August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 62856070510 SALAGEN TAB 5MG 12/31/9999 20121 62856077510 SALAGEN TAB 7.5MG 12/31/9999 20121 13548001206 SALEX SHA 6% 12/31/9999 20121 13548001017 SALEX CREAM KIT 6% 12/31/9999 20121 13548001109 SALEX LOTION KIT 6% 12/31/9999 20121 42192011270 SALICYLIC AER 6% 12/31/9999 20121 51552026406 SALICYLIC CRY ACID 12/31/9999 20121 51552026409 SALICYLIC CRY ACID 12/31/9999 20121 45802080601 SALICYLIC AC CRE 6% 12/31/9999 20121 42546027001 SALICYLIC AC KIT 6% 12/31/9999 20121 13925004010 SALICYLIC AC KIT 6% CREAM 12/31/9999 20121 13925005010 SALICYLIC AC KIT 6% LOTN 12/31/9999 20121 49908013710 SALICYLIC AC LIQ 26% 12/31/9999 20121 49908023710 SALICYLIC AC LIQ 27.5% 12/31/9999 20121 45802081841 SALICYLIC AC LOT 6% 12/31/9999 20121 42546027906 SALICYLIC AC SHA 6% 12/31/9999 20121 45802023701 SALICYLIC AC SHA 6% 12/31/9999 20121 00536250676 SALINE MIST SPR 0.65% 12/31/9999 20121 24385032558 SALINE NASAL SPR 0.65% 12/31/9999 20121 37205093013 SALINE NASAL SPR 0.65% 12/31/9999 20121 37205093021 SALINE NASAL SPR 0.65% 12/31/9999 20121 49614031213 SALINE NASAL SPR 0.65% 12/31/9999 20121 16781016760 SALKERA AER 6% 12/31/9999 20121 16781016796 SALKERA AER 6% 12/31/9999 20121 00884519215 SAL-PLANT GEL 17% 12/31/9999 20121 00904125061 SALSALATE TAB 500MG 12/31/9999 20121 00904562861 SALSALATE TAB 500MG 12/31/9999 20121 51862014001 SALSALATE TAB 500MG 12/31/9999 20121 64376050701 SALSALATE TAB 500MG 12/31/9999 20121 64376050705 SALSALATE TAB 500MG 12/31/9999 20121 65162051210 SALSALATE TAB 500MG 12/31/9999 20121 65162051211 SALSALATE TAB 500MG 12/31/9999 20121 65162051250 SALSALATE TAB 500MG 12/31/9999 20121 00904125161 SALSALATE TAB 750MG 12/31/9999 20121 51862014201 SALSALATE TAB 750MG 12/31/9999 20121 64376050801 SALSALATE TAB 750MG 12/31/9999 20121 64376050805 SALSALATE TAB 750MG 12/31/9999 20121 65162051310 SALSALATE TAB 750MG 12/31/9999 20121 65162051311 SALSALATE TAB 750MG 12/31/9999 20121 65162051350 SALSALATE TAB 750MG 12/31/9999 20121 59148002050 SAMSCA TAB 15MG 12/31/9999 20121 59148002150 SAMSCA TAB 30MG 12/31/9999 20121 00023351360 SANCTURA TAB 20MG 12/31/9999 20121 15456098004 SANCTURA TAB 20MG 12/31/9999 20121 00023935030 SANCTURA XR CAP 60MG 12/31/9999 20121 42747072601 SANCUSO DIS 3.1MG 12/31/9999 20121 00078024115 SANDIMMUNE CAP 100MG 12/31/9999 20121 00078024161 SANDIMMUNE CAP 100MG 12/31/9999 20121 00078024015 SANDIMMUNE CAP 25MG 12/31/9999 20121 00078024061 SANDIMMUNE CAP 25MG 12/31/9999 20121 00078010901 SANDIMMUNE INJ 50MG/ML 12/31/9999 20121 00078010961 SANDIMMUNE INJ 50MG/ML 12/31/9999 20121 00078011022 SANDIMMUNE SOL 100MG/ML 12/31/9999 20121 00078018425 SANDOSTATIN INJ 1000MCG 12/31/9999 20121 00078018101 SANDOSTATIN INJ 100MCG 12/31/9999 20121 00078018161 SANDOSTATIN INJ 100MCG 12/31/9999 20121 00078018325 SANDOSTATIN INJ 200MCG 12/31/9999 20121 00078018201 SANDOSTATIN INJ 500MCG 12/31/9999 20121 00078018261 SANDOSTATIN INJ 500MCG 12/31/9999 20121 00078018001 SANDOSTATIN INJ 50MCG/ML 12/31/9999 20121 00078018061 SANDOSTATIN INJ 50MCG/ML 12/31/9999 20121 00078034061 SANDOSTATIN KIT LAR 10MG 12/31/9999 20121 00078034161 SANDOSTATIN KIT LAR 20MG 12/31/9999 20121 00078034261 SANDOSTATIN KIT LAR 30MG 12/31/9999 20121 00713030898 SANI-PADS PAD 12/31/9999 20121 00713010109 SANI-SUPP SUP ADULT 12/31/9999 20121 00713010125 SANI-SUPP SUP ADULT 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00713010150 SANI-SUPP SUP ADULT 12/31/9999 20121 00713010209 SANI-SUPP SUP PEDIATRI 12/31/9999 20121 00713010225 SANI-SUPP SUP PEDIATRI 12/31/9999 20121 00064501015 SANTYL OIN 250/GM 12/31/9999 20121 00064501030 SANTYL OIN 250/GM 12/31/9999 20121 00052011906 SAPHRIS SUB 10MG 12/31/9999 20121 00052011990 SAPHRIS SUB 10MG 12/31/9999 20121 00052214203 SAPHRIS SUB 10MG 12/31/9999 20121 00052214204 SAPHRIS SUB 10MG 12/31/9999 20121 00052011806 SAPHRIS SUB 5MG 12/31/9999 20121 00052011890 SAPHRIS SUB 5MG 12/31/9999 20121 00052213903 SAPHRIS SUB 5MG 12/31/9999 20121 00052213904 SAPHRIS SUB 5MG 12/31/9999 20121 00430021014 SARAFEM TAB 10MG 12/31/9999 20121 00430022014 SARAFEM TAB 20MG 12/31/9999 20121 51552063909 SARDINE LIQ FLAVOR 12/31/9999 20121 00145062805 SARNA LOT 12/31/9999 20121 00145063005 SARNA SENSIT LOT 1% 12/31/9999 20121 00456150055 SAVELLA MIS TITR PAK 12/31/9999 20121 00456151060 SAVELLA TAB 100MG 12/31/9999 20121 00456151260 SAVELLA TAB 12.5MG 12/31/9999 20121 00456152560 SAVELLA TAB 25MG 12/31/9999 20121 00456155060 SAVELLA TAB 50MG 12/31/9999 20121 51552106206 SAW PALMETTO EXT 12/31/9999 20121 51552108506 SAW PALMETTO POW 12/31/9999 20121 15127028324 SB ALLERGY CAP 25MG 12/31/9999 20121 15127028336 SB ALLERGY CAP 25MG 12/31/9999 20121 15127028348 SB ALLERGY CAP 25MG 12/31/9999 20121 15127050404 SB ALLERGY LIQ 12.5/5ML 12/31/9999 20121 15127020524 SB ALLERGY TAB 25MG MED 12/31/9999 20121 15127097324 SB ALLERGY/ TAB COLD PE 12/31/9999 20121 15127021024 SB ANTACID CHW 500MG 12/31/9999 20121 15127021124 SB ANTACID CHW 500MG 12/31/9999 20121 15127020737 SB ANTACID CHW EX ST 12/31/9999 20121 15127054073 SB ANTACID SUS MINT 12/31/9999 20121 15127088352 SB ANTACID/ SUS ANTIGAS 12/31/9999 20121 15127073801 SB ASPIRIN TAB 325MG 12/31/9999 20121 15127073805 SB ASPIRIN TAB 325MG 12/31/9999 20121 15127073809 SB ASPIRIN TAB 325MG 12/31/9999 20121 15127073810 SB ASPIRIN TAB 325MG 12/31/9999 20121 15127073816 SB ASPIRIN TAB 325MG 12/31/9999 20121 15127073821 SB ASPIRIN TAB 325MG 12/31/9999 20121 15127001105 SB ASPIRIN TAB 325MG EC 12/31/9999 20121 15127076008 SB ASPIRIN TAB 325MG EC 12/31/9999 20121 15127044824 SB BACKACHE TAB 500MG 12/31/9999 20121 15127017807 SB BISACODYL TAB 5MG EC 12/31/9999 20121 15127055068 SB BISMUTH SUS 262/15ML 12/31/9999 20121 15127018008 SB BISMUTH TAB 262MG 12/31/9999 20121 15127094044 SB CGH CONTR SYP 100/5ML 12/31/9999 20121 15127094048 SB CGH CONTR SYP 100/5ML 12/31/9999 20121 15127024136 SB CHILD ASA CHW 81MG 12/31/9999 20121 15127080413 SB FIB LAX POW 33% 12/31/9999 20121 15127080419 SB FIB LAX POW 33% 12/31/9999 20121 15127021315 SB FIBER LAX TAB 625MG 12/31/9999 20121 15127021320 SB FIBER LAX TAB 625MG 12/31/9999 20121 15127031201 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031207 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031211 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031224 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031250 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031301 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031324 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127031350 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127033501 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127033511 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127033524 SB IBUPROFEN TAB 200MG 12/31/9999 20121 15127033550 SB IBUPROFEN TAB 200MG 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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