August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 62037056005 POT CHLORIDE CAP 10MEQ ER 12/31/9999 20121 62037056010 POT CHLORIDE CAP 10MEQ ER 12/31/9999 20121 62037056090 POT CHLORIDE CAP 10MEQ ER 12/31/9999 20121 68382070101 POT CHLORIDE CAP 10MEQ ER 12/31/9999 20121 68382070105 POT CHLORIDE CAP 10MEQ ER 12/31/9999 20121 00574018001 POT CHLORIDE CAP 8MEQ ER 12/31/9999 20121 51477000204 POT CHLORIDE CAP 8MEQ ER 09/30/2015 20121 62037055901 POT CHLORIDE CAP 8MEQ ER 12/31/9999 20121 62037055905 POT CHLORIDE CAP 8MEQ ER 12/31/9999 20121 68382070201 POT CHLORIDE CAP 8MEQ ER 12/31/9999 20121 51552032406 POT CHLORIDE GRA 12/31/9999 20121 51552032408 POT CHLORIDE GRA 12/31/9999 20121 00338070541 POT CHLORIDE INJ 10MEQ 12/31/9999 20121 00338070948 POT CHLORIDE INJ 10MEQ 12/31/9999 20121 00409707426 POT CHLORIDE INJ 10MEQ 12/31/9999 20121 00409707514 POT CHLORIDE INJ 10MEQ 12/31/9999 20121 00338070341 POT CHLORIDE INJ 20MEQ 12/31/9999 20121 00338070548 POT CHLORIDE INJ 20MEQ 12/31/9999 20121 00409707526 POT CHLORIDE INJ 20MEQ 12/31/9999 20121 00409707714 POT CHLORIDE INJ 20MEQ 12/31/9999 20121 00264194020 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 00409151302 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 00409663501 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 00409663601 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 00409665106 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 00409665305 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 63323096505 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 63323096510 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 63323096515 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 63323096520 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 63323096730 POT CHLORIDE INJ 2MEQ/ML 12/31/9999 20121 00338070748 POT CHLORIDE INJ 30MEQ 12/31/9999 20121 00338070348 POT CHLORIDE INJ 40MEQ 12/31/9999 20121 00409707726 POT CHLORIDE INJ 40MEQ 12/31/9999 20121 00603153258 POT CHLORIDE LIQ 10% 12/31/9999 20121 00603153458 POT CHLORIDE LIQ 10% 12/31/9999 20121 00603153558 POT CHLORIDE LIQ 10% 12/31/9999 20121 00472100016 POT CHLORIDE LIQ 10% SF 12/31/9999 20121 00472100028 POT CHLORIDE LIQ 10% SF 12/31/9999 20121 00603153658 POT CHLORIDE LIQ 20% 12/31/9999 20121 00121046615 POT CHLORIDE LIQ 20% SF 12/31/9999 20121 00121046616 POT CHLORIDE LIQ 20% SF 12/31/9999 20121 00472100116 POT CHLORIDE LIQ 20% SF 12/31/9999 20121 00121146515 POT CHLORIDE SOL 10% SF 12/31/9999 20121 00121146530 POT CHLORIDE SOL 10% SF 12/31/9999 20121 00904100716 POT CHLORIDE SOL 10% SF 12/31/9999 20121 00781152601 POT CHLORIDE TAB 10MEQ CR 12/31/9999 20121 00781152610 POT CHLORIDE TAB 10MEQ CR 12/31/9999 20121 00245004300 POT CHLORIDE TAB 10MEQ ER 12/31/9999 20121 00245004355 POT CHLORIDE TAB 10MEQ ER 12/31/9999 20121 00245024310 POT CHLORIDE TAB 10MEQ ER 12/31/9999 20121 00245024311 POT CHLORIDE TAB 10MEQ ER 12/31/9999 20121 68382060001 POT CHLORIDE TAB 10MEQ ER 12/31/9999 20121 68382060010 POT CHLORIDE TAB 10MEQ ER 12/31/9999 20121 00603350816 POT CHLORIDE TAB 25MEQ EF 12/31/9999 20121 00245004200 POT CHLORIDE TAB 8MEQ ER 12/31/9999 20121 00245004255 POT CHLORIDE TAB 8MEQ ER 12/31/9999 20121 00245024210 POT CHLORIDE TAB 8MEQ ER 12/31/9999 20121 00245024211 POT CHLORIDE TAB 8MEQ ER 12/31/9999 20121 00781151601 POT CHLORIDE TAB 8MEQ SR 12/31/9999 20121 00781151610 POT CHLORIDE TAB 8MEQ SR 12/31/9999 20121 00245007111 POT CITRATE TAB 1080MG 12/31/9999 20121 64980013801 POT CITRATE TAB 1080MG 12/31/9999 20121 00245007011 POT CITRATE TAB 540MG 12/31/9999 20121 64980013701 POT CITRATE TAB 540MG 12/31/9999 20121 62037071001 POT CL MICRO TAB 10MEQ CR 12/31/9999 20121 00085171701 POT CL MICRO TAB 10MEQ ER 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00781571001 POT CL MICRO TAB 10MEQ ER 12/31/9999 20121 00781571010 POT CL MICRO TAB 10MEQ ER 12/31/9999 20121 63739044610 POT CL MICRO TAB 10MEQ ER 12/31/9999 20121 00085171801 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 00085171802 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 00781572001 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 00781572005 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 00781572010 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 62037099901 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 62037099905 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 62037099910 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 63739044701 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 63739044710 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 68084036001 POT CL MICRO TAB 20MEQ ER 12/31/9999 20121 51552060706 POT GLUCONAT POW ANHYDROU 12/31/9999 20121 51552007106 POT HYDROXID SOL 10% 12/31/9999 20121 51552007206 POT HYDROXID SOL 20% 12/31/9999 20121 51552051106 POT HYDROXID SOL 50% 12/31/9999 20121 00409729601 POT PHOSPHAT INJ 3MM/ML 06/01/2012 20121 00517230525 POT PHOSPHAT INJ 3MM/ML 12/31/9999 20121 00517231525 POT PHOSPHAT INJ 3MM/ML 12/31/9999 20121 00517235025 POT PHOSPHAT INJ 3MM/ML 12/31/9999 20121 50201130002 POT/CHLORIDE TAB 25MEQ EF 03/01/2014 20121 50201130004 POT/CHLORIDE TAB 25MEQ EF 03/01/2014 20121 50201130006 POT/CHLORIDE TAB 25MEQ EF 03/01/2014 20121 51552113406 POTASSIUM GRA ACETATE 12/31/9999 20121 50201240002 POTASSIUM TAB 25MEQ EF 03/01/2014 20121 50201240004 POTASSIUM TAB 25MEQ EF 03/01/2014 20121 50201240006 POTASSIUM TAB 25MEQ EF 03/01/2014 20121 51552047906 POTASSIUM NA POW TARTRATE 12/31/9999 20121 51552047909 POTASSIUM NA POW TARTRATE 12/31/9999 20121 51552075905 POVIDONE POW IODINE 12/31/9999 20121 51552075906 POVIDONE POW IODINE 12/31/9999 20121 63868023008 POVIDONE/IOD SOL 10% 12/31/9999 20121 00603059950 POVIDONE-IOD OIN 10% 12/31/9999 20121 00904110231 POVIDONE-IOD OIN 10% 12/31/9999 20121 00603155056 POVIDONE-IOD SOL 10% 12/31/9999 20121 00603155058 POVIDONE-IOD SOL 10% 12/31/9999 20121 00904110309 POVIDONE-IOD SOL 10% 12/31/9999 20121 24385005355 POVIDONE-IOD SOL 10% 12/31/9999 20121 45802005255 POVIDONE-IOD SOL 10% 06/01/2013 20121 42546014516 PR BENZOYL LIQ 7% WASH 12/31/9999 20121 42546081130 PR NATAL 400 PAK 12/31/9999 20121 42546051730 PR NATAL 400 PAK EC 12/31/9999 20121 42546081230 PR NATAL 430 PAK 12/31/9999 20121 42546051830 PR NATAL 430 PAK EC 12/31/9999 20121 42546017030 PR NATAL 440 MIS EC 12/31/9999 20121 42546050104 PR OTIC SOL 12/31/9999 20121 00597013554 PRADAXA CAP 150MG 12/31/9999 20121 00597013560 PRADAXA CAP 150MG 12/31/9999 20121 00597010754 PRADAXA CAP 75MG 04/30/2013 20121 00597010760 PRADAXA CAP 75MG 03/31/2013 20121 00597014954 PRADAXA CAP 75MG 12/31/9999 20121 00597014960 PRADAXA CAP 75MG 12/31/9999 20121 49908015030 PRAMCORT CRE 1-1% 12/31/9999 20121 10337080841 PRAMEGEL GEL 1% 12/31/9999 20121 00378170405 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 00378170477 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 00555061762 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 00781524892 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 13668009105 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 13668009190 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 16714058401 PRAMIPEXOLE TAB 0.125MG 12/31/2020 20121 51079057601 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 51079057620 PRAMIPEXOLE TAB 0.125MG 08/31/2012 20121 51991062890 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 60951093392 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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