August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 10702000201 PROMETHAZINE TAB 12.5MG 12/31/9999 20121 57664010788 PROMETHAZINE TAB 12.5MG 12/31/9999 20121 65162074510 PROMETHAZINE TAB 12.5MG 12/31/9999 20121 68084015401 PROMETHAZINE TAB 12.5MG 12/31/9999 20121 68382004001 PROMETHAZINE TAB 12.5MG 12/31/9999 20121 00115104101 PROMETHAZINE TAB 25MG 12/31/9999 20121 00115104103 PROMETHAZINE TAB 25MG 12/31/9999 20121 00378702901 PROMETHAZINE TAB 25MG 12/31/9999 20121 00378702910 PROMETHAZINE TAB 25MG 12/31/9999 20121 00406204101 PROMETHAZINE TAB 25MG 12/31/9999 20121 00406204110 PROMETHAZINE TAB 25MG 12/31/9999 20121 00591530701 PROMETHAZINE TAB 25MG 12/31/9999 20121 00591530710 PROMETHAZINE TAB 25MG 12/31/9999 20121 00603543821 PROMETHAZINE TAB 25MG 12/31/9999 20121 00603543830 PROMETHAZINE TAB 25MG 12/31/9999 20121 00603543832 PROMETHAZINE TAB 25MG 12/31/9999 20121 00781183001 PROMETHAZINE TAB 25MG 12/31/9999 20121 00781183010 PROMETHAZINE TAB 25MG 12/31/9999 20121 00904584061 PROMETHAZINE TAB 25MG 12/31/9999 20121 00904625280 PROMETHAZINE TAB 25MG 12/31/9999 20121 10702000301 PROMETHAZINE TAB 25MG 12/31/9999 20121 10702000310 PROMETHAZINE TAB 25MG 12/31/9999 20121 51079089501 PROMETHAZINE TAB 25MG 12/31/9999 20121 51079089520 PROMETHAZINE TAB 25MG 12/31/9999 20121 57664010818 PROMETHAZINE TAB 25MG 12/31/9999 20121 57664010888 PROMETHAZINE TAB 25MG 12/31/9999 20121 63739021310 PROMETHAZINE TAB 25MG 12/31/9999 20121 65162052110 PROMETHAZINE TAB 25MG 12/31/9999 20121 65162052111 PROMETHAZINE TAB 25MG 12/31/9999 20121 68084015501 PROMETHAZINE TAB 25MG 12/31/9999 20121 68382004101 PROMETHAZINE TAB 25MG 12/31/9999 20121 68382004110 PROMETHAZINE TAB 25MG 12/31/9999 20121 00115104201 PROMETHAZINE TAB 50MG 12/31/9999 20121 00378703001 PROMETHAZINE TAB 50MG 12/31/9999 20121 00406204201 PROMETHAZINE TAB 50MG 12/31/9999 20121 00591531901 PROMETHAZINE TAB 50MG 12/31/9999 20121 00603543921 PROMETHAZINE TAB 50MG 12/31/9999 20121 00781183201 PROMETHAZINE TAB 50MG 12/31/9999 20121 00781183210 PROMETHAZINE TAB 50MG 12/31/9999 20121 10702000401 PROMETHAZINE TAB 50MG 12/31/9999 20121 57664010988 PROMETHAZINE TAB 50MG 12/31/9999 20121 65162052210 PROMETHAZINE TAB 50MG 12/31/9999 20121 68382004201 PROMETHAZINE TAB 50MG 12/31/9999 20121 00713053612 PROMETHEGAN SUP 12.5MG 12/31/9999 20121 00713052610 PROMETHEGAN SUP 25MG 12/31/9999 20121 00713052612 PROMETHEGAN SUP 25MG 12/31/9999 20121 00713013212 PROMETHEGAN SUP 50MG 12/31/9999 20121 00032170801 PROMETRIUM CAP 100MG 12/31/9999 20121 00032171101 PROMETRIUM CAP 200MG 12/31/9999 20121 49884009902 PROPAFENONE CAP 225MG ER 12/31/9999 20121 49884009905 PROPAFENONE CAP 225MG ER 12/31/9999 20121 49884009909 PROPAFENONE CAP 225MG ER 12/31/9999 20121 49884020902 PROPAFENONE CAP 225MG ER 01/31/2013 20121 49884020905 PROPAFENONE CAP 225MG ER 03/31/2013 20121 49884020909 PROPAFENONE CAP 225MG ER 01/31/2013 20121 49884021002 PROPAFENONE CAP 325MG ER 12/31/9999 20121 49884021005 PROPAFENONE CAP 325MG ER 12/31/9999 20121 49884021009 PROPAFENONE CAP 325MG ER 12/31/9999 20121 49884021102 PROPAFENONE CAP 425MG SR 12/31/9999 20121 49884021105 PROPAFENONE CAP 425MG SR 12/31/9999 20121 49884021109 PROPAFENONE CAP 425MG SR 12/31/9999 20121 00591058201 PROPAFENONE TAB 150MG 12/31/9999 20121 00603544821 PROPAFENONE TAB 150MG 12/31/9999 20121 00603544825 PROPAFENONE TAB 150MG 12/31/9999 20121 50111070801 PROPAFENONE TAB 150MG 05/31/2012 20121 51079099601 PROPAFENONE TAB 150MG 12/31/9999 20121 51079099620 PROPAFENONE TAB 150MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 53489055101 PROPAFENONE TAB 150MG 12/31/9999 20121 68084036101 PROPAFENONE TAB 150MG 12/31/9999 20121 00591058301 PROPAFENONE TAB 225MG 12/31/9999 20121 00603544921 PROPAFENONE TAB 225MG 12/31/9999 20121 53489055201 PROPAFENONE TAB 225MG 12/31/9999 20121 00603545021 PROPAFENONE TAB 300MG 12/31/9999 20121 50111071001 PROPAFENONE TAB 300MG 05/31/2012 20121 53489055301 PROPAFENONE TAB 300MG 12/31/9999 20121 00054472125 PROPANTHELIN TAB 15MG 12/31/9999 20121 17478026312 PROPARACAINE SOL 0.5% OP 12/31/9999 20121 24208073006 PROPARACAINE SOL 0.5% OP 12/31/9999 20121 61314001601 PROPARACAINE SOL 0.5% OP 12/31/9999 20121 00006007131 PROPECIA TAB 1MG 12/31/9999 20121 00006007154 PROPECIA TAB 1MG 12/31/9999 20121 00409469924 PROPOFOL INJ 10MG/ML 12/31/9999 20121 00409469930 PROPOFOL INJ 10MG/ML 12/31/9999 20121 00409469933 PROPOFOL INJ 10MG/ML 12/31/9999 20121 63323027020 PROPOFOL INJ 10MG/ML 12/30/2012 20121 63323027025 PROPOFOL INJ 10MG/ML 12/31/9999 20121 63323027026 PROPOFOL INJ 10MG/ML 12/31/9999 20121 63323027027 PROPOFOL INJ 10MG/ML 01/30/2013 20121 63323027050 PROPOFOL INJ 10MG/ML 12/31/9999 20121 63323027057 PROPOFOL INJ 10MG/ML 12/31/9999 20121 63323027065 PROPOFOL INJ 10MG/ML 12/31/9999 20121 63323027067 PROPOFOL INJ 10MG/ML 12/31/9999 20121 00093049001 PROPO-N/APAP TAB 100-650 10/31/2012 20121 00093049005 PROPO-N/APAP TAB 100-650 11/30/2012 20121 00093089001 PROPO-N/APAP TAB 100-650 08/31/2012 20121 00093089005 PROPO-N/APAP TAB 100-650 12/31/2012 20121 00172498070 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00172498080 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00228208510 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00228208550 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00378015501 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00378015505 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406172101 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406172105 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406172110 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406177201 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406177205 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406177210 PROPO-N/APAP TAB 100-650 12/31/9999 20121 00406177262 PROPO-N/APAP TAB 100-650 12/31/9999 20121 68084039301 PROPO-N/APAP TAB 100-650 07/31/2012 20121 63323029730 PROPOVEN INJ 10MG/ML 12/31/9999 20121 63323029731 PROPOVEN INJ 10MG/ML 12/31/9999 20121 63323029751 PROPOVEN INJ 10MG/ML 12/31/9999 20121 63323029753 PROPOVEN INJ 10MG/ML 12/31/9999 20121 00093074101 PROPOXY HCL CAP 65MG 10/31/2012 20121 00093074110 PROPOXY HCL CAP 65MG 05/31/2012 20121 00143323501 PROPOXY HCL CAP 65MG 12/31/9999 20121 00378706501 PROPOXY HCL CAP 65MG 12/31/9999 20121 00378013001 PROPOXY/APAP TAB 65-650MG 12/31/9999 20121 00378013005 PROPOXY/APAP TAB 65-650MG 12/31/9999 20121 00228235810 PROPRAN/HCTZ TAB 40/25 12/31/9999 20121 00228235850 PROPRAN/HCTZ TAB 40/25 12/31/9999 20121 00378073101 PROPRAN/HCTZ TAB 40/25 12/31/9999 20121 00228236010 PROPRAN/HCTZ TAB 80/25 12/31/9999 20121 00228236050 PROPRAN/HCTZ TAB 80/25 12/31/9999 20121 00228236096 PROPRAN/HCTZ TAB 80/25 12/31/9999 20121 00378034701 PROPRAN/HCTZ TAB 80/25 12/31/9999 20121 00228278011 PROPRANOLOL CAP 120MG ER 12/31/9999 20121 00228278050 PROPRANOLOL CAP 120MG ER 12/31/9999 20121 00245008610 PROPRANOLOL CAP 120MG ER 12/31/9999 20121 00245008611 PROPRANOLOL CAP 120MG ER 12/31/9999 20121 00378622001 PROPRANOLOL CAP 120MG ER 12/31/9999 20121 00378622005 PROPRANOLOL CAP 120MG ER 12/31/9999 20121 43478090288 PROPRANOLOL CAP 120MG ER 12/31/9999 20121
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Rebatable Drug List for Iowa Medica
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NDC Product Description Termination
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August 31, 2012 - Iowa Medicaid Enterprise

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