August 31, 2012 - Iowa Medicaid Enterprise

More documents

Recommendations

Info

NDC Product Description Termination Date Quarter Covered 00641255541 PHENYTOIN INJ 50MG/ML 12/31/9999 20121 00641255545 PHENYTOIN INJ 50MG/ML 12/31/9999 20121 39822405002 PHENYTOIN INJ 50MG/ML 12/31/9999 20121 39822405003 PHENYTOIN INJ 50MG/ML 12/31/9999 20121 39822405005 PHENYTOIN INJ 50MG/ML 12/31/9999 20121 39822405006 PHENYTOIN INJ 50MG/ML 12/31/9999 20121 68094053358 PHENYTOIN SUS 100/4ML 12/31/9999 20121 00472006708 PHENYTOIN SUS 125/5ML 12/31/9999 20121 00472500208 PHENYTOIN SUS 125/5ML 12/31/9999 20121 00472500260 PHENYTOIN SUS 125/5ML 12/31/9999 20121 51672406901 PHENYTOIN SUS 125/5ML 12/31/9999 20121 60432013108 PHENYTOIN SUS 125/5ML 12/31/9999 20121 66689003601 PHENYTOIN SUS 125/5ML 12/31/9999 20121 66689003650 PHENYTOIN SUS 125/5ML 12/31/9999 20121 00378156001 PHENYTOIN EX CAP 100MG 12/31/9999 20121 00378156010 PHENYTOIN EX CAP 100MG 12/31/9999 20121 00904618740 PHENYTOIN EX CAP 100MG 08/31/2012 20121 50268066011 PHENYTOIN EX CAP 100MG 12/31/9999 20121 50268066015 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51079090501 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51079090517 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51079090519 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51079090520 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51079090556 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51672411101 PHENYTOIN EX CAP 100MG 12/31/9999 20121 51672411103 PHENYTOIN EX CAP 100MG 12/31/9999 20121 62756040201 PHENYTOIN EX CAP 100MG 12/31/9999 20121 62756040203 PHENYTOIN EX CAP 100MG 12/31/9999 20121 64679072001 PHENYTOIN EX CAP 100MG 12/31/9999 20121 64679072002 PHENYTOIN EX CAP 100MG 12/31/9999 20121 65162021210 PHENYTOIN EX CAP 100MG 12/31/9999 20121 65162021211 PHENYTOIN EX CAP 100MG 12/31/9999 20121 65162021250 PHENYTOIN EX CAP 100MG 12/31/9999 20121 68084037601 PHENYTOIN EX CAP 100MG 12/31/9999 20121 62756029983 PHENYTOIN EX CAP 200MG 12/31/9999 20121 62756029988 PHENYTOIN EX CAP 200MG 12/31/9999 20121 62756043283 PHENYTOIN EX CAP 300MG 12/31/9999 20121 62756043288 PHENYTOIN EX CAP 300MG 12/31/9999 20121 00024153502 PHISOHEX LIQ 3% 12/31/9999 20121 00024153506 PHISOHEX LIQ 3% 12/31/9999 20121 00024153548 PHISOHEX LIQ 3% 03/31/2013 20121 00126013516 PHOS FLUR SOL 0.044% 12/31/9999 20121 00126013816 PHOS FLUR SOL 0.044% 12/31/9999 20121 00126013916 PHOS FLUR SOL 0.044% 12/31/9999 20121 00126013166 PHOS-FLUR GEL 1.1% 12/31/9999 20121 49230064021 PHOSLO CAP 667MG 12/31/9999 20121 49230064331 PHOSLYRA SOL 12/31/9999 20121 60258000601 PHOS-NAK POW CONCENTR 12/31/9999 20121 64980010401 PHOSPHA 250 TAB NEUTRAL 12/31/9999 20121 00904566675 PHOSPHATE SOL LAXATIVE 12/31/9999 20121 51552077306 PHOSPHATIDYL POW 20% 12/31/9999 20121 51552077307 PHOSPHATIDYL POW 20% 12/31/9999 20121 51552082307 PHOSPHATIDYL POW CHOLINE 12/31/9999 20121 00046106505 PHOSPHOLINE SOL 0.125%OP 12/31/9999 20121 00187084401 PHRENILIN CAP FORTE 12/31/9999 20121 00264220500 PHYSIOLYTE SOL 12/31/9999 20121 00409614109 PHYSIOSOL SOL IRRIGAT 12/31/9999 20121 17478051002 PHYSOS SALIC INJ 1MG/ML 12/31/9999 20121 50222050247 PICATO GEL 0.015% 12/31/9999 20121 50222050347 PICATO GEL 0.05% 12/31/9999 20121 24208067615 PILOCARPINE SOL 1% OP 12/31/9999 20121 61314020315 PILOCARPINE SOL 1% OP 12/31/9999 20121 24208068115 PILOCARPINE SOL 2% OP 12/31/9999 20121 61314020415 PILOCARPINE SOL 2% OP 12/31/9999 20121 24208068615 PILOCARPINE SOL 4% OP 12/31/9999 20121 61314020615 PILOCARPINE SOL 4% OP 12/31/9999 20121 00054005625 PILOCARPINE TAB 5MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00115592201 PILOCARPINE TAB 5MG 12/31/9999 20121 00228280111 PILOCARPINE TAB 5MG 12/31/9999 20121 00527131301 PILOCARPINE TAB 5MG 12/31/9999 20121 64720013710 PILOCARPINE TAB 5MG 12/31/9999 20121 00115591101 PILOCARPINE TAB 7.5MG 12/31/9999 20121 00228283711 PILOCARPINE TAB 7.5MG 12/31/9999 20121 00527140701 PILOCARPINE TAB 7.5MG 12/31/9999 20121 00065021535 PILOPINE HS GEL 4% OP 12/31/9999 20121 00228253510 PINDOLOL TAB 10MG 12/31/9999 20121 00378012701 PINDOLOL TAB 10MG 12/31/9999 20121 00378005201 PINDOLOL TAB 5MG 12/31/9999 20121 00182109117 PINK BISMUTH CHW 262MG 09/30/2012 20121 00603023516 PINK BISMUTH CHW 262MG 12/31/9999 20121 24385002465 PINK BISMUTH CHW 262MG 12/31/9999 20121 37205072065 PINK BISMUTH CHW 262MG 12/31/9999 20121 63868098930 PINK BISMUTH CHW 262MG 12/31/9999 20121 63868030223 PINK BISMUTH SUS 262/15ML 12/31/9999 20121 63868030234 PINK BISMUTH SUS 262/15ML 12/31/9999 20121 63868030235 PINK BISMUTH SUS 262/15ML 12/31/9999 20121 00121480330 PINK BISMUTH SUS 524/30ML 12/31/9999 20121 37205033734 PINK BISMUTH SUS 525/15ML 12/31/9999 20121 63868033734 PINK BISMUTH SUS MAX STR 12/31/9999 20121 24385001758 PINK BISMUTH TAB 262MG 12/31/9999 20121 63868017228 PINK BISMUTH TAB 262MG 12/31/9999 20121 68047005715 PINNACAINE DRO 20% OTIC 12/31/9999 20121 00409337402 PIPER/TAZOBA INJ 2-0.25GM 12/31/9999 20121 00409338302 PIPER/TAZOBA INJ 2-0.25GM 12/31/9999 20121 00781311095 PIPER/TAZOBA INJ 2-0.25GM 12/31/9999 20121 25021016430 PIPER/TAZOBA INJ 2-0.25GM 12/31/9999 20121 60505068604 PIPER/TAZOBA INJ 2-0.25GM 12/31/9999 20121 63323030920 PIPER/TAZOBA INJ 2-0.25GM 12/31/9999 20121 00409337813 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 00409338513 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 00781311390 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 00781311395 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 25021016530 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 60505068704 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 63323030020 PIPER/TAZOBA INJ 3-0.375G 12/31/9999 20121 60505077300 PIPER/TAZOBA INJ 36-4.5GM 12/31/9999 20121 63323030474 PIPER/TAZOBA INJ 36-4.5GM 12/31/9999 20121 00409337904 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 00409339004 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 00781311491 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 00781311495 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 25021016648 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 60505068804 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 63323032050 PIPER/TAZOBA INJ 4-0.5GM 12/31/9999 20121 00093075601 PIROXICAM CAP 10MG 12/31/9999 20121 16571001201 PIROXICAM CAP 10MG 12/31/9999 20121 29033001201 PIROXICAM CAP 10MG 12/31/9999 20121 00093075701 PIROXICAM CAP 20MG 12/31/9999 20121 00093075705 PIROXICAM CAP 20MG 12/31/9999 20121 16571001301 PIROXICAM CAP 20MG 12/31/9999 20121 29033001301 PIROXICAM CAP 20MG 12/31/9999 20121 29033001305 PIROXICAM CAP 20MG 12/31/9999 20121 42023011601 PITOCIN INJ 10UNT/ML 12/31/9999 20121 42023011602 PITOCIN INJ 10UNT/ML 12/31/9999 20121 42023011625 PITOCIN INJ 10UNT/ML 12/31/9999 20121 42023011725 PITRESSIN INJ 20UNT/ML 12/31/9999 20121 51285076993 PLAN B TAB 0.75MG 02/28/2013 20121 51285094288 PLAN B TAB 1.5MG 12/31/9999 20121 00024156210 PLAQUENIL TAB 200MG 12/31/9999 20121 13533068416 PLASBUMIN-25 INJ 25% 12/31/9999 20121 13533068420 PLASBUMIN-25 INJ 25% 12/31/9999 20121 13533068471 PLASBUMIN-25 INJ 25% 12/31/9999 20121 13533069216 PLASBUMIN-25 INJ 25% 12/31/9999 20121 13533069220 PLASBUMIN-25 INJ 25% 12/31/9999 20121
Page 1 and 2:
Rebatable Drug List for Iowa Medica
Page 3 and 4:
NDC Product Description Termination
Page 5 and 6:
Page 7 and 8:
Page 9 and 10:
Page 11 and 12:
Page 13 and 14:
Page 15 and 16:
Page 17 and 18:
Page 19 and 20:
Page 21 and 22:
Page 23 and 24:
Page 25 and 26:
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294: NDC Product Description Termination
Page 343: NDC Product Description Termination
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469:
show all

August 31, 2012 - Iowa Medicaid Enterprise

Create successful ePaper yourself

Delete template?

Save as template?