August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 60505017009 PRAVASTATIN TAB 40MG 12/31/9999 20121 63304059790 PRAVASTATIN TAB 40MG 12/31/9999 20121 68084018801 PRAVASTATIN TAB 40MG 12/31/9999 20121 68084050201 PRAVASTATIN TAB 40MG 12/31/9999 20121 68180048702 PRAVASTATIN TAB 40MG 12/31/9999 20121 68180048709 PRAVASTATIN TAB 40MG 12/31/9999 20121 68382007205 PRAVASTATIN TAB 40MG 12/31/9999 20121 68382007216 PRAVASTATIN TAB 40MG 12/31/9999 20121 68462019705 PRAVASTATIN TAB 40MG 12/31/9999 20121 68462019790 PRAVASTATIN TAB 40MG 12/31/9999 20121 00093727010 PRAVASTATIN TAB 80MG 12/31/9999 20121 00093727098 PRAVASTATIN TAB 80MG 12/31/9999 20121 00378055377 PRAVASTATIN TAB 80MG 12/31/9999 20121 16252052990 PRAVASTATIN TAB 80MG 12/31/9999 20121 55111027405 PRAVASTATIN TAB 80MG 12/31/9999 20121 55111027490 PRAVASTATIN TAB 80MG 12/31/9999 20121 60505132305 PRAVASTATIN TAB 80MG 12/31/9999 20121 60505132309 PRAVASTATIN TAB 80MG 12/31/9999 20121 63304059805 PRAVASTATIN TAB 80MG 12/31/9999 20121 63304059890 PRAVASTATIN TAB 80MG 12/31/9999 20121 68180048802 PRAVASTATIN TAB 80MG 12/31/9999 20121 68180048809 PRAVASTATIN TAB 80MG 12/31/9999 20121 68382007305 PRAVASTATIN TAB 80MG 12/31/9999 20121 68382007316 PRAVASTATIN TAB 80MG 12/31/9999 20121 68462019805 PRAVASTATIN TAB 80MG 12/31/9999 20121 68462019890 PRAVASTATIN TAB 80MG 12/31/9999 20121 38779009004 PRAZIQUANTEL POW 12/31/9999 20121 38779009005 PRAZIQUANTEL POW 12/31/9999 20121 68405802806 PRAZOLAMINE PAK 12/31/9999 20121 00093406701 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00093406710 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00093406752 PRAZOSIN HCL CAP 1MG 02/28/2013 20121 00228250010 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00228250025 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00228250096 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00378110101 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00378110110 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 51079063001 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 51079063020 PRAZOSIN HCL CAP 1MG 12/31/9999 20121 00093406801 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 00093406810 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 00093406852 PRAZOSIN HCL CAP 2MG 06/30/2013 20121 00228250110 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 00228250125 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 00378230201 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 00378230210 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 51079063101 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 51079063120 PRAZOSIN HCL CAP 2MG 12/31/9999 20121 00093406901 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00093406905 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00093406952 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00228250210 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00228250225 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00378320501 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00378320525 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 51079063201 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 51079063220 PRAZOSIN HCL CAP 5MG 12/31/9999 20121 00409163802 PRECEDEX INJ 100MCG 12/31/9999 20121 50419086251 PRECOSE TAB 100MG 12/31/9999 20121 50419086351 PRECOSE TAB 25MG 12/31/9999 20121 50419086148 PRECOSE TAB 50MG 12/31/9999 20121 50419086151 PRECOSE TAB 50MG 12/31/9999 20121 11980018001 PRED FORTE SUS 1% OP 12/31/9999 20121 11980018005 PRED FORTE SUS 1% OP 12/31/9999 20121 11980018010 PRED FORTE SUS 1% OP 12/31/9999 20121 11980018015 PRED FORTE SUS 1% OP 12/31/9999 20121 11980017405 PRED MILD SUS 0.12% OP 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 11980017410 PRED MILD SUS 0.12% OP 12/31/9999 20121 24208071510 PRED SOD PHO SOL 1% OP 12/31/9999 20121 50383004004 PRED SOD PHO SOL 5MG/5ML 12/31/9999 20121 65580025101 PRED SOD PHO SOL 6.7/5ML 12/31/9999 20121 00023010605 PRED-G SUS OP 12/31/9999 20121 00023006604 PRED-G S.O.P OIN OP 12/31/9999 20121 66993088015 PREDNICARBAT CRE 0.1% 12/31/9999 20121 66993088061 PREDNICARBAT CRE 0.1% 12/31/9999 20121 00168041060 PREDNICARBAT OIN 0.1% 12/31/9999 20121 00093611816 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 00093611887 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 00121075908 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 00603938856 PREDNISOLONE SOL 15MG/5ML 07/31/2012 20121 50383004224 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 50383004248 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 60432021208 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 65162066788 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 65162066790 PREDNISOLONE SOL 15MG/5ML 12/31/9999 20121 60758011905 PREDNISOLONE SUS 1% OP 12/31/9999 20121 60758011910 PREDNISOLONE SUS 1% OP 12/31/9999 20121 60758011915 PREDNISOLONE SUS 1% OP 12/31/9999 20121 61314063705 PREDNISOLONE SUS 1% OP 12/31/9999 20121 61314063710 PREDNISOLONE SUS 1% OP 12/31/9999 20121 61314063715 PREDNISOLONE SUS 1% OP 12/31/9999 20121 00472021208 PREDNISOLONE SYP 15MG/5ML 12/31/9999 20121 00472021216 PREDNISOLONE SYP 15MG/5ML 12/31/9999 20121 00054372144 PREDNISONE CON 5MG/ML 12/31/9999 20121 00603533815 PREDNISONE PAK 10MG 12/31/9999 20121 00603533831 PREDNISONE PAK 10MG 12/31/9999 20121 45802030321 PREDNISONE PAK 10MG 12/31/9999 20121 45802030367 PREDNISONE PAK 10MG 12/31/9999 20121 00603533715 PREDNISONE PAK 5MG 12/31/9999 20121 00603533731 PREDNISONE PAK 5MG 12/31/9999 20121 45802073321 PREDNISONE PAK 5MG 12/31/9999 20121 45802073367 PREDNISONE PAK 5MG 12/31/9999 20121 00054372250 PREDNISONE SOL 5MG/5ML 12/31/9999 20121 00054372263 PREDNISONE SOL 5MG/5ML 12/31/9999 20121 00054872216 PREDNISONE SOL 5MG/5ML 12/31/9999 20121 00054001720 PREDNISONE TAB 10MG 12/31/9999 20121 00054001725 PREDNISONE TAB 10MG 12/31/9999 20121 00054001729 PREDNISONE TAB 10MG 12/31/9999 20121 00143147301 PREDNISONE TAB 10MG 12/31/9999 20121 00143147310 PREDNISONE TAB 10MG 12/31/9999 20121 00228233810 PREDNISONE TAB 10MG 12/31/9999 20121 00591544201 PREDNISONE TAB 10MG 12/31/9999 20121 00591544205 PREDNISONE TAB 10MG 12/31/9999 20121 00591544210 PREDNISONE TAB 10MG 12/31/9999 20121 00603533821 PREDNISONE TAB 10MG 12/31/9999 20121 00603533828 PREDNISONE TAB 10MG 12/31/9999 20121 00603533832 PREDNISONE TAB 10MG 12/31/9999 20121 59746017306 PREDNISONE TAB 10MG 12/31/9999 20121 59746017310 PREDNISONE TAB 10MG 12/31/9999 20121 63739051910 PREDNISONE TAB 10MG 12/31/9999 20121 00054474125 PREDNISONE TAB 1MG 12/31/9999 20121 00054474131 PREDNISONE TAB 1MG 12/31/9999 20121 00054873925 PREDNISONE TAB 1MG 12/31/9999 20121 00603533521 PREDNISONE TAB 1MG 12/31/9999 20121 00603533532 PREDNISONE TAB 1MG 12/31/9999 20121 51991045801 PREDNISONE TAB 1MG 12/31/9999 20121 59746017106 PREDNISONE TAB 1MG 12/31/9999 20121 59746017110 PREDNISONE TAB 1MG 12/31/9999 20121 00054474225 PREDNISONE TAB 2.5MG 12/31/9999 20121 00054874025 PREDNISONE TAB 2.5MG 12/31/9999 20121 00143142501 PREDNISONE TAB 2.5MG 12/31/9999 20121 00603533621 PREDNISONE TAB 2.5MG 12/31/9999 20121 00054001820 PREDNISONE TAB 20MG 12/31/9999 20121 00054001825 PREDNISONE TAB 20MG 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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