August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 53329015704 REMEDY NUTRA CRE 1% 12/31/9999 20121 53329015713 REMEDY NUTRA CRE 1% 12/31/9999 20121 53329015796 REMEDY NUTRA CRE 1% 12/31/9999 20121 53329016104 REMEDY SKIN CRE REPAIR 12/31/9999 20121 53329016113 REMEDY SKIN CRE REPAIR 12/31/9999 20121 53329016123 REMEDY SKIN CRE REPAIR 12/31/9999 20121 53329016196 REMEDY SKIN CRE REPAIR 12/31/9999 20121 00052010530 REMERON TAB 15MG 12/31/9999 20121 00052010730 REMERON TAB 30MG 12/31/9999 20121 00052010930 REMERON TAB 45MG 12/31/9999 20121 00052010630 REMERON SLTB TAB 15MG 12/31/9999 20121 00052010830 REMERON SLTB TAB 30MG 12/31/9999 20121 00052011030 REMERON SLTB TAB 45MG 12/31/9999 20121 58980068050 REMEVEN CRE 50% 12/31/9999 20121 58980068090 REMEVEN CRE 50% 12/31/9999 20121 57894003001 REMICADE INJ 100MG 12/31/9999 20121 66302011001 REMODULIN INJ 10MG/ML 12/31/9999 20121 66302010101 REMODULIN INJ 1MG/ML 12/31/9999 20121 66302010201 REMODULIN INJ 2.5MG/ML 12/31/9999 20121 66302010501 REMODULIN INJ 5MG/ML 12/31/9999 20121 00327001105 RENACIDIN SOL IRR 12/31/9999 20121 58468002001 RENAGEL TAB 400MG 12/31/9999 20121 58468002101 RENAGEL TAB 800MG 12/31/9999 20121 60258016201 RENAL CAP SOFTGEL 12/31/9999 20121 60258016001 RENA-VITE TAB 12/31/9999 20121 00642274690 RENAX TAB 2.5MG 12/31/9999 20121 63044062201 RENO CAP 12/31/9999 20121 00062018702 RENOVA CRE 0.02% 12/31/9999 20121 00062018709 RENOVA CRE 0.02% 12/31/9999 20121 00062018715 RENOVA PUMP CRE 0.02% 12/31/9999 20121 58468013201 RENVELA PAK 0.8GM 12/31/9999 20121 58468013202 RENVELA PAK 0.8GM 12/31/9999 20121 58468013101 RENVELA PAK 2.4GM 12/31/9999 20121 58468013102 RENVELA PAK 2.4GM 12/31/9999 20121 58468013001 RENVELA TAB 800MG 12/31/9999 20121 00002714001 REOPRO INJ 2MG/ML 12/31/9999 20121 00642016210 REPAN TAB 12/31/9999 20121 63717090201 REPREXAIN TAB 10-200MG 12/31/9999 20121 63717090001 REPREXAIN TAB 2.5-200 12/31/9999 20121 11528041001 REPREXAIN TAB 5-200MG 12/31/9999 20121 63717090101 REPREXAIN TAB 5-200MG 12/31/9999 20121 11528042001 REPREXAIN TAB 7.5-200 12/31/9999 20121 55566718502 REPRONEX INJ 75UNIT 12/31/9999 20121 64543090001 REQ 49+ TAB 12/31/9999 20121 00007489020 REQUIP TAB 0.25MG 12/31/9999 20121 00007489120 REQUIP TAB 0.5MG 12/31/9999 20121 00007489220 REQUIP TAB 1MG 12/31/9999 20121 00007489320 REQUIP TAB 2MG 12/31/9999 20121 00007489520 REQUIP TAB 3MG 12/31/9999 20121 00007489620 REQUIP TAB 4MG 12/31/9999 20121 00007489420 REQUIP TAB 5MG 12/31/9999 20121 00007488213 REQUIP XL TAB 12MG 12/31/9999 20121 00007488513 REQUIP XL TAB 2MG 12/31/9999 20121 00007488559 REQUIP XL TAB 2MG 12/31/9999 20121 00007488713 REQUIP XL TAB 4MG 12/31/9999 20121 00007488759 REQUIP XL TAB 4MG 12/31/9999 20121 00007488313 REQUIP XL TAB 6MG 12/31/9999 20121 00007488813 REQUIP XL TAB 8MG 12/31/9999 20121 00007488859 REQUIP XL TAB 8MG 12/31/9999 20121 64543010504 RESCON-DM SYP 12/31/9999 20121 64543010516 RESCON-DM SYP 12/31/9999 20121 64543004404 RESCON-GG LIQ 12/31/9999 20121 64543004416 RESCON-GG LIQ 12/31/9999 20121 64543008490 RESCON-JR TAB 12/31/9999 20121 49702020924 RESCRIPTOR TAB 100 MG 12/31/9999 20121 49702021017 RESCRIPTOR TAB 200MG 12/31/9999 20121 63010002118 RESCRIPTOR TAB 200MG 08/31/2015 20121
NDC Product Description Termination Date Quarter Covered 00264230350 RESECTISOL SOL 5% 12/31/9999 20121 38779015901 RESERPINE POW 12/31/9999 20121 38779015903 RESERPINE POW 12/31/9999 20121 38779015906 RESERPINE POW 12/31/9999 20121 00185003201 RESERPINE TAB 0.1MG 12/31/9999 20121 00185003210 RESERPINE TAB 0.1MG 12/31/9999 20121 00185013401 RESERPINE TAB 0.25MG 12/31/9999 20121 00185013410 RESERPINE TAB 0.25MG 12/31/9999 20121 60575053119 RESPA C&C TAB 12/31/9999 20121 60575017719 RESPA-A.R. TAB 12/31/9999 20121 16477030601 RESPAIRE-30 CAP 12/31/9999 20121 63868078924 REST SIMPLY TAB 25MG 12/31/9999 20121 00023916330 RESTASIS EMU 0.05% 12/31/9999 20121 00023916360 RESTASIS EMU 0.05% 12/31/9999 20121 37205019462 RESTFULLY SL TAB 25MG 12/31/9999 20121 52747020030 RESTORA CAP 12/31/9999 20121 00406991601 RESTORIL CAP 15MG 12/31/9999 20121 00406991605 RESTORIL CAP 15MG 12/31/9999 20121 00406991403 RESTORIL CAP 22.5MG 12/31/9999 20121 00406991701 RESTORIL CAP 30MG 12/31/9999 20121 00406991705 RESTORIL CAP 30MG 12/31/9999 20121 00406991501 RESTORIL CAP 7.5MG 12/31/9999 20121 00406991503 RESTORIL CAP 7.5MG 12/31/9999 20121 00062016501 RETIN-A CRE 0.025% 12/31/9999 20121 00062016502 RETIN-A CRE 0.025% 12/31/9999 20121 00062017512 RETIN-A CRE 0.05% 12/31/9999 20121 00062017513 RETIN-A CRE 0.05% 12/31/9999 20121 00062027501 RETIN-A CRE 0.1% 12/31/9999 20121 00062027523 RETIN-A CRE 0.1% 12/31/9999 20121 00062057544 RETIN-A GEL 0.01% 12/31/9999 20121 00062057546 RETIN-A GEL 0.01% 12/31/9999 20121 00062047542 RETIN-A GEL 0.025% 12/31/9999 20121 00062047545 RETIN-A GEL 0.025% 12/31/9999 20121 00062020402 RETIN-A MICR GEL 0.04% 12/31/9999 20121 00062020403 RETIN-A MICR GEL 0.04% 12/31/9999 20121 00062020411 RETIN-A MICR GEL 0.04%PMP 12/31/9999 20121 00062019002 RETIN-A MICR GEL 0.1% 12/31/9999 20121 00062019003 RETIN-A MICR GEL 0.1% 12/31/9999 20121 00062019011 RETIN-A MICR GEL 0.1%PUMP 12/31/9999 20121 24208041601 RETISERT IMP 0.59MG 12/31/9999 20121 00173010855 RETROVIR CAP 100MG 06/30/2013 20121 49702021120 RETROVIR CAP 100MG 12/31/9999 20121 00173010793 RETROVIR INJ 10MG/ML 05/31/2013 20121 49702021305 RETROVIR INJ 10MG/ML 12/31/9999 20121 00173011318 RETROVIR SYP 50MG/5ML 09/30/2013 20121 49702021248 RETROVIR SYP 50MG/5ML 12/31/9999 20121 00173050100 RETROVIR TAB 300MG 03/14/2013 20121 49702021418 RETROVIR TAB 300MG 12/31/9999 20121 00069033801 REVATIO INJ 12/31/9999 20121 00069419068 REVATIO TAB 20MG 12/31/9999 20121 51285027502 REVIA TAB 50MG 12/31/9999 20121 66993091561 REVINA OIN 07/31/2012 20121 59572041000 REVLIMID CAP 10MG 12/31/9999 20121 59572041028 REVLIMID CAP 10MG 12/31/9999 20121 59572041500 REVLIMID CAP 15MG 12/31/9999 20121 59572041521 REVLIMID CAP 15MG 12/31/9999 20121 59572040200 REVLIMID CAP 2.5MG 12/31/9999 20121 59572040228 REVLIMID CAP 2.5MG 12/31/9999 20121 59572042500 REVLIMID CAP 25MG 12/31/9999 20121 59572042521 REVLIMID CAP 25MG 12/31/9999 20121 59572040500 REVLIMID CAP 5MG 12/31/9999 20121 59572040528 REVLIMID CAP 5MG 12/31/9999 20121 00003362312 REYATAZ CAP 100MG 12/31/9999 20121 00003362412 REYATAZ CAP 150MG 12/31/9999 20121 00003363112 REYATAZ CAP 200MG 12/31/9999 20121 00003362212 REYATAZ CAP 300MG 12/31/9999 20121 63717087516 REZIRA SOL 60-5/5ML 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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