August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 68180011302 LEVETIRACETA TAB 500MG 12/31/9999 20121 68180011309 LEVETIRACETA TAB 500MG 12/31/9999 20121 68180011316 LEVETIRACETA TAB 500MG 12/31/9999 20121 68462054608 LEVETIRACETA TAB 500MG 12/31/9999 20121 00093779506 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 00228441706 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 00228441750 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 00378630091 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 00591363560 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 10370019506 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 49884020402 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 51079012701 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 51079012706 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 60505328006 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 68180011707 LEVETIRACETA TAB 500MG ER 12/31/9999 20121 00054015223 LEVETIRACETA TAB 750MG 01/31/2013 20121 00093728789 LEVETIRACETA TAB 750MG 12/31/9999 20121 00378561705 LEVETIRACETA TAB 750MG 12/31/9999 20121 00378561707 LEVETIRACETA TAB 750MG 12/31/9999 20121 00378561712 LEVETIRACETA TAB 750MG 12/31/9999 20121 00378561778 LEVETIRACETA TAB 750MG 12/31/9999 20121 00781511372 LEVETIRACETA TAB 750MG 12/31/9999 20121 00904600261 LEVETIRACETA TAB 750MG 12/31/9999 20121 13668001605 LEVETIRACETA TAB 750MG 12/31/9999 20121 13668001612 LEVETIRACETA TAB 750MG 12/31/9999 20121 13668001625 LEVETIRACETA TAB 750MG 12/31/9999 20121 13668001660 LEVETIRACETA TAB 750MG 12/31/9999 20121 13668001661 LEVETIRACETA TAB 750MG 12/31/9999 20121 31722053805 LEVETIRACETA TAB 750MG 12/31/9999 20121 31722053812 LEVETIRACETA TAB 750MG 12/31/9999 20121 42043019204 LEVETIRACETA TAB 750MG 12/31/9999 20121 42043019205 LEVETIRACETA TAB 750MG 12/31/9999 20121 43547022315 LEVETIRACETA TAB 750MG 12/31/9999 20121 50268046915 LEVETIRACETA TAB 750MG 12/31/9999 20121 51079082201 LEVETIRACETA TAB 750MG 12/31/9999 20121 51079082220 LEVETIRACETA TAB 750MG 12/31/9999 20121 55111018304 LEVETIRACETA TAB 750MG 12/31/9999 20121 64376013805 LEVETIRACETA TAB 750MG 12/31/9999 20121 64376013812 LEVETIRACETA TAB 750MG 12/31/9999 20121 64376013861 LEVETIRACETA TAB 750MG 12/31/9999 20121 64376013890 LEVETIRACETA TAB 750MG 12/31/9999 20121 65162053816 LEVETIRACETA TAB 750MG 12/31/9999 20121 65862024708 LEVETIRACETA TAB 750MG 12/31/9999 20121 68084033801 LEVETIRACETA TAB 750MG 12/31/9999 20121 68180011402 LEVETIRACETA TAB 750MG 12/31/9999 20121 68180011409 LEVETIRACETA TAB 750MG 12/31/9999 20121 68180011416 LEVETIRACETA TAB 750MG 12/31/9999 20121 68462054708 LEVETIRACETA TAB 750MG 12/31/9999 20121 00093779606 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 00228297506 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 00228297550 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 00378630191 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 00591369960 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 10370021406 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 49884020502 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 60505351706 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 68180011807 LEVETIRACETA TAB 750MG ER 12/31/9999 20121 39822400001 LEVETIRACETM INJ 500/5ML 12/31/9999 20121 62756051340 LEVETIRACETM INJ 500/5ML 12/31/9999 20121 62756051344 LEVETIRACETM INJ 500/5ML 12/31/9999 20121 00085190101 LEVITRA TAB 10MG 12/31/9999 20121 00173083013 LEVITRA TAB 10MG 12/31/9999 20121 00085192301 LEVITRA TAB 2.5MG 12/31/9999 20121 00173082813 LEVITRA TAB 2.5MG 12/31/9999 20121 00085193401 LEVITRA TAB 20MG 12/31/9999 20121 00173083113 LEVITRA TAB 20MG 12/31/9999 20121 00085194501 LEVITRA TAB 5MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00173082913 LEVITRA TAB 5MG 12/31/9999 20121 60758006305 LEVOBUNOLOL SOL 0.25% OP 12/31/9999 20121 60758006310 LEVOBUNOLOL SOL 0.25% OP 12/31/9999 20121 24208050505 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 24208050510 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 24208050515 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 60758006005 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 60758006010 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 60758006015 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 61314022905 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 61314022910 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 61314022915 LEVOBUNOLOL SOL 0.5% OP 12/31/9999 20121 00517104525 LEVOCARNITIN INJ 200MG/ML 12/31/9999 20121 00703040401 LEVOCARNITIN INJ 200MG/ML 12/31/9999 20121 00703040402 LEVOCARNITIN INJ 200MG/ML 12/31/9999 20121 00703040501 LEVOCARNITIN INJ 200MG/ML 12/31/9999 20121 00703040502 LEVOCARNITIN INJ 200MG/ML 12/31/9999 20121 55390013605 LEVOCARNITIN INJ 200MG/ML 12/31/9999 20121 50383017104 LEVOCARNITIN SOL 1GM/10ML 12/31/9999 20121 64980050312 LEVOCARNITIN SOL 1GM/10ML 12/31/9999 20121 50383017290 LEVOCARNITIN TAB 330MG 12/31/9999 20121 64980013009 LEVOCARNITIN TAB 330MG 12/31/9999 20121 00955102621 LEVOCETIRIZI SOL 2.5/5ML 12/31/9999 20121 45802068028 LEVOCETIRIZI SOL 2.5/5ML 12/31/9999 20121 00093770198 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 00955102590 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 45802059401 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 45802059465 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 45802059475 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 45802059487 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 55111028290 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 68462034690 LEVOCETIRIZI TAB DHCL 5MG 12/31/9999 20121 00781334109 LEVOFLOX/D5W INJ 250/50ML 12/31/9999 20121 25021013281 LEVOFLOX/D5W INJ 250/50ML 12/31/9999 20121 25021082581 LEVOFLOX/D5W INJ 250/50ML 12/31/9999 20121 00781334209 LEVOFLOX/D5W INJ 500/100M 12/31/9999 20121 25021013282 LEVOFLOX/D5W INJ 500/100M 12/31/9999 20121 25021082582 LEVOFLOX/D5W INJ 500/100M 12/31/9999 20121 00781334309 LEVOFLOX/D5W INJ 750/150 12/31/9999 20121 25021013283 LEVOFLOX/D5W INJ 750/150 12/31/9999 20121 25021082583 LEVOFLOX/D5W INJ 750/150 12/31/9999 20121 17478010720 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 20121 17478010730 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 20121 25021013020 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 20121 25021013030 LEVOFLOXACIN INJ 25MG/ML 12/31/9999 20121 16571015050 LEVOFLOXACIN SOL 0.5% 12/31/9999 20121 17478010610 LEVOFLOXACIN SOL 0.5% 12/31/9999 20121 50383028305 LEVOFLOXACIN SOL 0.5% 12/31/9999 20121 50383028604 LEVOFLOXACIN SOL 25MG/ML 12/31/9999 20121 50383028608 LEVOFLOXACIN SOL 25MG/ML 12/31/9999 20121 50383028616 LEVOFLOXACIN SOL 25MG/ML 12/31/9999 20121 00093729153 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 00378121589 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 00781579050 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 00904624961 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 13668008201 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 13668008250 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 13668008274 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 51079003401 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 51079003420 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 55111027950 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 59762027802 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 64679054402 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 64679054403 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 65862053650 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 68084048101 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 68180024001 LEVOFLOXACIN TAB 250MG 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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