August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 11701000909 PERI-WASH II LIQ 12/31/9999 20121 00472024260 PERMETHRIN CRE 5% 12/31/9999 20121 45802026937 PERMETHRIN CRE 5% 12/31/9999 20121 00472524267 PERMETHRIN LOT 1% 12/31/9999 20121 00472524269 PERMETHRIN LOT 1% 12/31/9999 20121 00126008008 PEROXYL SOL 12/31/9999 20121 00126008016 PEROXYL SOL 12/31/9999 20121 00126008050 PEROXYL SOL 12/31/9999 20121 00378033001 PERPHEN/AMIT TAB 2-10MG 12/31/9999 20121 00378033005 PERPHEN/AMIT TAB 2-10MG 12/31/9999 20121 00378044201 PERPHEN/AMIT TAB 2-25MG 12/31/9999 20121 00378044205 PERPHEN/AMIT TAB 2-25MG 12/31/9999 20121 00378004201 PERPHEN/AMIT TAB 4-10MG 12/31/9999 20121 00378057401 PERPHEN/AMIT TAB 4-25MG 12/31/9999 20121 00378057405 PERPHEN/AMIT TAB 4-25MG 12/31/9999 20121 00378007301 PERPHEN/AMIT TAB 4-50MG 12/31/9999 20121 00603509321 PERPHENAZINE TAB 16MG 12/31/9999 20121 00781104901 PERPHENAZINE TAB 16MG 12/31/9999 20121 00603509021 PERPHENAZINE TAB 2MG 12/31/9999 20121 00603509028 PERPHENAZINE TAB 2MG 12/31/9999 20121 00781104601 PERPHENAZINE TAB 2MG 12/31/9999 20121 00781104613 PERPHENAZINE TAB 2MG 12/31/9999 20121 00603506121 PERPHENAZINE TAB 4MG 12/31/9999 20121 00603506128 PERPHENAZINE TAB 4MG 12/31/9999 20121 00603509121 PERPHENAZINE TAB 4MG 12/31/9999 20121 00603509128 PERPHENAZINE TAB 4MG 10/31/2013 20121 00781104701 PERPHENAZINE TAB 4MG 12/31/9999 20121 00781104713 PERPHENAZINE TAB 4MG 12/31/9999 20121 62584081701 PERPHENAZINE TAB 4MG 02/10/2013 20121 00603509221 PERPHENAZINE TAB 8MG 12/31/9999 20121 00603509228 PERPHENAZINE TAB 8MG 12/31/9999 20121 00781104801 PERPHENAZINE TAB 8MG 12/31/9999 20121 00781104813 PERPHENAZINE TAB 8MG 12/31/9999 20121 62584082001 PERPHENAZINE TAB 8MG 02/10/2013 20121 00597001701 PERSANTINE TAB 25MG 12/31/9999 20121 00597001801 PERSANTINE TAB 50MG 12/31/9999 20121 00597001901 PERSANTINE TAB 75MG 12/31/9999 20121 51552031704 PERUVIAN LIQ BALSAM 12/31/9999 20121 51552031706 PERUVIAN POW BALSAM 12/31/9999 20121 00168005316 PETROLATUM GEL WHITE 12/31/9999 20121 00168005321 PETROLATUM GEL WHITE 12/31/9999 20121 00168005331 PETROLATUM GEL WHITE 12/31/9999 20121 00168005345 PETROLATUM GEL WHITE 12/31/9999 20121 46287050816 PETROLATUM OIN 12/31/9999 20121 51552030906 PETROLATUM OIN YELLOW 12/31/9999 20121 00904573182 PETROLEUM GEL JELLY 12/31/9999 20121 58980073121 PEVIDERM SOL WOUND 12/31/9999 20121 58980073161 PEVIDERM SOL WOUND 12/31/9999 20121 68968201001 PEXEVA TAB 10MG 12/31/9999 20121 68968202001 PEXEVA TAB 20MG 12/31/9999 20121 68968203001 PEXEVA TAB 30MG 12/31/9999 20121 68968204001 PEXEVA TAB 40MG 12/31/9999 20121 51552087606 PFCB CRE 12/31/9999 20121 00049053022 PFIZERPEN-G INJ 20MU 12/31/9999 20121 00049053028 PFIZERPEN-G INJ 20MU 12/31/9999 20121 00049052022 PFIZERPEN-G INJ 5MU 12/31/9999 20121 00049052083 PFIZERPEN-G INJ 5MU 12/31/9999 20121 16103034811 PHARBEDRYL CAP 25MG 12/31/9999 20121 16103034711 PHARBEDRYL CAP 50MG 12/31/9999 20121 16103035308 PHARBETOL TAB 325MG 12/31/9999 20121 16103035008 PHARBETOL TAB 500MG 12/31/9999 20121 16103037608 PHARBETOL TAB 500MG 12/31/9999 20121 51552130006 PHARMABASE CRE HEAVY 12/31/9999 20121 51552130008 PHARMABASE CRE HEAVY 12/31/9999 20121 51552130106 PHARMABASE CRE LIGHT 12/31/9999 20121 51552130108 PHARMABASE CRE LIGHT 12/31/9999 20121 51552130109 PHARMABASE CRE LIGHT 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00813006512 PHARMAFLUR CHW 0.5MG 12/31/9999 20121 00813006612 PHARMAFLUR CHW 2.2MG 12/31/9999 20121 00135042900 PHAZYME CAP 180MG 12/31/9999 20121 00135042909 PHAZYME CAP 180MG 12/31/9999 20121 00135042912 PHAZYME CAP 180MG 12/31/9999 20121 10158042908 PHAZYME CAP 180MG 12/31/9999 20121 10158040580 PHAZYME CHW 125MG 12/31/9999 20121 00472114231 PHENADEX DRO PED 12/31/9999 20121 00574723612 PHENADOZ SUP 12.5MG 12/31/9999 20121 00574723412 PHENADOZ SUP 25MG 12/31/9999 20121 58809028101 PHENA-PLUS TAB 09/30/2012 20121 58809011201 PHENA-S LIQ 03/31/2013 20121 00536242558 PHENASEPTIC LIQ 1.4% 12/31/9999 20121 10267086001 PHENAZO TAB 200MG 12/31/9999 20121 10267086010 PHENAZO TAB 200MG 12/31/9999 20121 10267002501 PHENAZOPYRID TAB 100MG 12/31/9999 20121 51991052001 PHENAZOPYRID TAB 100MG 12/31/9999 20121 52152000302 PHENAZOPYRID TAB 100MG 12/31/9999 20121 52152000305 PHENAZOPYRID TAB 100MG 12/31/9999 20121 64376081101 PHENAZOPYRID TAB 100MG 12/31/9999 20121 65162051710 PHENAZOPYRID TAB 100MG 12/31/9999 20121 66424004301 PHENAZOPYRID TAB 100MG 12/31/9999 20121 68084029201 PHENAZOPYRID TAB 100MG 12/31/9999 20121 00472019710 PHENAZOPYRID TAB 200MG 12/31/9999 20121 52152000402 PHENAZOPYRID TAB 200MG 12/31/9999 20121 52152000405 PHENAZOPYRID TAB 200MG 12/31/9999 20121 64376081201 PHENAZOPYRID TAB 200MG 12/31/9999 20121 65162052010 PHENAZOPYRID TAB 200MG 12/31/9999 20121 66424004501 PHENAZOPYRID TAB 200MG 12/31/9999 20121 68084029301 PHENAZOPYRID TAB 200MG 12/31/9999 20121 10267292903 PHENAZOPYRID TAB PLUS 12/31/9999 20121 10267292905 PHENAZOPYRID TAB PLUS 12/31/9999 20121 00185525401 PHENDIMETRAZ CAP 105MG ER 12/31/9999 20121 00185525410 PHENDIMETRAZ CAP 105MG ER 12/31/9999 20121 00185405701 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 00185405710 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702004501 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702004503 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702004510 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702007701 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702007703 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702007710 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702007801 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702007803 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 10702007810 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 52152032702 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 52152032705 PHENDIMETRAZ TAB 35MG 12/31/9999 20121 43386036021 PHENELZINE TAB 15MG 12/31/9999 20121 59762011901 PHENELZINE TAB 15MG 12/31/9999 20121 00641608225 PHENERGAN INJ 25MG/ML 12/31/9999 20121 00641608425 PHENERGAN INJ 25MG/ML 12/31/9999 20121 60977000101 PHENERGAN INJ 25MG/ML 12/31/9999 20121 60977000103 PHENERGAN INJ 25MG/ML 12/31/9999 20121 60977000143 PHENERGAN INJ 25MG/ML 12/31/9999 20121 60977000144 PHENERGAN INJ 25MG/ML 12/31/9999 20121 00641608325 PHENERGAN INJ 50MG/ML 12/31/9999 20121 60977000202 PHENERGAN INJ 50MG/ML 12/31/9999 20121 60977000204 PHENERGAN INJ 50MG/ML 12/31/9999 20121 60977000243 PHENERGAN INJ 50MG/ML 12/31/9999 20121 60977000244 PHENERGAN INJ 50MG/ML 12/31/9999 20121 58605043301 PHENFLU CD TAB 12/31/9999 20121 58605043401 PHENFLU CDX TAB 12/31/9999 20121 58605043501 PHENFLU DM TAB 12/31/9999 20121 00121053105 PHENOBARB ELX 20MG/5ML 12/31/9999 20121 00121053107 PHENOBARB ELX 20MG/5ML 12/31/9999 20121 00121053115 PHENOBARB ELX 20MG/5ML 12/31/9999 20121 00121053116 PHENOBARB ELX 20MG/5ML 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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