August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00071101441 LYRICA CAP 75MG 12/31/9999 20121 00071101468 LYRICA CAP 75MG 12/31/9999 20121 00015308060 LYSODREN TAB 500MG 12/31/9999 20121 55566210001 LYSTEDA TAB 650MG 12/31/9999 20121 55566210002 LYSTEDA TAB 650MG 12/31/9999 20121 66479065001 LYSTEDA TAB 650MG 01/31/2013 20121 68405007006 LYTENSOPRIL PAK 12/31/9999 20121 68405800706 LYTENSOPRIL PAK 12/31/9999 20121 68405800736 LYTENSOPRIL PAK -90 12/31/9999 20121 61703042153 M.V.I PEDIAT INJ 12/31/9999 20121 61703042281 M.V.I. ADULT INJ 12/31/9999 20121 61703042282 M.V.I. ADULT INJ 12/31/9999 20121 61703042283 M.V.I. ADULT INJ 12/31/9999 20121 61703042381 M.V.I-12 W/O INJ VIT K 12/31/9999 20121 61703042383 M.V.I-12 W/O INJ VIT K 12/31/9999 20121 00067621159 MAALOX CHW 600MG 12/31/9999 20121 00067628144 MAALOX SUS ADVANCED 12/31/9999 20121 00067628162 MAALOX SUS ADVANCED 12/31/9999 20121 00067628171 MAALOX SUS ADVANCED 12/31/9999 20121 00067032871 MAALOX SUS REG ST 12/31/9999 20121 00067627935 MAALOX ADV CHW 1000-60 12/31/9999 20121 00067627965 MAALOX ADV CHW 1000-60 12/31/9999 20121 00067629165 MAALOX ADV CHW 1000-60 12/31/9999 20121 00067628012 MAALOX ADVAN SUS MAX ST 12/31/9999 20121 00067628026 MAALOX ADVAN SUS MAX ST 12/31/9999 20121 00067628212 MAALOX ADVAN SUS MAX ST 12/31/9999 20121 00067629012 MAALOX ADVAN SUS MAX ST 12/31/9999 20121 00067021935 MAALOX MAX CHW 1000-60 12/31/9999 20121 00067021965 MAALOX MAX CHW 1000-60 12/31/9999 20121 00067021990 MAALOX MAX CHW 1000-60 12/31/9999 20121 00067022535 MAALOX MAX CHW 1000-60 12/31/9999 20121 00067022565 MAALOX MAX CHW 1000-60 12/31/9999 20121 00067022665 MAALOX MAX CHW 1000-60 12/31/9999 20121 00067025444 MAALOX MAX SUS CHERRY 12/31/9999 20121 00067025471 MAALOX MAX SUS CHERRY 12/31/9999 20121 00067025671 MAALOX MAX SUS MINT 12/31/9999 20121 00067022812 MAALOX MAX SUS WILD BRY 12/31/9999 20121 00067036645 MAALOX QUICK CHW DISSOLVE 12/31/9999 20121 00067037085 MAALOX QUICK CHW DISSOLVE 12/31/9999 20121 00067032844 MAALOX REG SUS STRENGTH 12/31/9999 20121 00067032862 MAALOX REG SUS STRENGTH 12/31/9999 20121 00067610812 MAALOX TOTAL SUS 525/15ML 12/31/9999 20121 00067610912 MAALOX TOTAL SUS 525/15ML 12/31/9999 20121 00067628312 MAALOX TOTAL SUS 525/15ML 12/31/9999 20121 00149071001 MACROBID CAP 100MG 05/31/2012 20121 52427028501 MACROBID CAP 100MG 12/31/9999 20121 00149000905 MACRODANTIN CAP 100MG 07/31/2012 20121 52427028801 MACRODANTIN CAP 100MG 12/31/9999 20121 00149000705 MACRODANTIN CAP 25MG 10/31/2013 20121 52427028601 MACRODANTIN CAP 25MG 12/31/9999 20121 00149000805 MACRODANTIN CAP 50MG 11/30/2014 20121 68782000101 MACUGEN INJ 12/31/9999 20121 68782000102 MACUGEN INJ 12/31/9999 20121 51552050706 MAG CARBONAT POW LIGHT 12/31/9999 20121 51552050709 MAG CARBONAT POW LIGHT 12/31/9999 20121 51552064204 MAG CITRATE POW TRIBASIC 12/31/9999 20121 51552064206 MAG CITRATE POW TRIBASIC 12/31/9999 20121 00904604277 MAG CITRATE SOL LEMON 12/31/9999 20121 00904604377 MAG CITRATE SOL LEMON 12/31/9999 20121 00536352141 MAG OXIDE TAB 400MG 12/31/9999 20121 00603020922 MAG OXIDE TAB 400MG 12/31/9999 20121 00904531118 MAG OXIDE TAB 400MG 12/31/9999 20121 51645078508 MAG OXIDE TAB 400MG 12/31/9999 20121 60258017101 MAG OXIDE TAB 400MG 12/31/9999 20121 63739035401 MAG OXIDE TAB 400MG 12/31/9999 20121 63739035410 MAG OXIDE TAB 400MG 12/31/9999 20121 00603021321 MAG OXIDE TAB 420MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00121176030 MAG-AL LIQ 12/31/9999 20121 00121176130 MAG-AL PLUS LIQ 12/31/9999 20121 00121176230 MAG-AL PLUS LIQ XS 12/31/9999 20121 00904791152 MAG-DELAY TAB 12/31/9999 20121 60258017201 MAG-G TAB 500MG 12/31/9999 20121 51552021306 MAGN CHLORID POW 12/31/9999 20121 51552021309 MAGN CHLORID POW 12/31/9999 20121 38779211808 MAGN OXIDE POW HEAVY 12/31/9999 20121 23635099401 MAGNACET TAB 10-400MG 12/31/9999 20121 68453099410 MAGNACET TAB 10-400MG 12/31/9999 20121 23635099101 MAGNACET TAB 2.5-400 12/31/9999 20121 23635099201 MAGNACET TAB 5-400MG 12/31/9999 20121 59630099210 MAGNACET TAB 5-400MG 12/31/9999 20121 68453099210 MAGNACET TAB 5-400MG 12/31/9999 20121 23635099301 MAGNACET TAB 7.5-400 12/31/9999 20121 59630099310 MAGNACET TAB 7.5-400 12/31/9999 20121 68453099310 MAGNACET TAB 7.5-400 12/31/9999 20121 59528050805 MAGNEBIND TAB 300 12/31/9999 20121 59528041605 MAGNEBIND TAB 400 12/31/9999 20121 51552102006 MAGNESIUM POW GLUCONAT 12/31/9999 20121 51552128104 MAGNESIUM POW GLUCONAT 12/31/9999 20121 51552113606 MAGNESIUM POW HYDROXID 12/31/9999 20121 51552088706 MAGNESIUM POW STEARATE 12/31/9999 20121 00517503401 MAGNESIUM CL INJ 20% 12/31/9999 20121 67457013450 MAGNESIUM CL INJ 20% 12/31/9999 20121 00536668001 MAGNESIUM GL TAB 500MG 12/31/9999 20121 00409672903 MAGNESIUM SU INJ 40MG/ML 12/31/9999 20121 00409672909 MAGNESIUM SU INJ 40MG/ML 12/31/9999 20121 00409672923 MAGNESIUM SU INJ 40MG/ML 12/31/9999 20121 00409672924 MAGNESIUM SU INJ 40MG/ML 12/31/9999 20121 00409175410 MAGNESIUM SU INJ 50% 12/31/9999 20121 00409216802 MAGNESIUM SU INJ 50% 12/31/9999 20121 00517260225 MAGNESIUM SU INJ 50% 12/31/9999 20121 00517261025 MAGNESIUM SU INJ 50% 12/31/9999 20121 00517265025 MAGNESIUM SU INJ 50% 12/31/9999 20121 63323006402 MAGNESIUM SU INJ 50% 12/31/9999 20121 63323006410 MAGNESIUM SU INJ 50% 12/31/9999 20121 63323006420 MAGNESIUM SU INJ 50% 12/31/9999 20121 63323006450 MAGNESIUM SU INJ 50% 12/31/9999 20121 00409673013 MAGNESIUM SU INJ 80MG/ML 12/31/9999 20121 50419018801 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018802 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018805 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018811 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018815 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018836 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018837 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018838 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018847 MAGNEVIST INJ 46.9% 12/31/9999 20121 50419018858 MAGNEVIST INJ 46.9% 12/31/9999 20121 00256018407 MAGONATE LIQ 1000/5ML 12/31/9999 20121 00256017201 MAGONATE TAB 500MG 12/31/9999 20121 00178029901 MAGTRATE TAB 500MG 10/31/2012 20121 00904518402 MAJOR-PREP OIN 12/31/9999 20121 64011024301 MAKENA INJ 250MG/ML 12/31/9999 20121 51552060602 MALACHITE GR POW OXALATE 12/31/9999 20121 51552060604 MALACHITE GR POW OXALATE 12/31/9999 20121 00173067501 MALARONE TAB 250-100 12/31/9999 20121 00173067502 MALARONE TAB 250-100 12/31/9999 20121 00173067601 MALARONE TAB 62.5-25 12/31/9999 20121 51672527704 MALATHION LOT 0.5% 12/31/9999 20121 00409409101 MANGANESE CL INJ 0.1MG/ML 12/31/9999 20121 00517641025 MANGANESE SU INJ 0.1MG/ML 12/31/9999 20121 00264757810 MANNITOL INJ 20% 12/31/9999 20121 00264757820 MANNITOL INJ 20% 12/31/9999 20121 00409771502 MANNITOL INJ 20% 12/31/9999 20121 00409771503 MANNITOL INJ 20% 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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