August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00409488710 STERIL WATER INJ 12/31/9999 20121 00409488720 STERIL WATER INJ 12/31/9999 20121 00409488750 STERIL WATER INJ 12/31/9999 20121 00409488799 STERIL WATER INJ 12/31/9999 20121 00409711807 STERIL WATER INJ 12/31/9999 20121 00409799009 STERIL WATER INJ 12/31/9999 20121 00517300525 STERIL WATER INJ 12/31/9999 20121 00517301025 STERIL WATER INJ 12/31/9999 20121 00517302025 STERIL WATER INJ 12/31/9999 20121 00517305025 STERIL WATER INJ 12/31/9999 20121 63323018500 STERIL WATER INJ 12/31/9999 20121 63323018505 STERIL WATER INJ 12/31/9999 20121 63323018510 STERIL WATER INJ 12/31/9999 20121 63323018520 STERIL WATER INJ 12/31/9999 20121 63323018550 STERIL WATER INJ 12/31/9999 20121 00264210100 STERIL WATER SOL IRRIG 12/31/9999 20121 00264210110 STERIL WATER SOL IRRIG 12/31/9999 20121 00264210150 STERIL WATER SOL IRRIG 12/31/9999 20121 00264210170 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000344 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000346 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000347 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000349 STERIL WATER SOL IRRIG 05/31/2012 20121 00338000402 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000403 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000404 STERIL WATER SOL IRRIG 12/31/9999 20121 00338000405 STERIL WATER SOL IRRIG 12/31/9999 20121 00409613903 STERIL WATER SOL IRRIG 12/31/9999 20121 00409613922 STERIL WATER SOL IRRIG 12/31/9999 20121 00409713909 STERIL WATER SOL IRRIG 12/31/9999 20121 00409713936 STERIL WATER SOL IRRIG 12/31/9999 20121 00409797305 STERIL WATER SOL IRRIG 12/31/9999 20121 00409797307 STERIL WATER SOL IRRIG 12/31/9999 20121 00409797308 STERIL WATER SOL IRRIG 12/31/9999 20121 24385021852 STERILE PAD 3"X3" 12/31/9999 20121 00703925809 STERILE DILU SOL EPOPROS 12/31/9999 20121 00173051801 STERILE DILU SOL FLOLAN 12/31/9999 20121 00053687100 STIMATE SOL 1.5MG/ML 12/31/9999 20121 36800046965 STOMACH RELF CHW 262MG 12/31/9999 20121 49348095344 STOMACH RELF CHW 262MG 12/31/9999 20121 00113030234 STOMACH RELF SUS 262/15ML 12/31/9999 20121 00113030240 STOMACH RELF SUS 262/15ML 12/31/9999 20121 00113030243 STOMACH RELF SUS 262/15ML 12/31/9999 20121 24385030234 STOMACH RELF SUS 262/15ML 12/31/9999 20121 36800030234 STOMACH RELF SUS 262/15ML 12/31/9999 20121 36800030240 STOMACH RELF SUS 262/15ML 12/31/9999 20121 37205030234 STOMACH RELF SUS 262/15ML 12/31/9999 20121 37205030240 STOMACH RELF SUS 262/15ML 12/31/9999 20121 00113033734 STOMACH RELF SUS 525/15ML 12/31/9999 20121 24385033734 STOMACH RELF SUS 525/15ML 12/31/9999 20121 36800033734 STOMACH RELF SUS 525/15ML 12/31/9999 20121 36800033740 STOMACH RELF SUS 525/15ML 12/31/9999 20121 49348092337 STOMACH RELF SUS 525/15ML 12/31/9999 20121 49348051159 STOMACH RELF TAB 262MG 12/31/9999 20121 00113048672 STOOL SOFTNR CAP 100MG 12/31/9999 20121 24385043672 STOOL SOFTNR CAP 100MG 12/31/9999 20121 24385043678 STOOL SOFTNR CAP 100MG 12/31/9999 20121 36800048672 STOOL SOFTNR CAP 100MG 12/31/9999 20121 36800048678 STOOL SOFTNR CAP 100MG 12/31/9999 20121 37205026501 STOOL SOFTNR CAP 100MG 12/31/9999 20121 49348005819 STOOL SOFTNR CAP 100MG 12/31/9999 20121 49348061610 STOOL SOFTNR CAP 100MG 12/31/9999 20121 49348061690 STOOL SOFTNR CAP 100MG 12/31/9999 20121 49348091705 STOOL SOFTNR CAP 100MG 12/31/9999 20121 63868011001 STOOL SOFTNR CAP 100MG 12/31/9999 20121 63868011025 STOOL SOFTNR CAP 100MG 12/31/9999 20121 66424003010 STOOL SOFTNR CAP 100MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 24385044378 STOOL SOFTNR CAP 250MG 12/31/9999 20121 49348071410 STOOL SOFTNR CAP 250MG 12/31/9999 20121 24385046943 STOOL SOFTNR SYP 60/15ML 12/31/9999 20121 24385049572 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 20121 24385049578 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 20121 49348054410 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 20121 49348054419 STOOL SOFTNR TAB 8.6-50MG 12/31/9999 20121 37205034978 STOOL SOFTNR TAB LAXATIVE 12/31/9999 20121 63868013101 STOOL SOFTNR TAB LAXATIVE 12/31/9999 20121 00002325130 STRATTERA CAP 100MG 12/31/9999 20121 00002322730 STRATTERA CAP 10MG 12/31/9999 20121 00002323830 STRATTERA CAP 18MG 12/31/9999 20121 00002322830 STRATTERA CAP 25MG 12/31/9999 20121 00002322930 STRATTERA CAP 40MG 12/31/9999 20121 00002323930 STRATTERA CAP 60MG 12/31/9999 20121 00002325030 STRATTERA CAP 80MG 12/31/9999 20121 51552028303 STRAWBERRY LIQ FLAVOR 12/31/9999 20121 68405801306 STRAZEPAM PAK 12/31/9999 20121 39822070601 STREPTOMYCIN INJ 1GM 12/31/9999 20121 39822070602 STREPTOMYCIN INJ 1GM 12/31/9999 20121 00182449126 STRESS W/ZN TAB NF 06/30/2012 20121 00006003220 STROMECTOL TAB 3MG 12/31/9999 20121 00642020010 STROVITE TAB 12/31/9999 20121 00642020810 STROVITE TAB ADVANCE 12/31/9999 20121 00642020410 STROVITE FOR TAB 12/31/9999 20121 00642020790 STROVITE ONE TAB 12/31/9999 20121 00642020110 STROVITE PLU TAB 12/31/9999 20121 64731079501 STUART PREN TAB 11/30/2013 20121 66479079606 STUART PRENA PAK + DHA 05/26/2013 20121 12496120201 SUBOXONE MIS 2-0.5MG 12/31/9999 20121 12496120203 SUBOXONE MIS 2-0.5MG 12/31/9999 20121 12496120801 SUBOXONE MIS 8-2MG 12/31/9999 20121 12496120803 SUBOXONE MIS 8-2MG 12/31/9999 20121 12496128302 SUBOXONE SUB 2-0.5MG 12/31/9999 20121 12496130602 SUBOXONE SUB 8-2MG 12/31/9999 20121 12496127802 SUBUTEX SUB 2MG 12/31/9999 20121 12496131002 SUBUTEX SUB 8MG 12/31/9999 20121 00121074710 SUCRALFATE SUS 1GM/10ML 12/31/9999 20121 66689079001 SUCRALFATE SUS 1GM/10ML 12/31/9999 20121 66689079050 SUCRALFATE SUS 1GM/10ML 12/31/9999 20121 68094017159 SUCRALFATE SUS 1GM/10ML 12/31/9999 20121 68094017161 SUCRALFATE SUS 1GM/10ML 12/31/9999 20121 68094017162 SUCRALFATE SUS 1GM/10ML 12/31/9999 20121 00093221001 SUCRALFATE TAB 1GM 12/31/9999 20121 00093221005 SUCRALFATE TAB 1GM 12/31/9999 20121 00093221019 SUCRALFATE TAB 1GM 12/31/9999 20121 00093221093 SUCRALFATE TAB 1GM 12/31/9999 20121 00093221098 SUCRALFATE TAB 1GM 12/31/9999 20121 00591078001 SUCRALFATE TAB 1GM 12/31/9999 20121 00591078005 SUCRALFATE TAB 1GM 12/31/9999 20121 00591078019 SUCRALFATE TAB 1GM 07/31/2012 20121 00591078036 SUCRALFATE TAB 1GM 10/31/2012 20121 29033000301 SUCRALFATE TAB 1GM 12/31/9999 20121 29033000305 SUCRALFATE TAB 1GM 12/31/9999 20121 51079087101 SUCRALFATE TAB 1GM 12/31/9999 20121 51079087117 SUCRALFATE TAB 1GM 12/31/9999 20121 51079087119 SUCRALFATE TAB 1GM 12/31/9999 20121 51079087120 SUCRALFATE TAB 1GM 12/31/9999 20121 63739026110 SUCRALFATE TAB 1GM 10/31/2012 20121 51552050206 SUCROSE CRY 12/31/9999 20121 51552050208 SUCROSE CRY 12/31/9999 20121 51552079505 SUCROSE OCTA CRY ACETATE 12/31/9999 20121 68047024401 SUDATEX G TAB 40-400MG 12/31/9999 20121 68047024701 SUDATEX-DM TAB 12/31/9999 20121 00904580315 SUDOGEST TAB 120MG ER 12/31/9999 20121 00904505324 SUDOGEST TAB 30MG 12/31/9999 20121 00904505359 SUDOGEST TAB 30MG 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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