August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 24090080184 LO/OVRAL-28 TAB 12/31/9999 20121 00056051168 LODOSYN TAB 25MG 10/31/2013 20121 25010071115 LODOSYN TAB 25MG 12/31/9999 20121 00095086006 LODRANE D CAP 4-60MG 12/31/9999 20121 51285007997 LOESTRIN TAB 1/20-21 12/31/9999 20121 51285008297 LOESTRIN 21 TAB 1.5/30 12/31/9999 20121 00430053014 LOESTRIN 24 TAB FE 12/31/9999 20121 51285008370 LOESTRIN FE TAB 1.5/30 12/31/9999 20121 51285008498 LOESTRIN FE TAB 1.5/30 12/31/9999 20121 51285008070 LOESTRIN FE TAB 1/20 12/31/9999 20121 51285008198 LOESTRIN FE TAB 1/20 12/31/9999 20121 57844032301 LOFIBRA CAP 134MG 12/31/9999 20121 57844032401 LOFIBRA CAP 200MG 12/31/9999 20121 57844032201 LOFIBRA CAP 67MG 12/31/9999 20121 57844069298 LOFIBRA TAB 160MG 12/31/9999 20121 57844069198 LOFIBRA TAB 54MG 12/31/9999 20121 68047003202 LOHIST DRO 1-2.5MG 12/31/9999 20121 68047012016 LOHIST-D LIQ 12/31/9999 20121 68047012916 LOHIST-DM SYP 5-2-10MG 12/31/9999 20121 68047034004 LOHIST-PEB LIQ 4-10/5ML 12/31/9999 20121 68047034016 LOHIST-PEB LIQ 4-10/5ML 12/31/9999 20121 68047034116 LOHIST-PEB- LIQ DM 12/31/9999 20121 68047034216 LOHIST-PSB LIQ 4-20/5ML 12/31/9999 20121 68047034316 LOHIST-PSB- LIQ DM 12/31/9999 20121 51552128706 LOLLIBASE POW 12/31/9999 20121 61480021505 LOMA ASTHMA TAB 12/31/9999 20121 61480011505 LOMA ECZEMA TAB 12/31/9999 20121 61480012503 LOMA LUX LIQ PSORIASI 12/31/9999 20121 61480013505 LOMA LUX TAB ACNEPILL 12/31/9999 20121 61480023505 LOMA SINUS/ TAB ALLERGY 12/31/9999 20121 00025006131 LOMOTIL TAB 2.5MG 12/31/9999 20121 63868005630 LONG ACTING SPR 0.05% 12/31/9999 20121 00781126201 LONOX TAB 2.5MG 12/31/9999 20121 00093031101 LOPERAMIDE CAP 2MG 12/31/9999 20121 00093031105 LOPERAMIDE CAP 2MG 12/31/9999 20121 00378210001 LOPERAMIDE CAP 2MG 12/31/9999 20121 00378210005 LOPERAMIDE CAP 2MG 12/31/9999 20121 51079069001 LOPERAMIDE CAP 2MG 12/31/9999 20121 51079069017 LOPERAMIDE CAP 2MG 12/31/9999 20121 51079069019 LOPERAMIDE CAP 2MG 12/31/9999 20121 51079069020 LOPERAMIDE CAP 2MG 12/31/9999 20121 37205037726 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 20121 50383061804 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 20121 68094010659 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 20121 68094010662 LOPERAMIDE LIQ 1MG/5ML 12/31/9999 20121 68094021759 LOPERAMIDE LIQ 2MG/10ML 12/31/9999 20121 68094021762 LOPERAMIDE LIQ 2MG/10ML 12/31/9999 20121 00113064526 LOPERAMIDE SUS 1MG/7.5 12/31/9999 20121 00071073720 LOPID TAB 600MG 12/31/9999 20121 00071073730 LOPID TAB 600MG 12/31/9999 20121 00078046105 LOPRESS HCT TAB 100-25MG 12/31/9999 20121 00078046005 LOPRESS HCT TAB 50-25MG 12/31/9999 20121 00078040001 LOPRESSOR INJ 5MG/5ML 12/31/9999 20121 00078045905 LOPRESSOR TAB 100MG 12/31/9999 20121 00078045805 LOPRESSOR TAB 50MG 12/31/9999 20121 99207001301 LOPROX GEL 0.77% 12/31/9999 20121 99207001330 LOPROX GEL 0.77% 12/31/9999 20121 99207001345 LOPROX GEL 0.77% 12/31/9999 20121 99207001010 LOPROX SHA 1% 12/31/9999 20121 00904572720 LORATADINE SOL 5MG/5ML 12/31/9999 20121 00904623420 LORATADINE SOL 5MG/5ML 12/31/9999 20121 54838053840 LORATADINE SOL 5MG/5ML 06/30/2012 20121 54838055440 LORATADINE SOL 5MG/5ML 12/31/9999 20121 54838055840 LORATADINE SOL 5MG/5ML 12/31/9999 20121 24385053126 LORATADINE SYP 5MG/5ML 12/31/9999 20121 24385054326 LORATADINE SYP 5MG/5ML 12/31/9999 20121 49348084934 LORATADINE SYP 5MG/5ML 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 51672207308 LORATADINE SYP 5MG/5ML 12/31/9999 20121 51672208508 LORATADINE SYP 5MG/5ML 12/31/9999 20121 62011007201 LORATADINE SYP 5MG/5ML 12/31/9999 20121 00067607010 LORATADINE TAB 10MG 12/31/9999 20121 00067607030 LORATADINE TAB 10MG 12/31/9999 20121 00781507701 LORATADINE TAB 10MG 12/31/9999 20121 00781507764 LORATADINE TAB 10MG 12/31/9999 20121 00781507776 LORATADINE TAB 10MG 12/31/9999 20121 00904607461 LORATADINE TAB 10MG 12/31/9999 20121 15127071501 LORATADINE TAB 10MG 12/31/9999 20121 15127071510 LORATADINE TAB 10MG 12/31/9999 20121 15127071530 LORATADINE TAB 10MG 12/31/9999 20121 15127071560 LORATADINE TAB 10MG 12/31/9999 20121 24385047152 LORATADINE TAB 10MG 12/31/9999 20121 24385047165 LORATADINE TAB 10MG 12/31/9999 20121 24385047176 LORATADINE TAB 10MG 12/31/9999 20121 24385047178 LORATADINE TAB 10MG 12/31/9999 20121 24385047199 LORATADINE TAB 10MG 12/31/9999 20121 37205034647 LORATADINE TAB 10MG 12/31/9999 20121 37205034652 LORATADINE TAB 10MG 12/31/9999 20121 37205034660 LORATADINE TAB 10MG 12/31/9999 20121 37205034665 LORATADINE TAB 10MG 12/31/9999 20121 37205034672 LORATADINE TAB 10MG 12/31/9999 20121 37205034675 LORATADINE TAB 10MG 12/31/9999 20121 45802065065 LORATADINE TAB 10MG 12/31/9999 20121 45802065078 LORATADINE TAB 10MG 12/31/9999 20121 45802065087 LORATADINE TAB 10MG 12/31/9999 20121 49614017065 LORATADINE TAB 10MG 12/31/9999 20121 49614017075 LORATADINE TAB 10MG 12/31/9999 20121 51079053801 LORATADINE TAB 10MG 12/31/9999 20121 51079053820 LORATADINE TAB 10MG 12/31/9999 20121 60505014701 LORATADINE TAB 10MG 12/31/9999 20121 60505014708 LORATADINE TAB 10MG 12/31/9999 20121 63868015101 LORATADINE TAB 10MG 12/31/9999 20121 63868015110 LORATADINE TAB 10MG 12/31/9999 20121 63868015130 LORATADINE TAB 10MG 12/31/9999 20121 68084024801 LORATADINE TAB 10MG 12/31/9999 20121 49348054301 LORATA-DINE TAB D 24HR 12/31/9999 20121 49348054357 LORATA-DINE TAB D 24HR 12/31/9999 20121 00904583315 LORATADINE-D TAB 10-240MG 12/31/9999 20121 00904583348 LORATADINE-D TAB 10-240MG 12/31/9999 20121 63868015410 LORATADINE-D TAB 10-240MG 12/31/9999 20121 45802010639 LORATADINE-D TAB 5-120MG 12/31/9999 20121 45802010652 LORATADINE-D TAB 5-120MG 12/31/9999 20121 45802010660 LORATADINE-D TAB 5-120MG 12/31/9999 20121 00054353244 LORAZEPAM CON 2MG/ML 12/31/9999 20121 00121077001 LORAZEPAM CON 2MG/ML 12/31/9999 20121 00574016330 LORAZEPAM CON 2MG/ML 12/31/9999 20121 65162068784 LORAZEPAM CON 2MG/ML 12/31/9999 20121 00409198505 LORAZEPAM INJ 2MG/ML 07/01/2012 20121 00409198530 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 00409677802 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 00409678002 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010201 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010210 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010237 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010239 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010501 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010502 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010544 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 10019010571 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 17478004001 LORAZEPAM INJ 2MG/ML 12/31/9999 20121 00409153931 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 00409677902 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 00409678102 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010301 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010310 LORAZEPAM INJ 4MG/ML 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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