August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00713063337 METRONIDAZOL CRE 0.75% 12/31/9999 20121 67405011045 METRONIDAZOL CRE 0.75% 12/31/9999 20121 00168027545 METRONIDAZOL GEL 0.75% 12/31/9999 20121 00713063737 METRONIDAZOL GEL 0.75% 12/31/9999 20121 00781707819 METRONIDAZOL GEL 0.75% 12/31/9999 20121 51672411606 METRONIDAZOL GEL 0.75% 12/31/9999 20121 00781707787 METRONIDAZOL GEL 0.75%VAG 12/31/9999 20121 66993093570 METRONIDAZOL GEL 0.75%VAG 12/31/9999 20121 00168038360 METRONIDAZOL LOT 0.75% 12/31/9999 20121 00472091202 METRONIDAZOL LOT 0.75% 12/31/9999 20121 00228225810 METRONIDAZOL TAB 250MG 12/31/9999 20121 00591252101 METRONIDAZOL TAB 250MG 12/31/9999 20121 00591252105 METRONIDAZOL TAB 250MG 12/31/9999 20121 00591252125 METRONIDAZOL TAB 250MG 12/31/9999 20121 00591396901 METRONIDAZOL TAB 250MG 08/31/2012 20121 00591396905 METRONIDAZOL TAB 250MG 02/28/2013 20121 00591396925 METRONIDAZOL TAB 250MG 02/28/2013 20121 00904145361 METRONIDAZOL TAB 250MG 12/31/9999 20121 50111033301 METRONIDAZOL TAB 250MG 12/31/9999 20121 50111033302 METRONIDAZOL TAB 250MG 12/31/9999 20121 50111033306 METRONIDAZOL TAB 250MG 12/31/9999 20121 51079012201 METRONIDAZOL TAB 250MG 12/31/9999 20121 51079012217 METRONIDAZOL TAB 250MG 12/31/9999 20121 51079012219 METRONIDAZOL TAB 250MG 12/31/9999 20121 51079012220 METRONIDAZOL TAB 250MG 12/31/9999 20121 00591252205 METRONIDAZOL TAB 500MG 12/31/9999 20121 00591252250 METRONIDAZOL TAB 500MG 12/31/9999 20121 00591397005 METRONIDAZOL TAB 500MG 03/31/2013 20121 00591397050 METRONIDAZOL TAB 500MG 04/30/2013 20121 15338015004 METRONIDAZOL TAB 500MG 12/31/9999 20121 15338015014 METRONIDAZOL TAB 500MG 12/31/9999 20121 50111033401 METRONIDAZOL TAB 500MG 12/31/9999 20121 50111033402 METRONIDAZOL TAB 500MG 12/31/9999 20121 51079012601 METRONIDAZOL TAB 500MG 12/31/9999 20121 51079012617 METRONIDAZOL TAB 500MG 12/31/9999 20121 51079012619 METRONIDAZOL TAB 500MG 12/31/9999 20121 51079012620 METRONIDAZOL TAB 500MG 12/31/9999 20121 63739017610 METRONIDAZOL TAB 500MG 05/31/2012 20121 00299630002 METVIXIA CRE 16.8% 12/31/9999 20121 00006073161 MEVACOR TAB 20MG 12/31/9999 20121 00006073261 MEVACOR TAB 40MG 12/31/9999 20121 00093873901 MEXILETINE CAP 150MG 12/31/9999 20121 00093874001 MEXILETINE CAP 200MG 12/31/9999 20121 00093874101 MEXILETINE CAP 250MG 12/31/9999 20121 00409672723 MG SO4/D5W INJ 10MG/ML 12/31/9999 20121 00078014923 MIACALCIN INJ 200/ML 12/31/9999 20121 00078031154 MIACALCIN SPR 200/ACT 12/31/9999 20121 00904511571 MI-ACID CHW 12/31/9999 20121 00904000414 MI-ACID SUS 12/31/9999 20121 00904000514 MI-ACID SUS MAX ST 12/31/9999 20121 00904506860 MI-ACID GAS CHW 80MG 12/31/9999 20121 00597003937 MICARDIS TAB 20MG 12/31/9999 20121 00597004037 MICARDIS TAB 40MG 12/31/9999 20121 00597004137 MICARDIS TAB 80MG 12/31/9999 20121 00597004337 MICARDIS HCT TAB 40/12.5 12/31/9999 20121 00597004437 MICARDIS HCT TAB 80/12.5 12/31/9999 20121 00597004237 MICARDIS HCT TAB 80-25MG 12/31/9999 20121 37205099866 MICONAZOLE AER 2% POWD 12/31/9999 20121 00472073041 MICONAZOLE CRE 2% 12/31/9999 20121 00472073052 MICONAZOLE CRE 2% 12/31/9999 20121 00472073063 MICONAZOLE CRE 2% 12/31/9999 20121 00472073514 MICONAZOLE CRE 2% 12/31/9999 20121 00472073526 MICONAZOLE CRE 2% 12/31/9999 20121 00472073542 MICONAZOLE CRE 2% 12/31/9999 20121 00472073556 MICONAZOLE CRE 2% 12/31/9999 20121 00603780550 MICONAZOLE CRE 2% 12/31/9999 20121 00713025237 MICONAZOLE CRE 2% 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00904773445 MICONAZOLE CRE 2% 12/31/9999 20121 00904773457 MICONAZOLE CRE 2% 12/31/9999 20121 51672200101 MICONAZOLE CRE 2% 12/31/9999 20121 51672200102 MICONAZOLE CRE 2% 12/31/9999 20121 51672203506 MICONAZOLE CRE 2% 12/31/9999 20121 00713019757 MICONAZOLE SUP 100MG 12/31/9999 20121 36800073745 MICONAZOLE 1 KIT 12/31/9999 20121 46122002702 MICONAZOLE 1 KIT 12/31/9999 20121 36800098200 MICONAZOLE 3 KIT COMBINAT 12/31/9999 20121 37205058303 MICONAZOLE 3 KIT COMBINAT 12/31/9999 20121 49348064573 MICONAZOLE 3 KIT COMBINAT 12/31/9999 20121 00113008100 MICONAZOLE 3 KIT COMBO PK 12/31/9999 20121 00113060500 MICONAZOLE 3 KIT COMBO PK 12/31/9999 20121 00904541501 MICONAZOLE 3 KIT COMBO PK 12/31/9999 20121 36800008100 MICONAZOLE 3 KIT COMBO PK 12/31/9999 20121 37205058903 MICONAZOLE 3 KIT COMBO PK 12/31/9999 20121 00472173803 MICONAZOLE 3 SUP 200MG 12/31/9999 20121 00113082529 MICONAZOLE 7 CRE 2% 12/31/9999 20121 00536142326 MICONAZOLE 7 CRE 2% 03/31/2013 20121 24385059029 MICONAZOLE 7 CRE 2% 12/31/9999 20121 36800082529 MICONAZOLE 7 CRE 2% 12/31/9999 20121 37205059029 MICONAZOLE 7 CRE 2% 12/31/9999 20121 49348053077 MICONAZOLE 7 CRE 2% 12/31/9999 20121 49348087277 MICONAZOLE 7 CRE 2% 12/31/9999 20121 63868020046 MICONAZOLE 7 CRE 2% 12/31/9999 20121 00113021429 MICONAZOLE 7 CRE TUBE/KIT 12/31/9999 20121 00472173607 MICONAZOLE 7 SUP 100MG 12/31/9999 20121 37205065318 MICONAZORB POW AF 2% 12/31/9999 20121 46122003927 MICONAZORB POW AF 2% 12/31/9999 20121 11701003723 MICRO GUARD CRE 2% 12/31/9999 20121 11701003816 MICRO GUARD POW 2% 12/31/9999 20121 52544095121 MICROGESTIN TAB 1.5/30 12/31/9999 20121 52544095021 MICROGESTIN TAB 1/20 12/31/9999 20121 52544063028 MICROGESTIN TAB FE 1/20 12/31/9999 20121 52544063128 MICROGESTIN TAB FE1.5/30 12/31/9999 20121 64011000904 MICRO-K CAP 10MEQ CR 12/31/9999 20121 64011001004 MICRO-K CAP 8MEQ CR 12/31/9999 20121 52544062201 MICROZIDE CAP 12.5MG 12/31/9999 20121 00641605610 MIDAZOLAM INJ 10MG/10 12/31/9999 20121 25021066010 MIDAZOLAM INJ 10MG/10 12/31/9999 20121 55390012510 MIDAZOLAM INJ 10MG/10 12/31/9999 20121 63323041110 MIDAZOLAM INJ 10MG/10 12/31/9999 20121 00409230802 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 00409230850 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 00641606310 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 00641606325 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 10019002707 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 10019002708 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 10019002759 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 25021065602 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 55390013802 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 63323041202 MIDAZOLAM INJ 10MG/2ML 12/31/9999 20121 00409230502 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 00409230517 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 00409230521 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 00409258705 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 00409258753 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 10019002810 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 10019002839 MIDAZOLAM INJ 1MG/ML 12/31/9999 20121 25021066105 MIDAZOLAM INJ 25MG/5ML 12/31/9999 20121 55390012605 MIDAZOLAM INJ 25MG/5ML 12/31/9999 20121 63323041205 MIDAZOLAM INJ 25MG/5ML 12/31/9999 20121 00409230612 MIDAZOLAM INJ 2MG/2ML 12/31/9999 20121 00409230662 MIDAZOLAM INJ 2MG/2ML 12/31/9999 20121 00641605710 MIDAZOLAM INJ 2MG/2ML 12/31/9999 20121 00641605725 MIDAZOLAM INJ 2MG/2ML 12/31/9999 20121 10019002801 MIDAZOLAM INJ 2MG/2ML 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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