August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00069154041 NORVASC TAB 10MG 12/31/9999 20121 00069154068 NORVASC TAB 10MG 12/31/9999 20121 00069152068 NORVASC TAB 2.5MG 12/31/9999 20121 00069153041 NORVASC TAB 5MG 12/31/9999 20121 00069153068 NORVASC TAB 5MG 12/31/9999 20121 00069153072 NORVASC TAB 5MG 12/31/9999 20121 00074663330 NORVIR CAP 100MG 12/31/9999 20121 00074194063 NORVIR SOL 80MG/ML 12/31/9999 20121 00074333330 NORVIR TAB 100MG 12/31/9999 20121 36800039010 NOSE DRO EX ST 12/31/9999 20121 24839034916 NOTUSS-NX LIQ 12/31/9999 20121 24839034816 NOTUSS-NXD LIQ 12/31/9999 20121 68040070426 NOVACORT GEL 12/31/9999 20121 52304071204 NOVAFERRUM SOL 12/31/9999 20121 00135010836 NOVAHISTINE LIQ DH 12/31/9999 20121 00135010842 NOVAHISTINE LIQ DH 12/31/9999 20121 00135010936 NOVAHISTINE SOL EXPECT 12/31/9999 20121 00135010942 NOVAHISTINE SOL EXPECT 12/31/9999 20121 44087152001 NOVANTRONE INJ 2MG/ML 11/30/2013 20121 55566150101 NOVAREL INJ 10000UNT 12/31/9999 20121 00169183711 NOVOLIN INJ 70/30 12/31/9999 20121 00169183717 NOVOLIN INJ 70/30 12/31/9999 20121 00169183411 NOVOLIN N INJ U-100 12/31/9999 20121 00169183417 NOVOLIN N INJ U-100 12/31/9999 20121 00169183311 NOVOLIN R INJ U-100 12/31/9999 20121 00169183317 NOVOLIN R INJ U-100 12/31/9999 20121 00169750111 NOVOLOG INJ 100/ML 12/31/9999 20121 00169633910 NOVOLOG INJ FLEXPEN 12/31/9999 20121 00169330312 NOVOLOG INJ PENFILL 12/31/9999 20121 00169368512 NOVOLOG MIX INJ 70/30 12/31/9999 20121 00169369619 NOVOLOG MIX INJ FLEXPEN 12/31/9999 20121 00169701001 NOVOSEVEN RT INJ 1MG 12/31/9999 20121 00169702001 NOVOSEVEN RT INJ 2MG 12/31/9999 20121 00169705001 NOVOSEVEN RT INJ 5MG 12/31/9999 20121 00169704001 NOVOSEVEN RT INJ 8MG 12/31/9999 20121 00085132801 NOXAFIL SUS 40MG/ML 12/31/9999 20121 55513022101 NPLATE INJ 250MCG 12/31/9999 20121 55513022201 NPLATE INJ 500MCG 12/31/9999 20121 00536500572 NRS NASAL SPR 0.05% 12/31/9999 20121 00536500575 NRS NASAL SPR 0.05% 12/31/9999 20121 00472124516 NUCOTUSS SYP EXPECT 12/31/9999 20121 00472124016 NUCOTUSS EXP SYP PED 12/31/9999 20121 50458084002 NUCYNTA TAB 100MG 12/31/9999 20121 50458084004 NUCYNTA TAB 100MG 12/31/9999 20121 50458082002 NUCYNTA TAB 50MG 12/31/9999 20121 50458082004 NUCYNTA TAB 50MG 12/31/9999 20121 50458083002 NUCYNTA TAB 75MG 12/31/9999 20121 50458083004 NUCYNTA TAB 75MG 12/31/9999 20121 50458086101 NUCYNTA ER TAB 100MG 12/31/9999 20121 50458086201 NUCYNTA ER TAB 150MG 12/31/9999 20121 50458086301 NUCYNTA ER TAB 200MG 12/31/9999 20121 50458086401 NUCYNTA ER TAB 250MG 12/31/9999 20121 50458086001 NUCYNTA ER TAB 50MG 12/31/9999 20121 64597030160 NUEDEXTA CAP 20-10MG 12/31/9999 20121 52544014987 NULECIT INJ 12.5MG/M 12/31/9999 20121 68220011810 NULEV TAB 0.125MG 12/31/9999 20121 00003037113 NULOJIX INJ 250MG 12/31/9999 20121 52268040001 NULYTELY SOL FLAV PKS 12/31/9999 20121 00067581286 NUPERCAINAL OIN 1% 12/31/9999 20121 00067581296 NUPERCAINAL OIN 1% 12/31/9999 20121 58980047405 NUQUIN HP CRE 4% 12/31/9999 20121 58980047410 NUQUIN HP CRE 4% 12/31/9999 20121 58980047420 NUQUIN HP CRE 4% 12/31/9999 20121 58980057405 NUQUIN HP CRE 4% 12/31/9999 20121 58980057410 NUQUIN HP CRE 4% 12/31/9999 20121 58980057420 NUQUIN HP CRE 4% 12/31/9999 20121 58980047505 NUQUIN HP GEL 4% 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 58980047510 NUQUIN HP GEL 4% 12/31/9999 20121 00064211003 NUTRAPLUS CRE 10% 12/31/9999 20121 00064211016 NUTRAPLUS CRE 10% 12/31/9999 20121 00064212008 NUTRAPLUS LOT 10% 12/31/9999 20121 00064212016 NUTRAPLUS LOT 10% 12/31/9999 20121 42457000184 NUTRESTORE PAK 5GM 12/31/9999 20121 24385015334 NUTRI DRINK LIQ CHOCOLAT 12/31/9999 20121 24385015134 NUTRI DRINK LIQ PLUS 12/31/9999 20121 24385022234 NUTRI DRINK LIQ STRWBER 12/31/9999 20121 24385015034 NUTRI DRINK LIQ VANILLA 12/31/9999 20121 24385015234 NUTRI DRINK LIQ VANILLA 12/31/9999 20121 00517310025 NUTRILYTE INJ 12/31/9999 20121 00517312025 NUTRILYTE INJ 12/31/9999 20121 00517200025 NUTRILYTE II INJ 12/31/9999 20121 00517202025 NUTRILYTE II INJ 12/31/9999 20121 54859050108 NUTRIVIT LIQ 800-15-1 12/31/9999 20121 50242001821 NUTROPIN INJ 10MG 05/31/2012 20121 50242002020 NUTROPIN INJ 10MG 05/31/2012 20121 50242001902 NUTROPIN INJ 5MG 05/31/2012 20121 50242007203 NUTROPIN INJ 5MG 05/31/2012 20121 50242002220 NUTROPIN AQ INJ 10MG/2ML 12/31/9999 20121 50242004314 NUTROPIN AQ INJ 10MG/2ML 12/31/9999 20121 50242007401 NUTROPIN AQ INJ 10MG/2ML 12/31/9999 20121 50242007301 NUTROPIN AQ INJ 20MG/2ML 12/31/9999 20121 50242007601 NUTROPIN AQ INJ 20MG/2ML 12/31/9999 20121 50242007501 NUTROPIN AQ INJ NUSPIN 5 12/31/9999 20121 00052027301 NUVARING MIS 12/31/9999 20121 00052027303 NUVARING MIS 12/31/9999 20121 63459021530 NUVIGIL TAB 150MG 12/31/9999 20121 63459021560 NUVIGIL TAB 150MG 12/31/9999 20121 63459022530 NUVIGIL TAB 250MG 12/31/9999 20121 63459022560 NUVIGIL TAB 250MG 12/31/9999 20121 63459020530 NUVIGIL TAB 50MG 12/31/9999 20121 63459020560 NUVIGIL TAB 50MG 12/31/9999 20121 00832046515 NYAMYC POW 100000 12/31/9999 20121 00832046530 NYAMYC POW 100000 12/31/9999 20121 00832046560 NYAMYC POW 100000 12/31/9999 20121 00168008115 NYSTAT/TRIAM CRE 12/31/9999 20121 00168008130 NYSTAT/TRIAM CRE 12/31/9999 20121 00168008160 NYSTAT/TRIAM CRE 12/31/9999 20121 51672126301 NYSTAT/TRIAM CRE 12/31/9999 20121 51672126302 NYSTAT/TRIAM CRE 12/31/9999 20121 51672126303 NYSTAT/TRIAM CRE 12/31/9999 20121 00168008915 NYSTAT/TRIAM OIN 12/31/9999 20121 00168008930 NYSTAT/TRIAM OIN 12/31/9999 20121 00168008960 NYSTAT/TRIAM OIN 12/31/9999 20121 00472015530 NYSTAT/TRIAM OIN 12/31/9999 20121 00472015560 NYSTAT/TRIAM OIN 12/31/9999 20121 51672127201 NYSTAT/TRIAM OIN 12/31/9999 20121 51672127202 NYSTAT/TRIAM OIN 12/31/9999 20121 51672127203 NYSTAT/TRIAM OIN 12/31/9999 20121 00168005415 NYSTATIN CRE 100000 12/31/9999 20121 00168005430 NYSTATIN CRE 100000 12/31/9999 20121 00472016315 NYSTATIN CRE 100000 12/31/9999 20121 00603781874 NYSTATIN CRE 100000 12/31/9999 20121 00603781878 NYSTATIN CRE 100000 12/31/9999 20121 45802005911 NYSTATIN CRE 100000 12/31/9999 20121 45802005935 NYSTATIN CRE 100000 12/31/9999 20121 51672128901 NYSTATIN CRE 100000 12/31/9999 20121 51672128902 NYSTATIN CRE 100000 12/31/9999 20121 00168000715 NYSTATIN OIN 100000 12/31/9999 20121 00168000730 NYSTATIN OIN 100000 12/31/9999 20121 45802004811 NYSTATIN OIN 100000 12/31/9999 20121 45802004835 NYSTATIN OIN 100000 12/31/9999 20121 00574040405 NYSTATIN POW 12/31/9999 20121 00574040415 NYSTATIN POW 12/31/9999 20121 00574040450 NYSTATIN POW 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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