August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 10019010337 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010339 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010601 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010602 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010644 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 10019010671 LORAZEPAM INJ 4MG/ML 12/31/9999 20121 00093482001 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00093482005 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00228205710 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00228205750 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00378232101 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00378232105 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00591024001 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00591024005 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00591024010 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00904150061 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00904150080 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00904598061 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00904600740 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00904600760 LORAZEPAM TAB 0.5MG 12/31/9999 20121 51079041701 LORAZEPAM TAB 0.5MG 12/31/9999 20121 51079041720 LORAZEPAM TAB 0.5MG 12/31/9999 20121 51079041721 LORAZEPAM TAB 0.5MG 12/31/9999 20121 51079041756 LORAZEPAM TAB 0.5MG 12/31/9999 20121 63304077201 LORAZEPAM TAB 0.5MG 12/31/9999 20121 63304077205 LORAZEPAM TAB 0.5MG 12/31/9999 20121 63304077290 LORAZEPAM TAB 0.5MG 12/31/9999 20121 63739049910 LORAZEPAM TAB 0.5MG 12/31/9999 20121 64125090401 LORAZEPAM TAB 0.5MG 12/31/9999 20121 64125090405 LORAZEPAM TAB 0.5MG 12/31/9999 20121 64125090410 LORAZEPAM TAB 0.5MG 12/31/9999 20121 68084008801 LORAZEPAM TAB 0.5MG 12/31/9999 20121 00093482101 LORAZEPAM TAB 1MG 12/31/9999 20121 00093482105 LORAZEPAM TAB 1MG 12/31/9999 20121 00093482110 LORAZEPAM TAB 1MG 12/31/9999 20121 00228205910 LORAZEPAM TAB 1MG 12/31/9999 20121 00228205950 LORAZEPAM TAB 1MG 12/31/9999 20121 00378245701 LORAZEPAM TAB 1MG 12/31/9999 20121 00378245710 LORAZEPAM TAB 1MG 12/31/9999 20121 00591024101 LORAZEPAM TAB 1MG 12/31/9999 20121 00591024105 LORAZEPAM TAB 1MG 12/31/9999 20121 00591024110 LORAZEPAM TAB 1MG 12/31/9999 20121 00904598161 LORAZEPAM TAB 1MG 12/31/9999 20121 00904600860 LORAZEPAM TAB 1MG 12/31/9999 20121 51079038601 LORAZEPAM TAB 1MG 12/31/9999 20121 51079038620 LORAZEPAM TAB 1MG 12/31/9999 20121 51079038621 LORAZEPAM TAB 1MG 12/31/9999 20121 51079038656 LORAZEPAM TAB 1MG 12/31/9999 20121 63304077301 LORAZEPAM TAB 1MG 12/31/9999 20121 63304077305 LORAZEPAM TAB 1MG 12/31/9999 20121 63304077310 LORAZEPAM TAB 1MG 12/31/9999 20121 63304077390 LORAZEPAM TAB 1MG 12/31/9999 20121 63739050010 LORAZEPAM TAB 1MG 12/31/9999 20121 64125090501 LORAZEPAM TAB 1MG 12/31/9999 20121 64125090505 LORAZEPAM TAB 1MG 12/31/9999 20121 64125090510 LORAZEPAM TAB 1MG 12/31/9999 20121 65162001810 LORAZEPAM TAB 1MG 12/31/9999 20121 65162001850 LORAZEPAM TAB 1MG 12/31/9999 20121 68084008901 LORAZEPAM TAB 1MG 12/31/9999 20121 00093482201 LORAZEPAM TAB 2MG 12/31/9999 20121 00093482210 LORAZEPAM TAB 2MG 12/31/9999 20121 00228206310 LORAZEPAM TAB 2MG 12/31/9999 20121 00228206350 LORAZEPAM TAB 2MG 12/31/9999 20121 00228206396 LORAZEPAM TAB 2MG 12/31/9999 20121 00378277701 LORAZEPAM TAB 2MG 12/31/9999 20121 00378277705 LORAZEPAM TAB 2MG 12/31/9999 20121 00591024201 LORAZEPAM TAB 2MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00591024205 LORAZEPAM TAB 2MG 12/31/9999 20121 00591024210 LORAZEPAM TAB 2MG 12/31/9999 20121 00904598261 LORAZEPAM TAB 2MG 12/31/9999 20121 00904600960 LORAZEPAM TAB 2MG 12/31/9999 20121 50268050915 LORAZEPAM TAB 2MG 12/31/9999 20121 51079038701 LORAZEPAM TAB 2MG 12/31/9999 20121 51079038720 LORAZEPAM TAB 2MG 12/31/9999 20121 51079038721 LORAZEPAM TAB 2MG 12/31/9999 20121 63304077401 LORAZEPAM TAB 2MG 12/31/9999 20121 63304077405 LORAZEPAM TAB 2MG 12/31/9999 20121 63304077490 LORAZEPAM TAB 2MG 12/31/9999 20121 63739050110 LORAZEPAM TAB 2MG 12/31/9999 20121 64125090601 LORAZEPAM TAB 2MG 12/31/9999 20121 64125090605 LORAZEPAM TAB 2MG 12/31/9999 20121 64125090610 LORAZEPAM TAB 2MG 12/31/9999 20121 65162001710 LORAZEPAM TAB 2MG 12/31/9999 20121 65162001750 LORAZEPAM TAB 2MG 12/31/9999 20121 68084009001 LORAZEPAM TAB 2MG 12/31/9999 20121 00785635001 LORCET TAB 10/650 12/31/9999 20121 00785635050 LORCET TAB 10/650 12/31/9999 20121 00785112201 LORCET PLUS TAB 7.5-650 12/31/9999 20121 00785112250 LORCET PLUS TAB 7.5-650 12/31/9999 20121 50474090916 LORTAB ELX 7.5-500 12/31/9999 20121 50474091001 LORTAB TAB 10-500MG 12/31/9999 20121 50474091050 LORTAB TAB 10-500MG 12/31/9999 20121 50474091060 LORTAB TAB 10-500MG 12/31/9999 20121 50474090201 LORTAB TAB 5-500MG 12/31/9999 20121 50474090250 LORTAB TAB 5-500MG 12/31/9999 20121 50474090701 LORTAB TAB 7.5-500 12/31/9999 20121 50474090750 LORTAB TAB 7.5-500 12/31/9999 20121 50991059816 LORTUSS DM LIQ 12/31/9999 20121 50991051516 LORTUSS EX LIQ 12/31/9999 20121 50991059716 LORTUSS LQ LIQ 12/31/9999 20121 00781565615 LORYNA TAB 3-0.02MG 12/31/9999 20121 00054012522 LOSARTAN POT TAB 100MG 12/31/9999 20121 00093736610 LOSARTAN POT TAB 100MG 12/31/9999 20121 00093736656 LOSARTAN POT TAB 100MG 12/31/9999 20121 00093736698 LOSARTAN POT TAB 100MG 12/31/9999 20121 00245019501 LOSARTAN POT TAB 100MG 12/31/9999 20121 00245019510 LOSARTAN POT TAB 100MG 12/31/9999 20121 00245019530 LOSARTAN POT TAB 100MG 12/31/9999 20121 00245019590 LOSARTAN POT TAB 100MG 12/31/9999 20121 00378404377 LOSARTAN POT TAB 100MG 12/31/9999 20121 00378404393 LOSARTAN POT TAB 100MG 12/31/9999 20121 00591374710 LOSARTAN POT TAB 100MG 07/31/2012 20121 00591374719 LOSARTAN POT TAB 100MG 07/31/2012 20121 00591374730 LOSARTAN POT TAB 100MG 07/30/2012 20121 00781570210 LOSARTAN POT TAB 100MG 12/31/9999 20121 00781570231 LOSARTAN POT TAB 100MG 12/31/9999 20121 00781570292 LOSARTAN POT TAB 100MG 12/31/9999 20121 00781580710 LOSARTAN POT TAB 100MG 06/30/2013 20121 00781580731 LOSARTAN POT TAB 100MG 08/31/2013 20121 00781580792 LOSARTAN POT TAB 100MG 08/31/2013 20121 13668011510 LOSARTAN POT TAB 100MG 12/31/9999 20121 13668011530 LOSARTAN POT TAB 100MG 12/31/9999 20121 13668011590 LOSARTAN POT TAB 100MG 12/31/9999 20121 16571050211 LOSARTAN POT TAB 100MG 12/31/9999 20121 16714058301 LOSARTAN POT TAB 100MG 12/31/2020 20121 16714058302 LOSARTAN POT TAB 100MG 12/31/2020 20121 16714058303 LOSARTAN POT TAB 100MG 12/31/2020 20121 51079075201 LOSARTAN POT TAB 100MG 12/31/9999 20121 51079075220 LOSARTAN POT TAB 100MG 09/30/2012 20121 59762007201 LOSARTAN POT TAB 100MG 12/31/9999 20121 59762007202 LOSARTAN POT TAB 100MG 12/31/2012 20121 60505316203 LOSARTAN POT TAB 100MG 12/31/9999 20121 60505316209 LOSARTAN POT TAB 100MG 12/31/9999 20121 60951018730 LOSARTAN POT TAB 100MG 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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