 ISORDIL TAB 40MG 12/31/9999 20121 64455015201 ISORDIL TAB 5MG 12/31/9999 20121 00143176501 ISOSORB DIN SUB 2.5MG 12/31/9999 20121 00603412221 ISOSORB DIN SUB 2.5MG 10/31/2012 20121 00143176701 ISOSORB DIN SUB 5MG 12/31/9999 20121 00143176710 ISOSORB DIN SUB 5MG 12/31/9999 20121 00143177101 ISOSORB DIN TAB 10MG 12/31/9999 20121 00143177110 ISOSORB DIN TAB 10MG 12/31/9999 20121 00615156039 ISOSORB DIN TAB 10MG 12/31/9999 20121 00781155601 ISOSORB DIN TAB 10MG 12/31/9999 20121 00781155610 ISOSORB DIN TAB 10MG 12/31/9999 20121 00781155613 ISOSORB DIN TAB 10MG 12/31/9999 20121 00904215161 ISOSORB DIN TAB 10MG 12/31/9999 20121 49884002101 ISOSORB DIN TAB 10MG 07/31/2012 20121 49884002110 ISOSORB DIN TAB 10MG 07/31/2012 20121 00143177201 ISOSORB DIN TAB 20MG 12/31/9999 20121 00143177210 ISOSORB DIN TAB 20MG 12/31/9999 20121 00603411821 ISOSORB DIN TAB 20MG 05/31/2013 20121 00781169501 ISOSORB DIN TAB 20MG 12/31/9999 20121 00781169510 ISOSORB DIN TAB 20MG 12/31/9999 20121 00781169513 ISOSORB DIN TAB 20MG 12/31/9999 20121 00904215461 ISOSORB DIN TAB 20MG 12/31/9999 20121 49884002201 ISOSORB DIN TAB 20MG 02/28/2014 20121 49884002210 ISOSORB DIN TAB 20MG 02/28/2014 20121 00143177301 ISOSORB DIN TAB 30MG 12/31/9999 20121 00143177310 ISOSORB DIN TAB 30MG 12/31/9999 20121 49884000901 ISOSORB DIN TAB 30MG 12/31/9999 20121 49884000910 ISOSORB DIN TAB 30MG 12/31/9999 20121 57664060088 ISOSORB DIN TAB 40MG ER 12/31/9999 20121 64980014401 ISOSORB DIN TAB 40MG ER 12/31/9999 20121 00143176901 ISOSORB DIN TAB 5MG 12/31/9999 20121 00143176910 ISOSORB DIN TAB 5MG 12/31/9999 20121 00603411621 ISOSORB DIN TAB 5MG 08/31/2013 20121 00603411632 ISOSORB DIN TAB 5MG 08/31/2013 20121 00781163501 ISOSORB DIN TAB 5MG 12/31/9999 20121 00781163510 ISOSORB DIN TAB 5MG 12/31/9999 20121 00904215061 ISOSORB DIN TAB 5MG 12/31/9999 20121 49884002001 ISOSORB DIN TAB 5MG 10/31/2012 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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