August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00135014702 NICODERM CQ DIS 7MG/24HR 12/31/9999 20121 00135019602 NICODERM CQ DIS 7MG/24HR 12/31/9999 20121 00904573611 NICORELIEF GUM 2MG MINT 12/31/9999 20121 00904573651 NICORELIEF GUM 2MG MINT 12/31/9999 20121 00904573411 NICORELIEF GUM 2MG ORIG 12/31/9999 20121 00904573451 NICORELIEF GUM 2MG ORIG 12/31/9999 20121 00904573711 NICORELIEF GUM 4MG MINT 12/31/9999 20121 00904573751 NICORELIEF GUM 4MG MINT 12/31/9999 20121 00904573511 NICORELIEF GUM 4MG ORIG 12/31/9999 20121 00904573551 NICORELIEF GUM 4MG ORIG 12/31/9999 20121 00904625762 NICORELIEF LOZ 2MG 12/31/9999 20121 00904625862 NICORELIEF LOZ 4MG 12/31/9999 20121 00135015702 NICORETTE GUM 2MG 12/31/9999 20121 00135019702 NICORETTE GUM 2MG 12/31/9999 20121 00135046602 NICORETTE GUM 2MG CINN 12/31/9999 20121 00135046603 NICORETTE GUM 2MG CINN 12/31/9999 20121 00135022501 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135022503 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135022904 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135022905 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135047402 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135047403 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135047405 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135047407 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135047408 NICORETTE GUM 2MG MINT 12/31/9999 20121 00135015709 NICORETTE GUM 2MG ORIG 12/31/9999 20121 00135015710 NICORETTE GUM 2MG ORIG 12/31/9999 20121 00135015711 NICORETTE GUM 2MG ORIG 12/31/9999 20121 00135015701 NICORETTE GUM 2MG REF 12/31/9999 20121 00135015705 NICORETTE GUM 2MG REF 12/31/9999 20121 00135015706 NICORETTE GUM 2MG REF 12/31/9999 20121 00135015708 NICORETTE GUM 2MG REF 12/31/9999 20121 00135019701 NICORETTE GUM 2MG REF 12/31/9999 20121 00135024101 NICORETTE GUM 2MGFRUIT 12/31/9999 20121 00135024102 NICORETTE GUM 2MGFRUIT 12/31/9999 20121 00135024103 NICORETTE GUM 2MGFRUIT 12/31/9999 20121 00135024106 NICORETTE GUM 2MGFRUIT 12/31/9999 20121 00135024108 NICORETTE GUM 2MGFRUIT 12/31/9999 20121 00135046702 NICORETTE GUM 4MG CINN 12/31/9999 20121 00135046703 NICORETTE GUM 4MG CINN 12/31/9999 20121 00135046705 NICORETTE GUM 4MG CINN 12/31/9999 20121 00135022601 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135022602 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135022603 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135023004 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135023005 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135047502 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135047503 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135047507 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135047508 NICORETTE GUM 4MG MINT 12/31/9999 20121 00135015802 NICORETTE GUM 4MG ORIG 12/31/9999 20121 00135015803 NICORETTE GUM 4MG ORIG 12/31/9999 20121 00135015809 NICORETTE GUM 4MG ORIG 12/31/9999 20121 00135015810 NICORETTE GUM 4MG ORIG 12/31/9999 20121 00135015811 NICORETTE GUM 4MG ORIG 12/31/9999 20121 00135015801 NICORETTE GUM 4MG REF 12/31/9999 20121 00135015805 NICORETTE GUM 4MG REF 12/31/9999 20121 00135015806 NICORETTE GUM 4MG REF 12/31/9999 20121 00135015808 NICORETTE GUM 4MG REF 12/31/9999 20121 00135019801 NICORETTE GUM 4MG REF 12/31/9999 20121 00135024201 NICORETTE GUM 4MGFRUIT 12/31/9999 20121 00135024202 NICORETTE GUM 4MGFRUIT 12/31/9999 20121 00135024203 NICORETTE GUM 4MGFRUIT 12/31/9999 20121 00135024206 NICORETTE GUM 4MGFRUIT 12/31/9999 20121 00135024208 NICORETTE GUM 4MGFRUIT 12/31/9999 20121 00135051001 NICORETTE LOZ 2MG 12/31/9999 20121 00135051002 NICORETTE LOZ 2MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00135051005 NICORETTE LOZ 2MG 12/31/9999 20121 00135051201 NICORETTE LOZ 2MG 12/31/9999 20121 00135051205 NICORETTE LOZ 2MG 12/31/9999 20121 00135051403 NICORETTE LOZ 2MG 12/31/9999 20121 00135051101 NICORETTE LOZ 4MG 12/31/9999 20121 00135051102 NICORETTE LOZ 4MG 12/31/9999 20121 00135051105 NICORETTE LOZ 4MG 12/31/9999 20121 00135051301 NICORETTE LOZ 4MG 12/31/9999 20121 00135051305 NICORETTE LOZ 4MG 12/31/9999 20121 00135051503 NICORETTE LOZ 4MG 12/31/9999 20121 00135050802 NICORETTE LOZ MINI 2MG 12/31/9999 20121 00135050803 NICORETTE LOZ MINI 2MG 12/31/9999 20121 00135050902 NICORETTE LOZ MINI 4MG 12/31/9999 20121 00135050903 NICORETTE LOZ MINI 4MG 12/31/9999 20121 00135022502 NICORETTE ST GUM 2MG MINT 12/31/9999 20121 00135015707 NICORETTE ST GUM 2MG ORIG 12/31/9999 20121 00135019802 NICORETTE ST GUM 4MG 12/31/9999 20121 00135015807 NICORETTE ST GUM 4MG ORIG 12/31/9999 20121 42192030860 NICOTINAMIDE TAB ZN/CU/FA 12/31/9999 20121 42546091760 NICOTINAMIDE TAB ZN/CU/FA 12/31/9999 20121 00067021407 NICOTINE DIS 14MG/24H 12/31/9999 20121 00067489007 NICOTINE DIS 14MG/24H 12/31/9999 20121 00067512507 NICOTINE DIS 14MG/24H 12/31/9999 20121 00067512514 NICOTINE DIS 14MG/24H 12/31/9999 20121 00067021507 NICOTINE DIS 21MG/24H 12/31/9999 20121 00067021528 NICOTINE DIS 21MG/24H 12/31/9999 20121 00067512607 NICOTINE DIS 21MG/24H 12/31/9999 20121 00067512614 NICOTINE DIS 21MG/24H 12/31/9999 20121 00067512628 NICOTINE DIS 21MG/24H 12/31/9999 20121 00067021307 NICOTINE DIS 7MG/24HR 12/31/9999 20121 00067021314 NICOTINE DIS 7MG/24HR 12/31/9999 20121 00067512407 NICOTINE DIS 7MG/24HR 12/31/9999 20121 00067512414 NICOTINE DIS 7MG/24HR 12/31/9999 20121 37205020371 NICOTINE GUM 2MG 12/31/9999 20121 37205020471 NICOTINE GUM 4MG 12/31/9999 20121 37205098769 NICOTINE LOZ 2MG MINT 12/31/9999 20121 37205098869 NICOTINE LOZ 4MG MINT 12/31/9999 20121 00113002960 NICOTINE POL GUM 2MG 12/31/9999 20121 00536340401 NICOTINE POL GUM 2MG CINN 12/31/9999 20121 00536340437 NICOTINE POL GUM 2MG CINN 12/31/9999 20121 00113020625 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 00113045678 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 00536311201 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 00536311237 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 36800020625 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 36800045678 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 37205096758 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 37205096778 NICOTINE POL GUM 2MG MINT 12/31/9999 20121 00536302906 NICOTINE POL GUM 2MG ORIG 12/31/9999 20121 00536302923 NICOTINE POL GUM 2MG ORIG 12/31/9999 20121 00536302934 NICOTINE POL GUM 2MG ORIG 12/31/9999 20121 36800002925 NICOTINE POL GUM 2MG ORIG 12/31/9999 20121 00536136206 NICOTINE POL GUM 2MG REF 12/31/9999 20121 00536136234 NICOTINE POL GUM 2MG REF 12/31/9999 20121 00536136223 NICOTINE POL GUM 2MG STRT 12/31/9999 20121 00536338601 NICOTINE POL GUM 2MGFRUIT 12/31/9999 20121 00536338637 NICOTINE POL GUM 2MGFRUIT 12/31/9999 20121 36800035278 NICOTINE POL GUM 2MGFRUIT 12/31/9999 20121 00536338701 NICOTINE POL GUM 4MG 12/31/9999 20121 00536338737 NICOTINE POL GUM 4MG 12/31/9999 20121 00536340501 NICOTINE POL GUM 4MG 12/31/9999 20121 00536340537 NICOTINE POL GUM 4MG 12/31/9999 20121 00113042225 NICOTINE POL GUM 4MG MINT 12/31/9999 20121 00113053278 NICOTINE POL GUM 4MG MINT 12/31/9999 20121 00536311301 NICOTINE POL GUM 4MG MINT 12/31/9999 20121 00536311337 NICOTINE POL GUM 4MG MINT 12/31/9999 20121 36800042271 NICOTINE POL GUM 4MG MINT 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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