August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 68382019616 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 68462033090 PRAMIPEXOLE TAB 0.125MG 12/31/9999 20121 00378170505 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 00378170577 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 00555061214 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 00781524992 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 13668009205 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 13668009290 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 16714058501 PRAMIPEXOLE TAB 0.25MG 12/31/2020 20121 51079057701 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 51079057720 PRAMIPEXOLE TAB 0.25MG 08/31/2012 20121 51991062990 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 60951093492 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 68084044001 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 68382019716 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 68462033190 PRAMIPEXOLE TAB 0.25MG 12/31/9999 20121 00378170705 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 00378170777 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 00555061314 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 00781525092 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 13668009305 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 13668009390 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 16714058601 PRAMIPEXOLE TAB 0.5MG 12/31/2020 20121 51079057801 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 51079057820 PRAMIPEXOLE TAB 0.5MG 03/31/2013 20121 51991063090 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 60951093592 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 68382019816 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 68462033290 PRAMIPEXOLE TAB 0.5MG 12/31/9999 20121 00093801998 PRAMIPEXOLE TAB 0.75MG 12/31/9999 20121 00378171377 PRAMIPEXOLE TAB 0.75MG 12/31/9999 20121 00781528192 PRAMIPEXOLE TAB 0.75MG 12/31/9999 20121 13668018405 PRAMIPEXOLE TAB 0.75MG 12/31/9999 20121 13668018490 PRAMIPEXOLE TAB 0.75MG 12/31/9999 20121 16714058901 PRAMIPEXOLE TAB 0.75MG 12/31/2020 20121 00555061514 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 00781525292 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 13668009505 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 13668009590 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 16714058801 PRAMIPEXOLE TAB 1.5MG 12/31/2020 20121 51991063290 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 60951093792 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 68382020016 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 68462033490 PRAMIPEXOLE TAB 1.5MG 12/31/9999 20121 00555061414 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 00781525192 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 13668009405 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 13668009490 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 16714058701 PRAMIPEXOLE TAB 1MG 12/31/2020 20121 51079057901 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 51079057920 PRAMIPEXOLE TAB 1MG 08/31/2012 20121 51991063190 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 60951093692 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 68382019916 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 68462033390 PRAMIPEXOLE TAB 1MG 12/31/9999 20121 63717040010 PRAMOTIC DRO 1-0.1% 09/30/2012 20121 00677196579 PRAMOXINE AER 1% 06/30/2013 20121 51862018015 PRAMOXINE AER 1% 12/31/9999 20121 00169009301 PRANDIMET TAB 1-500MG 12/31/9999 20121 00169009201 PRANDIMET TAB 2-500MG 12/31/9999 20121 00169008181 PRANDIN TAB 0.5MG 12/31/9999 20121 00169008183 PRANDIN TAB 0.5MG 10/31/2012 20121 00169008281 PRANDIN TAB 1MG 12/31/9999 20121 00169008283 PRANDIN TAB 1MG 09/30/2012 20121 00169008481 PRANDIN TAB 2MG 12/31/9999 20121 00169008483 PRANDIN TAB 2MG 03/31/2013 20121 66993090206 PRASCION EMU 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 66993090212 PRASCION EMU 12/31/9999 20121 66993090530 PRASCION FC PAD 10-5% 12/31/9999 20121 66993090560 PRASCION FC PAD 10-5% 12/31/9999 20121 66993090445 PRASCION RA CRE 10-5% 12/31/9999 20121 66993092545 PRASCION RA CRE 10-5% 10/31/2012 20121 00003515405 PRAVACHOL TAB 10MG 06/30/2012 20121 00003517805 PRAVACHOL TAB 20MG 12/31/9999 20121 00003519410 PRAVACHOL TAB 40MG 12/31/9999 20121 00003519510 PRAVACHOL TAB 80MG 12/31/9999 20121 00093077110 PRAVASTATIN TAB 10MG 12/31/9999 20121 00093077198 PRAVASTATIN TAB 10MG 12/31/9999 20121 00378055277 PRAVASTATIN TAB 10MG 12/31/9999 20121 00904611361 PRAVASTATIN TAB 10MG 12/31/9999 20121 16252052690 PRAVASTATIN TAB 10MG 12/31/9999 20121 54458092710 PRAVASTATIN TAB 10MG 12/31/9999 20121 54458098709 PRAVASTATIN TAB 10MG 12/31/9999 20121 55111022905 PRAVASTATIN TAB 10MG 12/31/9999 20121 55111022990 PRAVASTATIN TAB 10MG 12/31/9999 20121 60505016805 PRAVASTATIN TAB 10MG 12/31/9999 20121 60505016809 PRAVASTATIN TAB 10MG 12/31/9999 20121 63304059590 PRAVASTATIN TAB 10MG 12/31/9999 20121 68084018601 PRAVASTATIN TAB 10MG 12/31/9999 20121 68084050001 PRAVASTATIN TAB 10MG 12/31/9999 20121 68180048502 PRAVASTATIN TAB 10MG 12/31/9999 20121 68180048509 PRAVASTATIN TAB 10MG 12/31/9999 20121 68382007005 PRAVASTATIN TAB 10MG 12/31/9999 20121 68382007016 PRAVASTATIN TAB 10MG 12/31/9999 20121 68462019505 PRAVASTATIN TAB 10MG 12/31/9999 20121 68462019590 PRAVASTATIN TAB 10MG 12/31/9999 20121 00093720110 PRAVASTATIN TAB 20MG 12/31/9999 20121 00093720198 PRAVASTATIN TAB 20MG 12/31/9999 20121 00378055477 PRAVASTATIN TAB 20MG 12/31/9999 20121 00781523292 PRAVASTATIN TAB 20MG 12/31/9999 20121 00904611461 PRAVASTATIN TAB 20MG 12/31/9999 20121 16252052750 PRAVASTATIN TAB 20MG 12/31/9999 20121 16252052790 PRAVASTATIN TAB 20MG 12/31/9999 20121 51079045801 PRAVASTATIN TAB 20MG 12/31/9999 20121 51079045820 PRAVASTATIN TAB 20MG 12/31/9999 20121 54458092610 PRAVASTATIN TAB 20MG 12/31/9999 20121 54458098610 PRAVASTATIN TAB 20MG 12/31/9999 20121 55111023005 PRAVASTATIN TAB 20MG 12/31/9999 20121 55111023090 PRAVASTATIN TAB 20MG 12/31/9999 20121 60505016907 PRAVASTATIN TAB 20MG 12/31/9999 20121 60505016909 PRAVASTATIN TAB 20MG 12/31/9999 20121 63304059690 PRAVASTATIN TAB 20MG 12/31/9999 20121 68084018701 PRAVASTATIN TAB 20MG 12/31/9999 20121 68084050101 PRAVASTATIN TAB 20MG 12/31/9999 20121 68180048602 PRAVASTATIN TAB 20MG 12/31/9999 20121 68180048609 PRAVASTATIN TAB 20MG 12/31/9999 20121 68382007105 PRAVASTATIN TAB 20MG 12/31/9999 20121 68382007116 PRAVASTATIN TAB 20MG 12/31/9999 20121 68462019605 PRAVASTATIN TAB 20MG 12/31/9999 20121 68462019690 PRAVASTATIN TAB 20MG 12/31/9999 20121 00093720210 PRAVASTATIN TAB 40MG 12/31/9999 20121 00093720298 PRAVASTATIN TAB 40MG 12/31/9999 20121 00378055777 PRAVASTATIN TAB 40MG 12/31/9999 20121 00904611561 PRAVASTATIN TAB 40MG 12/31/9999 20121 16252052850 PRAVASTATIN TAB 40MG 12/31/9999 20121 16252052890 PRAVASTATIN TAB 40MG 12/31/9999 20121 51079078201 PRAVASTATIN TAB 40MG 12/31/9999 20121 51079078220 PRAVASTATIN TAB 40MG 12/31/9999 20121 54458092510 PRAVASTATIN TAB 40MG 12/31/9999 20121 54458098510 PRAVASTATIN TAB 40MG 12/31/9999 20121 55111023105 PRAVASTATIN TAB 40MG 12/31/9999 20121 55111023190 PRAVASTATIN TAB 40MG 12/31/9999 20121 60505017007 PRAVASTATIN TAB 40MG 12/31/9999 20121 60505017008 PRAVASTATIN TAB 40MG 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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