August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 68180024008 LEVOFLOXACIN TAB 250MG 12/31/9999 20121 00093729253 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 00378121789 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 00781579101 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 00781579150 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 00904625061 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 13668008301 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 13668008350 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 13668008374 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 51079003501 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 51079003520 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 55111028050 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 59762027902 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 64679054502 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 64679054503 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 65862053750 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 68084048201 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 68180024101 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 68180024102 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 68180024108 LEVOFLOXACIN TAB 500MG 12/31/9999 20121 00093729353 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 00781579250 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 00904625161 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 13668008401 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 13668008421 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 13668008474 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 55111028130 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 59762028003 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 64679054701 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 64679054702 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 64679054703 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 65862053820 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 68084048301 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 68180024201 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 68180024220 LEVOFLOXACIN TAB 750MG 12/31/9999 20121 68180084813 LEVONOR/ETHI TAB ESTRADIO 12/31/9999 20121 45802084054 LEVONORGESTR TAB 0.75MG 12/31/9999 20121 00409144304 LEVOPHED INJ 1MG/ML 12/31/9999 20121 00409337504 LEVOPHED INJ 1MG/ML 12/31/9999 20121 52544027928 LEVORA-28 TAB 0.15/30 12/31/9999 20121 00054043825 LEVORPHANOL TAB 2MG 12/31/9999 20121 00054449425 LEVORPHANOL TAB 2MG 05/31/2012 20121 00456132300 LEVOTHROID TAB 100MCG 12/31/9999 20121 00456132301 LEVOTHROID TAB 100MCG 12/31/9999 20121 00456133000 LEVOTHROID TAB 112MCG 12/31/9999 20121 00456133001 LEVOTHROID TAB 112MCG 12/31/9999 20121 00456132400 LEVOTHROID TAB 125MCG 12/31/9999 20121 00456132401 LEVOTHROID TAB 125MCG 12/31/9999 20121 00456133100 LEVOTHROID TAB 137MCG 12/31/9999 20121 00456133101 LEVOTHROID TAB 137MCG 12/31/9999 20121 00456132500 LEVOTHROID TAB 150MCG 12/31/9999 20121 00456132501 LEVOTHROID TAB 150MCG 12/31/9999 20121 00456132600 LEVOTHROID TAB 175MCG 12/31/9999 20121 00456132601 LEVOTHROID TAB 175MCG 12/31/9999 20121 00456132700 LEVOTHROID TAB 200MCG 12/31/9999 20121 00456132701 LEVOTHROID TAB 200MCG 12/31/9999 20121 00456132000 LEVOTHROID TAB 25MCG 12/31/9999 20121 00456132001 LEVOTHROID TAB 25MCG 12/31/9999 20121 00456132800 LEVOTHROID TAB 300MCG 12/31/9999 20121 00456132801 LEVOTHROID TAB 300MCG 12/31/9999 20121 00456132100 LEVOTHROID TAB 50MCG 12/31/9999 20121 00456132101 LEVOTHROID TAB 50MCG 12/31/9999 20121 00456132200 LEVOTHROID TAB 75MCG 12/31/9999 20121 00456132201 LEVOTHROID TAB 75MCG 12/31/9999 20121 00456132900 LEVOTHROID TAB 88MCG 12/31/9999 20121 00456132901 LEVOTHROID TAB 88MCG 12/31/9999 20121 63323064907 LEVOTHYROXIN INJ 100MCG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 63323024710 LEVOTHYROXIN INJ 200MCG 12/31/9999 20121 63323024810 LEVOTHYROXIN INJ 500MCG 12/31/9999 20121 63323064810 LEVOTHYROXIN INJ 500MCG 12/31/9999 20121 00378180901 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 00378180910 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 00527134501 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 00527134510 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 00781518401 LEVOTHYROXIN TAB 100MCG 09/30/2012 20121 00781518410 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 00781518492 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 51079044201 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 51079044220 LEVOTHYROXIN TAB 100MCG 12/31/9999 20121 00378181101 LEVOTHYROXIN TAB 112MCG 12/31/9999 20121 00378181110 LEVOTHYROXIN TAB 112MCG 12/31/9999 20121 00527134601 LEVOTHYROXIN TAB 112MCG 12/31/9999 20121 00527134610 LEVOTHYROXIN TAB 112MCG 12/31/9999 20121 00781518501 LEVOTHYROXIN TAB 112MCG 08/31/2012 20121 00781518592 LEVOTHYROXIN TAB 112MCG 12/31/9999 20121 00378181301 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 00378181310 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 00527134701 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 00527134710 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 00781518601 LEVOTHYROXIN TAB 125MCG 07/31/2012 20121 00781518610 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 00781518692 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 51079044301 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 51079044320 LEVOTHYROXIN TAB 125MCG 12/31/9999 20121 00378182301 LEVOTHYROXIN TAB 137MCG 12/31/9999 20121 00378182310 LEVOTHYROXIN TAB 137MCG 12/31/9999 20121 00527163801 LEVOTHYROXIN TAB 137MCG 12/31/9999 20121 00527163810 LEVOTHYROXIN TAB 137MCG 12/31/9999 20121 00781519101 LEVOTHYROXIN TAB 137MCG 08/31/2012 20121 00781519192 LEVOTHYROXIN TAB 137MCG 12/31/9999 20121 00378181501 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 00378181510 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 00527134901 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 00527134910 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 00781518701 LEVOTHYROXIN TAB 150MCG 07/31/2012 20121 00781518710 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 00781518792 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 51079044501 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 51079044520 LEVOTHYROXIN TAB 150MCG 12/31/9999 20121 00378181701 LEVOTHYROXIN TAB 175MCG 12/31/9999 20121 00378181710 LEVOTHYROXIN TAB 175MCG 12/31/9999 20121 00527135001 LEVOTHYROXIN TAB 175MCG 12/31/9999 20121 00527135010 LEVOTHYROXIN TAB 175MCG 12/31/9999 20121 00781518801 LEVOTHYROXIN TAB 175MCG 12/31/9999 20121 00781518892 LEVOTHYROXIN TAB 175MCG 12/31/9999 20121 00378181901 LEVOTHYROXIN TAB 200MCG 12/31/9999 20121 00378181910 LEVOTHYROXIN TAB 200MCG 12/31/9999 20121 00527135101 LEVOTHYROXIN TAB 200MCG 12/31/9999 20121 00527135110 LEVOTHYROXIN TAB 200MCG 12/31/9999 20121 00781518901 LEVOTHYROXIN TAB 200MCG 07/31/2012 20121 00781518992 LEVOTHYROXIN TAB 200MCG 12/31/9999 20121 00378180001 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 00378180010 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 00527134101 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 00527134110 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 00781518001 LEVOTHYROXIN TAB 25MCG 06/30/2012 20121 00781518010 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 00781518092 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 51079044401 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 51079044420 LEVOTHYROXIN TAB 25MCG 12/31/9999 20121 00378182101 LEVOTHYROXIN TAB 300MCG 12/31/9999 20121 00527135201 LEVOTHYROXIN TAB 300MCG 12/31/9999 20121 00527135210 LEVOTHYROXIN TAB 300MCG 12/31/9999 20121 00781519092 LEVOTHYROXIN TAB 300MCG 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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