August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 62011007901 SINUS NASAL SPR 0.05% 12/31/9999 20121 46122007560 SINUS RELIEF PAK CNG/PAIN 12/31/9999 20121 36800068805 SINUS RELIEF SPR 12 HOUR 12/31/9999 20121 49348093844 SINUS WASH KIT NETI POT 12/31/9999 20121 36800035862 SINUS/ALERGY TAB PE MAX 12/31/9999 20121 24385096162 SINUS/ALLERG TAB 4-10MG 12/31/9999 20121 15127098209 SINUS/ALLERG TAB MAX ST 12/31/9999 20121 60793013601 SKELAXIN TAB 800MG 12/31/9999 20121 60793013605 SKELAXIN TAB 800MG 12/31/9999 20121 00024180016 SKELID TAB 200MG 12/31/9999 20121 49348021538 SKIN CLEANSR LOT SENSITIV 12/31/9999 20121 00904427451 SLEEP TAB 25MG 12/31/9999 20121 00113043162 SLEEP AID TAB 25MG 12/31/9999 20121 00113044164 SLEEP AID TAB 25MG 12/31/9999 20121 00113044173 SLEEP AID TAB 25MG 12/31/9999 20121 24385044164 SLEEP AID TAB 25MG 12/31/9999 20121 36800043162 SLEEP AID TAB 25MG 12/31/9999 20121 36800043167 SLEEP AID TAB 25MG 12/31/9999 20121 36800044164 SLEEP AID TAB 25MG 12/31/9999 20121 37205012164 SLEEP AID TAB 25MG 12/31/9999 20121 67618010760 SLOW-MAG TAB 12/31/9999 20121 49348047227 SM 12-HOUR SPR 0.05% 12/31/9999 20121 49348024644 SM ACID REDU TAB 200MG 12/31/9999 20121 49348093944 SM ALL DAY TAB ALLERGY 12/31/9999 20121 49348098446 SM ALL DAY TAB ALLERGY 12/31/9999 20121 49348081909 SM ALL DAY TAB RELIEF 12/31/9999 20121 49348081910 SM ALL DAY TAB RELIEF 12/31/9999 20121 49348082009 SM ALL DAY TAB RELIEF 12/31/9999 20121 49348082010 SM ALL DAY TAB RELIEF 12/31/9999 20121 49348098310 SM ALLERGY TAB 25MG RLF 12/31/9999 20121 49348002504 SM ALLERGY TAB 4MG 12/31/9999 20121 49348002510 SM ALLERGY TAB 4MG 12/31/9999 20121 49348077804 SM ALLERGY TAB MULTI-SY 12/31/9999 20121 49348095916 SM ANTACID CHW 1000MG 12/31/9999 20121 49348095721 SM ANTACID CHW 500MG 12/31/9999 20121 49348095821 SM ANTACID CHW 500MG 12/31/9999 20121 49348095434 SM ANTACID CHW 750MG XS 12/31/9999 20121 49348002039 SM ANTACID SUS ANTI-GAS 12/31/9999 20121 49348096239 SM ANTACID SUS MAX ST 12/31/9999 20121 49348001939 SM ANTACID/ SUS ANTIGAS 12/31/9999 20121 49348069069 SM ANTIBIOTI CRE PLUS 12/31/9999 20121 49348052902 SM ANTI-DIAR TAB 2MG 12/31/9999 20121 49348052904 SM ANTI-DIAR TAB 2MG 12/31/9999 20121 49348052908 SM ANTI-DIAR TAB 2MG 12/31/9999 20121 49348052934 SM ANTI-DIAR TAB 2MG 12/31/9999 20121 49348015529 SM ANTIFUNGL CRE 1% 12/31/9999 20121 49348027972 SM ANTIFUNGL CRE 1% 12/31/9999 20121 49348082769 SM ANTIFUNGL CRE 1% 12/31/9999 20121 49348068972 SM ANTIFUNGL CRE 2% 12/31/9999 20121 49348085472 SM ANTI-ITCH CRE 2-0.1% 12/31/9999 20121 49348066362 SM ANTISEPT LIQ MTH RINS 12/31/9999 20121 49348092109 SM ARTHRITIS TAB 650MG 12/31/9999 20121 49348092110 SM ARTHRITIS TAB 650MG 12/31/9999 20121 49348069929 SM ARTIFICIA SOL TEARS 12/31/9999 20121 49348049807 SM ASPIRIN CHW 81MG 12/31/9999 20121 49348000110 SM ASPIRIN TAB 325MG 12/31/9999 20121 49348000114 SM ASPIRIN TAB 325MG 12/31/9999 20121 49348000123 SM ASPIRIN TAB 325MG 12/31/9999 20121 49348093714 SM ASPIRIN TAB 325MG EC 12/31/9999 20121 49348093782 SM ASPIRIN TAB 325MG EC 12/31/9999 20121 49348075623 SM ASPIRIN TAB 81MG EC 12/31/9999 20121 49348023787 SM BEDDING AER LICE 12/31/9999 20121 49348080130 SM BENZOIN TIN 12/31/9999 20121 49348001134 SM CALAMINE LOT 12/31/9999 20121 49348080234 SM CALAMINE LOT PHENOLAT 12/31/9999 20121 49348033736 SM CALDYPHEN LOT 1-8% 12/31/9999 20121 49348061036 SM CALDYPHEN LOT CLEAR 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 49348014830 SM CAMPHOR SOL SPIRIT 12/31/9999 20121 49348001636 SM CASTOR OIL 95% 12/31/9999 20121 49348019107 SM CHILD ASA CHW 81MG 12/31/9999 20121 49348075707 SM CHILD ASA CHW 81MG 12/31/9999 20121 49348087934 SM CHILDRENS SUS MS COLD 12/31/9999 20121 49348077734 SM CLD/ALRGY ELX CHILDREN 12/31/9999 20121 49348077737 SM CLD/ALRGY ELX CHILDREN 12/31/9999 20121 49348089350 SM CLEARLAX POW 12/31/9999 20121 49348089370 SM CLEARLAX POW 12/31/9999 20121 49348089392 SM CLEARLAX POW 12/31/9999 20121 49348084004 SM COLD HEAD TAB CONGEST 12/31/9999 20121 49348077534 SM COLD/CGH ELX DM CHILD 12/31/9999 20121 49348090334 SM COUGH REL SYP 15MG/5ML 12/31/9999 20121 49348052071 SM DANDRUFF SHA 1% 12/31/9999 20121 49348089071 SM DANDRUFF SHA 2 IN 1 12/31/9999 20121 49348073802 SM DAY TIME CAP PE 12/31/9999 20121 49348073847 SM DAY TIME CAP PE 12/31/9999 20121 49348075336 SM DAY TIME LIQ COLD/FLU 12/31/9999 20121 49348052720 SM ENEMA ENE 12/31/9999 20121 49348001863 SM EPSOM GRA SALT 12/31/9999 20121 49348001875 SM EPSOM GRA SALT 12/31/9999 20121 49348069729 SM EYE DRO 12/31/9999 20121 49348003729 SM EYE DROPS SOL 0.05% OP 12/31/9999 20121 49348004765 SM FIBER POW 28.3% 12/31/9999 20121 49348009168 SM FIBER POW 28.3% 12/31/9999 20121 49348016665 SM FIBER POW 48.57% 12/31/9999 20121 49348016693 SM FIBER POW 48.57% 12/31/9999 20121 49348009092 SM FIBER POW 58.6% 12/31/9999 20121 49348075913 SM FIBER TAB LAXATIVE 12/31/9999 20121 49348063349 SM FIBER LAX CAP 0.52GM 12/31/9999 20121 49348054110 SM FIBER LAX TAB 500MG 12/31/9999 20121 49348015472 SM FIRST AID OIN 500/GM 12/31/9999 20121 49348090470 SM FLU RELF LIQ NIGHTIME 12/31/9999 20121 49348060315 SM FLUORIDE SOL MINT 12/31/9999 20121 49348048912 SM GAS REL CAP 180MG 12/31/9999 20121 49348026309 SM GAS RELF CAP 125MG 12/31/9999 20121 49348094644 SM GAS RELF CAP 125MG 12/31/9999 20121 49348050907 SM GAS RELF CHW 80MG 12/31/9999 20121 49348091301 SM GLUCOSE CHW ORANGE 12/31/9999 20121 49348091409 SM GLUCOSE CHW ORANGE 12/31/9999 20121 49348091501 SM GLUCOSE CHW RASPBERY 12/31/9999 20121 49348091609 SM GLUCOSE CHW RASPBERY 12/31/9999 20121 49348073401 SM GLUCOSE CHW SOUR APP 12/31/9999 20121 49348073409 SM GLUCOSE CHW SOUR APP 12/31/9999 20121 49348083936 SM GLYCERIN LIQ 12/31/9999 20121 49348015805 SM GLYCERIN SUP 80.7% 12/31/9999 20121 49348052172 SM HYDROCORT CRE 1% 12/31/9999 20121 49348044172 SM HYDROCORT CRE 1% PLUS 12/31/9999 20121 49348052272 SM HYDROCORT OIN 1% 12/31/9999 20121 49348056847 SM IBUPROFEN CAP 200MG 12/31/9999 20121 49348056859 SM IBUPROFEN CAP 200MG 12/31/9999 20121 49348072709 SM IBUPROFEN TAB 200MG 12/31/9999 20121 49348072710 SM IBUPROFEN TAB 200MG 12/31/9999 20121 49348082909 SM IBUPROFEN TAB 200MG 12/31/9999 20121 49348082910 SM IBUPROFEN TAB 200MG 12/31/9999 20121 49348071130 SM IODIDES TIN 12/31/9999 20121 49348059905 SM LAXATIVE TAB 5MG EC 12/31/9999 20121 49348046030 SM LICE LOT TREATMNT 12/31/9999 20121 49348046034 SM LICE LOT TREATMNT 12/31/9999 20121 49348063634 SM LORATADIN SYP 5MG/5ML 12/31/9999 20121 49348093001 SM LORATADIN TAB ALLG REL 12/31/9999 20121 49348093044 SM LORATADIN TAB ALLG REL 12/31/9999 20121 49348089185 SM LUBRICATI GEL JELLY 12/31/9999 20121 49348050449 SM MAG CITR SOL CHERRY 12/31/9999 20121 49348069649 SM MAG CITR SOL LEMON 12/31/9999 20121 49348039896 SM MEDICATED MIS CHST RUB 12/31/9999 20121 49348083492 SM MEDICATED POW BODY 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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