August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 51552044806 SOD BISULFIT GRA 12/31/9999 20121 51552044809 SOD BISULFIT GRA 12/31/9999 20121 51552020406 SOD CARBONAT POW MONOHYDR 12/31/9999 20121 00264402155 SOD CHLORIDE INJ 0.45% 09/30/2015 20121 00264780200 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00264780210 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00338004303 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00338004304 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409713202 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409713266 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409713267 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409773036 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409773037 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409798502 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409798503 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409798509 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00409798525 SOD CHLORIDE INJ 0.45% 12/31/9999 20121 00264180031 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00264180032 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00264180036 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00264400055 SOD CHLORIDE INJ 0.9% 06/30/2015 20121 00264400155 SOD CHLORIDE INJ 0.9% 09/30/2015 20121 00264400255 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00264780000 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00264780010 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00264780020 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004901 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004902 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004903 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004904 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004910 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004911 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004918 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004931 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004938 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004941 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338004948 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338055311 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338055318 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338630402 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338630403 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00338630404 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409191832 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409191833 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409191835 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409210202 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409210205 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409488810 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409488812 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409488820 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409488850 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409710102 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409710166 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409710167 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798302 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798303 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798309 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798325 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798330 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798348 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798353 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798355 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798361 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798406 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798411 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798413 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798420 SOD CHLORIDE INJ 0.9% 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00409798423 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798436 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409798437 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00517280225 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00517281025 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 63323018600 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 63323018602 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 63323018610 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 63323018620 SOD CHLORIDE INJ 0.9% 12/31/9999 20121 00409196605 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 20121 00409196607 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 20121 00409196612 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 20121 00517064825 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 20121 63323025930 SOD CHLORIDE INJ 0.9%BACT 12/31/9999 20121 00409665773 SOD CHLORIDE INJ 2.5/ML 12/31/9999 20121 00409666075 SOD CHLORIDE INJ 2.5/ML 12/31/9999 20121 63323013920 SOD CHLORIDE INJ 2.5/ML 12/31/9999 20121 63323013940 SOD CHLORIDE INJ 2.5/ML 12/31/9999 20121 00409113002 SOD CHLORIDE INJ 23.4% 12/31/9999 20121 00409114102 SOD CHLORIDE INJ 23.4% 12/31/9999 20121 63323008861 SOD CHLORIDE INJ 23.4% 12/31/9999 20121 63323008863 SOD CHLORIDE INJ 23.4% 12/31/9999 20121 00264780510 SOD CHLORIDE INJ 3% 12/31/9999 20121 00338005403 SOD CHLORIDE INJ 3% 12/31/9999 20121 00517290025 SOD CHLORIDE INJ 4MEQ/ML 12/31/9999 20121 00517293025 SOD CHLORIDE INJ 4MEQ/ML 12/31/9999 20121 63323018730 SOD CHLORIDE INJ 4MEQ/ML 12/31/9999 20121 00264780610 SOD CHLORIDE INJ 5% 12/31/9999 20121 00338005603 SOD CHLORIDE INJ 5% 12/31/9999 20121 00487930102 SOD CHLORIDE NEB 0.9% 12/31/9999 20121 00487930103 SOD CHLORIDE NEB 0.9% 12/31/9999 20121 00487930133 SOD CHLORIDE NEB 0.9% 12/31/9999 20121 00904531538 SOD CHLORIDE OIN 5% OP 12/31/9999 20121 17478062235 SOD CHLORIDE OIN 5% OP 12/31/9999 20121 00904531435 SOD CHLORIDE SOL 5% OP 12/31/9999 20121 17478062312 SOD CHLORIDE SOL 5% OP 12/31/9999 20121 00527111610 SOD CHLORIDE TAB 1000MG 12/31/9999 20121 25010021027 SOD EDECRIN INJ 50MG 12/31/9999 20121 51991067636 SOD FLUORIDE CHW 0.25MG F 12/31/9999 20121 52152012705 SOD FLUORIDE CHW 0.5MG 12/31/9999 20121 51991067736 SOD FLUORIDE CHW 0.5MG F 12/31/9999 20121 52152012805 SOD FLUORIDE CHW 1MG 12/31/9999 20121 51991067836 SOD FLUORIDE CHW 1MG F 12/31/9999 20121 44946103208 SOD FLUORIDE DRO 0.5MG/ML 12/31/9999 20121 50383065650 SOD FLUORIDE DRO 0.5MG/ML 12/31/9999 20121 51862016550 SOD FLUORIDE DRO 0.5MG/ML 12/31/9999 20121 60258015816 SOD FLUORIDE SOL 0.2%MINT 12/31/9999 20121 10267164001 SOD FLUORIDE TAB 0.5MG F 12/31/9999 20121 10267164004 SOD FLUORIDE TAB 0.5MG F 12/31/9999 20121 10267164101 SOD FLUORIDE TAB 1MG F 12/31/9999 20121 10267164104 SOD FLUORIDE TAB 1MG F 12/31/9999 20121 51552049404 SOD IODIDE POW 12/31/9999 20121 51552049406 SOD IODIDE POW 12/31/9999 20121 00338012904 SOD LACTATE INJ 1/6M 10/31/2012 20121 00409666402 SOD LACTATE INJ 5MEQ/ML 12/31/9999 20121 51552026304 SOD LAURYL POW SULFATE 12/31/9999 20121 51552026306 SOD LAURYL POW SULFATE 12/31/9999 20121 51552026308 SOD LAURYL POW SULFATE 12/31/9999 20121 51552016906 SOD NITRITE GRA 12/31/9999 20121 51552016909 SOD NITRITE GRA 12/31/9999 20121 51552050306 SOD PHOS DIB CRY HEPTAHYD 12/31/9999 20121 51552008406 SOD PHOSPHAT CRY TRIBASIC 12/31/9999 20121 00409739172 SOD PHOSPHAT INJ 3MM/ML 12/31/9999 20121 00517340525 SOD PHOSPHAT INJ 3MM/ML 12/31/9999 20121 00517341525 SOD PHOSPHAT INJ 3MM/ML 12/31/9999 20121 00517345025 SOD PHOSPHAT INJ 3MM/ML 12/31/9999 20121 46287001216 SOD POLY SUL POW 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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