August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 49483022310 NITRO-TIME CAP 9MG CR 12/31/9999 20121 00093106505 NIZATIDINE CAP 150MG 10/31/2012 20121 00093106506 NIZATIDINE CAP 150MG 10/31/2012 20121 00185015005 NIZATIDINE CAP 150MG 12/31/9999 20121 00185015060 NIZATIDINE CAP 150MG 12/31/9999 20121 00378515005 NIZATIDINE CAP 150MG 08/31/2013 20121 00378515091 NIZATIDINE CAP 150MG 12/31/9999 20121 00591313760 NIZATIDINE CAP 150MG 12/31/9999 20121 55111031005 NIZATIDINE CAP 150MG 09/30/2014 20121 55111031060 NIZATIDINE CAP 150MG 01/13/2014 20121 60505023004 NIZATIDINE CAP 150MG 12/31/9999 20121 68462042560 NIZATIDINE CAP 150MG 12/31/9999 20121 00093106656 NIZATIDINE CAP 300MG 10/31/2012 20121 00185030001 NIZATIDINE CAP 300MG 12/31/9999 20121 00185030030 NIZATIDINE CAP 300MG 12/31/9999 20121 00378530093 NIZATIDINE CAP 300MG 12/31/9999 20121 00591313830 NIZATIDINE CAP 300MG 12/31/9999 20121 55111031130 NIZATIDINE CAP 300MG 07/31/2013 20121 60505023101 NIZATIDINE CAP 300MG 12/31/9999 20121 68462042630 NIZATIDINE CAP 300MG 12/31/9999 20121 10572014762 NIZATIDINE SOL 15MG/ML 12/31/9999 20121 65162065990 NIZATIDINE SOL 15MG/ML 12/31/9999 20121 50458068008 NIZORAL SHA 2% 12/31/9999 20121 51552115806 N-JELLY GEL 12/31/9999 20121 00067207016 NO DOZ TAB 200MG 12/31/9999 20121 00067207036 NO DOZ TAB 200MG 12/31/9999 20121 00067207060 NO DOZ TAB 200MG 12/31/9999 20121 36800038810 NO DRIP NASL SPR 0.05% 12/31/9999 20121 37205033610 NO DRIP NASL SPR 0.05% 12/31/9999 20121 68047018616 NOHIST-DM LIQ 12/31/9999 20121 68047018516 NOHIST-LQ LIQ 4-10/5ML 12/31/9999 20121 63868017526 NON-ASA CHLD SUS 160/5ML 12/31/9999 20121 63868015824 NON-ASA JR TAB 160MG 12/31/9999 20121 63868099030 NON-ASPIRIN CHW 80MG 12/31/9999 20121 63868099130 NON-ASPIRIN CHW 80MG 12/31/9999 20121 63868083701 NON-ASPIRIN DRO 80/0.8ML 12/31/9999 20121 63868017626 NON-ASPIRIN SUS 160/5ML 12/31/9999 20121 15127007208 NON-ASPIRIN TAB 325MG 12/31/9999 20121 15127007224 NON-ASPIRIN TAB 325MG 12/31/9999 20121 63868031410 NON-ASPIRIN TAB 325MG 12/31/9999 20121 15127002030 NON-ASPIRIN TAB 500MG 12/31/9999 20121 15127003630 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868008801 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868008803 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868008824 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868008850 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868031510 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868031560 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868050350 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868050701 NON-ASPIRIN TAB 500MG 12/31/9999 20121 63868098750 NON-ASPIRIN TAB 500MG/RR 12/31/9999 20121 63868008905 NON-ASPIRIN TAB 650MG 12/31/9999 20121 63868008910 NON-ASPIRIN TAB 650MG 12/31/9999 20121 63868009050 NON-ASPIRIN TAB PM 12/31/9999 20121 52544062928 NORA-BE TAB 0.35MG 12/31/9999 20121 52544053901 NORCO TAB 10-325MG 12/31/9999 20121 52544053905 NORCO TAB 10-325MG 12/31/9999 20121 52544091301 NORCO TAB 5-325MG 12/31/9999 20121 52544072901 NORCO TAB 7.5-325 12/31/9999 20121 51285009158 NORDETTE-28 TAB 12/31/9999 20121 00169770511 NORDITROPIN INJ 10/1.5ML 09/30/2012 20121 00169770521 NORDITROPIN INJ 10/1.5ML 12/31/9999 20121 00169770811 NORDITROPIN INJ 15/1.5ML 09/30/2012 20121 00169770821 NORDITROPIN INJ 15/1.5ML 12/31/9999 20121 00169770311 NORDITROPIN INJ 30/3ML 12/31/9999 20121 00169770411 NORDITROPIN INJ 5/1.5ML 06/30/2012 20121 00169770421 NORDITROPIN INJ 5/1.5ML 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00703115301 NOREPINEPHR INJ 1MG/ML 12/31/9999 20121 00703115303 NOREPINEPHR INJ 1MG/ML 12/31/9999 20121 55390000210 NOREPINEPHR INJ 1MG/ML 12/31/9999 20121 00555021110 NORETHIN ACE TAB 5MG 12/31/9999 20121 68462030450 NORETHIN ACE TAB 5MG 12/31/9999 20121 68180087613 NORETHINDRON TAB 0.35MG 12/31/9999 20121 68462030529 NORETHINDRON TAB 0.35MG 12/31/9999 20121 29336054006 NORFLEX INJ 30MG/ML 02/28/2013 20121 24090096184 NORGEST/ETH TAB ESTRAD 12/31/9999 20121 68462056529 NORGEST/ETHI TAB ESTRADIO 12/31/9999 20121 52544025928 NORINYL TAB 1+35-28 12/31/9999 20121 52544026531 NORINYL TAB 1+50-28 12/31/9999 20121 00066985060 NORITATE CRE 1% 12/31/9999 20121 66977002204 NORMLSHIELD CRE 4.5% 12/31/9999 20121 00409796503 NORMOSOL -M INJ /D5W 12/31/9999 20121 00409796509 NORMOSOL -M INJ /D5W 12/31/9999 20121 00409796709 NORMOSOL -R INJ 12/31/9999 20121 00409796809 NORMOSOL -R INJ /D5W 12/31/9999 20121 00409767003 NORMOSOL-R INJ PH 7.4 12/31/9999 20121 00409767009 NORMOSOL-R INJ PH 7.4 12/31/9999 20121 00006070520 NOROXIN TAB 400MG 12/31/9999 20121 00025275231 NORPACE CAP 100MG 12/31/9999 20121 00025273231 NORPACE CAP 100MG CR 12/31/9999 20121 00025273251 NORPACE CAP 100MG CR 12/31/9999 20121 00025276231 NORPACE CAP 150MG 12/31/9999 20121 00025274231 NORPACE CAP 150MG CR 12/31/9999 20121 00025274251 NORPACE CAP 150MG CR 12/31/9999 20121 00068002001 NORPRAMIN TAB 100MG 12/31/9999 20121 00068000701 NORPRAMIN TAB 10MG 12/31/9999 20121 00068002150 NORPRAMIN TAB 150MG 12/31/9999 20121 00068001101 NORPRAMIN TAB 25MG 12/31/9999 20121 00068001501 NORPRAMIN TAB 50MG 12/31/9999 20121 00068001901 NORPRAMIN TAB 75MG 12/31/9999 20121 52544023528 NOR-QD TAB 0.35MG 12/31/9999 20121 63162051012 NORTEMP SUS 160/5ML 12/31/9999 20121 63162051830 NORTEMP SUS INFANTS 12/31/9999 20121 00555900942 NORTREL (21) TAB 1/35 12/31/9999 20121 00555901058 NORTREL (28) TAB 1/35 12/31/9999 20121 00555900867 NORTREL 28 TAB 0.5/35 12/31/9999 20121 00555901258 NORTREL7/7/7 TAB 28 DAYS 12/31/9999 20121 00093081001 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 00093081005 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 00591578601 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 00591578605 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 51672400105 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 51672400106 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 68084003101 NORTRIPTYLIN CAP 10MG 12/31/9999 20121 00093081101 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 00093081105 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 00591578701 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 00591578705 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 00591578710 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 51672400205 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 51672400206 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 68084003201 NORTRIPTYLIN CAP 25MG 12/31/9999 20121 00093081201 NORTRIPTYLIN CAP 50MG 12/31/9999 20121 00093081205 NORTRIPTYLIN CAP 50MG 12/31/9999 20121 00591578801 NORTRIPTYLIN CAP 50MG 12/31/9999 20121 00591578805 NORTRIPTYLIN CAP 50MG 12/31/9999 20121 51672400305 NORTRIPTYLIN CAP 50MG 12/31/9999 20121 51672400306 NORTRIPTYLIN CAP 50MG 12/31/9999 20121 00093081301 NORTRIPTYLIN CAP 75MG 12/31/9999 20121 00093081305 NORTRIPTYLIN CAP 75MG 12/31/9999 20121 00591578901 NORTRIPTYLIN CAP 75MG 12/31/9999 20121 51672400405 NORTRIPTYLIN CAP 75MG 12/31/9999 20121 00121067816 NORTRIPTYLIN SOL 10MG/5ML 12/31/9999 20121 63304020201 NORTRIPTYLIN SOL 10MG/5ML 08/31/2012 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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