August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 68084035401 OXYCODONE TAB 5MG 12/31/9999 20121 52152041102 OXYCODONE TAB 80MG CR 12/31/9999 20121 58177068304 OXYCODONE TAB 80MG CR 08/31/2012 20121 60505354001 OXYCODONE TAB 80MG CR 10/31/2012 20121 00406059601 OXYCODONE TAB 80MG ER 12/31/9999 20121 59011010010 OXYCONTIN TAB 10MG CR 12/31/9999 20121 59011010020 OXYCONTIN TAB 10MG CR 12/31/9999 20121 59011041010 OXYCONTIN TAB 10MG CR 12/31/9999 20121 59011041020 OXYCONTIN TAB 10MG CR 12/31/9999 20121 59011041510 OXYCONTIN TAB 15MG CR 12/31/9999 20121 59011041520 OXYCONTIN TAB 15MG CR 12/31/9999 20121 59011081510 OXYCONTIN TAB 15MG CR 12/31/9999 20121 59011010910 OXYCONTIN TAB 160MG CR 12/31/9999 20121 59011010925 OXYCONTIN TAB 160MG CR 12/31/9999 20121 59011010310 OXYCONTIN TAB 20MG CR 12/31/9999 20121 59011010320 OXYCONTIN TAB 20MG CR 12/31/9999 20121 59011042010 OXYCONTIN TAB 20MG CR 12/31/9999 20121 59011042020 OXYCONTIN TAB 20MG CR 12/31/9999 20121 59011043010 OXYCONTIN TAB 30MG CR 12/31/9999 20121 59011043020 OXYCONTIN TAB 30MG CR 12/31/9999 20121 59011083010 OXYCONTIN TAB 30MG CR 12/31/9999 20121 59011010510 OXYCONTIN TAB 40MG CR 12/31/9999 20121 59011010520 OXYCONTIN TAB 40MG CR 12/31/9999 20121 59011044010 OXYCONTIN TAB 40MG CR 12/31/9999 20121 59011044020 OXYCONTIN TAB 40MG CR 12/31/9999 20121 59011046010 OXYCONTIN TAB 60MG CR 12/31/9999 20121 59011046020 OXYCONTIN TAB 60MG CR 12/31/9999 20121 59011086010 OXYCONTIN TAB 60MG CR 12/31/9999 20121 59011010710 OXYCONTIN TAB 80MG CR 12/31/9999 20121 59011010720 OXYCONTIN TAB 80MG CR 12/31/9999 20121 59011048010 OXYCONTIN TAB 80MG CR 12/31/9999 20121 59011048020 OXYCONTIN TAB 80MG CR 12/31/9999 20121 00228326211 OXYMORPHONE TAB 15MG ER 12/31/9999 20121 00228326111 OXYMORPHONE TAB 7.5MG ER 12/31/9999 20121 00054028425 OXYMORPHONE TAB HCL 10MG 12/31/9999 20121 60951079570 OXYMORPHONE TAB HCL 10MG 12/31/9999 20121 00054028325 OXYMORPHONE TAB HCL 5MG 12/31/9999 20121 60951079470 OXYMORPHONE TAB HCL 5MG 12/31/9999 20121 10019029102 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 10019029104 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 10019029112 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 10019029171 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 63323001201 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 63323001210 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 63323001212 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 63323001230 OXYTOCIN INJ 10UNT/ML 12/31/9999 20121 52544092008 OXYTROL DIS 3.9MG/24 12/31/9999 20121 00023334807 OZURDEX IMP 0.7MG 12/31/9999 20121 00245014401 PACERONE TAB 100MG 12/31/9999 20121 00245014430 PACERONE TAB 100MG 12/31/9999 20121 00245014701 PACERONE TAB 200MG 12/31/9999 20121 00245014715 PACERONE TAB 200MG 12/31/9999 20121 00245014760 PACERONE TAB 200MG 12/31/9999 20121 00245014790 PACERONE TAB 200MG 12/31/9999 20121 00245014501 PACERONE TAB 400MG 12/31/9999 20121 00245014530 PACERONE TAB 400MG 12/31/9999 20121 00069007601 PACLITAXEL INJ 100MG 12/31/9999 20121 00703476601 PACLITAXEL INJ 100MG 12/31/9999 20121 25021021317 PACLITAXEL INJ 100MG 12/31/9999 20121 55390011420 PACLITAXEL INJ 100MG 12/31/9999 20121 55390030420 PACLITAXEL INJ 100MG 12/31/9999 20121 55390031420 PACLITAXEL INJ 100MG 12/31/9999 20121 61703034222 PACLITAXEL INJ 100MG 12/31/9999 20121 63323076316 PACLITAXEL INJ 100MG 12/31/9999 20121 66758004302 PACLITAXEL INJ 100MG 12/31/9999 20121 00703476701 PACLITAXEL INJ 150/25ML 12/31/9999 20121 00069007801 PACLITAXEL INJ 300/50ML 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00703476801 PACLITAXEL INJ 300/50ML 12/31/9999 20121 25021021350 PACLITAXEL INJ 300/50ML 12/31/9999 20121 55390011450 PACLITAXEL INJ 300/50ML 12/31/9999 20121 55390030450 PACLITAXEL INJ 300/50ML 12/31/9999 20121 55390031450 PACLITAXEL INJ 300/50ML 12/31/9999 20121 61703034250 PACLITAXEL INJ 300/50ML 12/31/9999 20121 63323076350 PACLITAXEL INJ 300/50ML 12/31/9999 20121 66758004303 PACLITAXEL INJ 300/50ML 12/31/9999 20121 00069007901 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 00703476401 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 25021021305 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 55390011405 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 55390030405 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 55390031405 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 61703034209 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 63323076305 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 66758004301 PACLITAXEL INJ 30MG/5ML 12/31/9999 20121 43538014060 PACNEX HP PAD 7% 12/31/9999 20121 43538015060 PACNEX LP PAD 4.25% 12/31/9999 20121 43538012016 PACNEX MX LIQ 4.25% 12/31/9999 20121 43538011016 PACNEX WASH LIQ 7% 12/31/9999 20121 00536012285 PAIN & FEVER SOL 160/5ML 12/31/9999 20121 00536012297 PAIN & FEVER SOL 160/5ML 12/31/9999 20121 62011000101 PAIN & FEVER SUS 160/5ML 12/31/9999 20121 62011000201 PAIN & FEVER SUS 160/5ML 12/31/9999 20121 62011002201 PAIN & FEVER SUS 160/5ML 12/31/9999 20121 00113021771 PAIN REL 8HR TAB 650MG 12/31/9999 20121 00113028905 PAIN RELIEF DRO 80/0.8ML 09/02/2013 20121 24385028905 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 24385028910 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 24385031305 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 36800000805 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 36800028905 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 36800028910 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 46122003103 PAIN RELIEF DRO 80/0.8ML 12/31/9999 20121 00113000805 PAIN RELIEF DRO INFANTS 02/22/2013 20121 00113000810 PAIN RELIEF DRO INFANTS 02/04/2013 20121 00113010526 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 00113013026 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 00113017526 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 24385010526 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 24385013026 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 24385014626 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 36800010526 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 36800013026 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 36800017526 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 62011002901 PAIN RELIEF SUS 160/5ML 12/31/9999 20121 24385098426 PAIN RELIEF SUS PLS COLD 12/31/9999 20121 36800090326 PAIN RELIEF SUS PLS COLD 12/31/9999 20121 00113040378 PAIN RELIEF TAB 325MG 03/26/2014 20121 24385040378 PAIN RELIEF TAB 325MG 12/31/9999 20121 36800040378 PAIN RELIEF TAB 325MG 12/31/9999 20121 00113022771 PAIN RELIEF TAB 500MG 12/31/9999 20121 00113040572 PAIN RELIEF TAB 500MG 03/05/2014 20121 00113048452 PAIN RELIEF TAB 500MG 12/31/9999 20121 00113048462 PAIN RELIEF TAB 500MG 12/31/9999 20121 00113048471 PAIN RELIEF TAB 500MG 12/31/9999 20121 00113048478 PAIN RELIEF TAB 500MG 12/31/9999 20121 00113048490 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385008778 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385014571 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385040572 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385040578 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385048447 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385048452 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385048471 PAIN RELIEF TAB 500MG 12/31/9999 20121 24385048478 PAIN RELIEF TAB 500MG 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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