August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 55111029390 SUMATRIPTAN TAB 100MG 12/31/9999 20121 59762185209 SUMATRIPTAN TAB 100MG 12/31/9999 20121 62756052269 SUMATRIPTAN TAB 100MG 12/31/9999 20121 62756052288 SUMATRIPTAN TAB 100MG 12/31/9999 20121 63304009919 SUMATRIPTAN TAB 100MG 12/31/9999 20121 65862014836 SUMATRIPTAN TAB 100MG 12/31/9999 20121 68084034197 SUMATRIPTAN TAB 100MG 12/31/9999 20121 00093022219 SUMATRIPTAN TAB 25MG 12/31/9999 20121 00093022290 SUMATRIPTAN TAB 25MG 12/31/9999 20121 00378563059 SUMATRIPTAN TAB 25MG 12/31/9999 20121 16252059099 SUMATRIPTAN TAB 25MG 12/31/9999 20121 16714053111 SUMATRIPTAN TAB 25MG 12/31/2020 20121 55111029109 SUMATRIPTAN TAB 25MG 12/31/9999 20121 55111029136 SUMATRIPTAN TAB 25MG 12/31/9999 20121 55111029190 SUMATRIPTAN TAB 25MG 12/31/9999 20121 59762185009 SUMATRIPTAN TAB 25MG 12/31/9999 20121 62756052069 SUMATRIPTAN TAB 25MG 12/31/9999 20121 62756052088 SUMATRIPTAN TAB 25MG 12/31/9999 20121 63304009719 SUMATRIPTAN TAB 25MG 12/31/9999 20121 65862014636 SUMATRIPTAN TAB 25MG 12/31/9999 20121 68084033997 SUMATRIPTAN TAB 25MG 12/31/9999 20121 00093022319 SUMATRIPTAN TAB 50MG 12/31/9999 20121 00093022390 SUMATRIPTAN TAB 50MG 12/31/9999 20121 00378563159 SUMATRIPTAN TAB 50MG 12/31/9999 20121 16252059199 SUMATRIPTAN TAB 50MG 12/31/9999 20121 16714053211 SUMATRIPTAN TAB 50MG 12/31/2020 20121 55111029209 SUMATRIPTAN TAB 50MG 12/31/9999 20121 55111029236 SUMATRIPTAN TAB 50MG 12/31/9999 20121 55111029290 SUMATRIPTAN TAB 50MG 12/31/9999 20121 59762185109 SUMATRIPTAN TAB 50MG 12/31/9999 20121 62756052169 SUMATRIPTAN TAB 50MG 12/31/9999 20121 62756052188 SUMATRIPTAN TAB 50MG 12/31/9999 20121 63304009819 SUMATRIPTAN TAB 50MG 12/31/9999 20121 65862014736 SUMATRIPTAN TAB 50MG 12/31/9999 20121 68084034097 SUMATRIPTAN TAB 50MG 12/31/9999 20121 43376010601 SUMAVEL DOSE INJ 6MG/0.5 12/31/9999 20121 43376010606 SUMAVEL DOSE INJ 6MG/0.5 12/31/9999 20121 43538010060 SUMAXIN PAD 10-4% 12/31/9999 20121 43538010160 SUMAXIN CP KIT 12/31/9999 20121 43538016016 SUMAXIN TS SUS 8-4% 12/31/9999 20121 43538013016 SUMAXIN WASH LIQ 9-4% 12/31/9999 20121 63868014418 SUPHEDRINE TAB 10MG 12/31/9999 20121 63868014436 SUPHEDRINE TAB 10MG 12/31/9999 20121 63868014472 SUPHEDRINE TAB 10MG 12/31/9999 20121 63868014624 SUPHEDRINE TAB 30MG 12/31/9999 20121 63868014648 SUPHEDRINE TAB 30MG 12/31/9999 20121 51552115606 SUPPOSIBLEND MIS 12/31/9999 20121 67979000201 SUPPRELIN LA KIT 50MG 12/31/9999 20121 10019064124 SUPRANE INH 12/31/9999 20121 10019064424 SUPRANE SOL 12/31/9999 20121 10019064460 SUPRANE SOL 12/31/9999 20121 10019064624 SUPRANE SOL 12/31/9999 20121 68180020201 SUPRAX SUS 100/5ML 12/31/9999 20121 68180020202 SUPRAX SUS 100/5ML 12/31/9999 20121 68180020203 SUPRAX SUS 100/5ML 12/31/9999 20121 27437020602 SUPRAX SUS 200/5ML 12/31/9999 20121 27437020603 SUPRAX SUS 200/5ML 12/31/9999 20121 27437020108 SUPRAX TAB 400MG 12/31/9999 20121 24090072085 SUPRENZA TAB 15MG 12/31/9999 20121 24090072185 SUPRENZA TAB 30MG 12/31/9999 20121 52268001201 SUPREP BOWEL SOL PREP 12/31/9999 20121 51285055402 SURMONTIL CAP 100MG 12/31/9999 20121 51285053802 SURMONTIL CAP 25MG 12/31/9999 20121 51285053902 SURMONTIL CAP 50MG 12/31/9999 20121 00074104004 SURVANTA INH 12/31/9999 20121 00074104008 SURVANTA INH 12/31/9999 20121 00574030716 SUSPENDOL-S LIQ 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00056047492 SUSTIVA CAP 200MG 12/31/9999 20121 00056047030 SUSTIVA CAP 50MG 12/31/9999 20121 00056051030 SUSTIVA TAB 600MG 12/31/9999 20121 00069055038 SUTENT CAP 12.5MG 12/31/9999 20121 00069077038 SUTENT CAP 25MG 12/31/9999 20121 00069098038 SUTENT CAP 50MG 12/31/9999 20121 11701000201 SWEEN CRE 12/31/9999 20121 11701000203 SWEEN CRE 12/31/9999 20121 11701000213 SWEEN CRE 12/31/9999 20121 11701000214 SWEEN CRE 12/31/9999 20121 11701000221 SWEEN CRE 12/31/9999 20121 11701000223 SWEEN CRE 12/31/9999 20121 11701001903 SWEEN CRE 12/31/9999 20121 11701004314 SWEEN CRE 12/31/9999 20121 11701004321 SWEEN CRE 12/31/9999 20121 11701004323 SWEEN CRE 12/31/9999 20121 11701000720 SWEEN PREP PAD WIPES 12/31/9999 20121 11701000798 SWEEN PREP PAD WIPES 12/31/9999 20121 11701000703 SWEEN PREP SOL W/DABBER 12/31/9999 20121 00228161501 SWEET OLIVE OIL 12/31/9999 20121 00228161502 SWEET OLIVE OIL 12/31/9999 20121 00168012691 SWIM EAR LIQ 95% OTIC 12/31/9999 20121 00168012662 SWIM EAR SOL OTIC 12/31/9999 20121 00781565815 SYEDA TAB 3-0.03MG 12/31/9999 20121 00085138801 SYLATRON KIT 296MCG 12/31/9999 20121 00085138802 SYLATRON KIT 296MCG 12/31/9999 20121 00085128702 SYLATRON KIT 444MCG 12/31/9999 20121 00085128703 SYLATRON KIT 444MCG 12/31/9999 20121 00085131201 SYLATRON KIT 888MCG 12/31/9999 20121 64543011401 SYMAX FASTAB TAB 0.125MG 12/31/9999 20121 64543011101 SYMAX-SL SUB 0.125MG 12/31/9999 20121 00186037020 SYMBICORT AER 160-4.5 12/31/9999 20121 00186037028 SYMBICORT AER 160-4.5 12/31/9999 20121 00186037220 SYMBICORT AER 80-4.5 12/31/9999 20121 00186037228 SYMBICORT AER 80-4.5 12/31/9999 20121 00002323230 SYMBYAX CAP 12-25MG 12/31/9999 20121 00002323430 SYMBYAX CAP 12-50MG 12/31/9999 20121 00002323030 SYMBYAX CAP 3-25MG 12/31/9999 20121 00002323101 SYMBYAX CAP 6-25MG 02/28/2013 20121 00002323130 SYMBYAX CAP 6-25MG 12/31/9999 20121 00002323133 SYMBYAX CAP 6-25MG 02/28/2013 20121 00002323330 SYMBYAX CAP 6-50MG 12/31/9999 20121 66780011001 SYMLIN INJ 600MCG 12/31/9999 20121 66780011502 SYMLINPEN 60 INJ 1000MCG 12/31/9999 20121 66780012102 SYMLNPEN 120 INJ 1000MCG 12/31/9999 20121 00338917091 SYMPT-X POW 12/31/9999 20121 00338917891 SYMPT-X G.I. POW RAP RLS 12/31/9999 20121 60574411301 SYNAGIS INJ 100MG/ML 12/31/9999 20121 60574411401 SYNAGIS INJ 50MG 12/31/9999 20121 49708041988 SYNALGOS-DC CAP 12/31/9999 20121 00025016608 SYNAREL SOL 2MG/ML 12/31/9999 20121 43469086410 SYNERA DIS 70-70MG 12/31/9999 20121 61570026001 SYNERCID INJ 500MG 12/31/9999 20121 61570026010 SYNERCID INJ 500MG 12/31/9999 20121 00074662411 SYNTHROID TAB 100MCG 12/31/9999 20121 00074662419 SYNTHROID TAB 100MCG 12/31/9999 20121 00074662490 SYNTHROID TAB 100MCG 12/31/9999 20121 00074929619 SYNTHROID TAB 112MCG 12/31/9999 20121 00074929690 SYNTHROID TAB 112MCG 12/31/9999 20121 00074706811 SYNTHROID TAB 125MCG 12/31/9999 20121 00074706819 SYNTHROID TAB 125MCG 12/31/9999 20121 00074706890 SYNTHROID TAB 125MCG 12/31/9999 20121 00074372790 SYNTHROID TAB 137MCG 12/31/9999 20121 00074706911 SYNTHROID TAB 150MCG 12/31/9999 20121 00074706919 SYNTHROID TAB 150MCG 12/31/9999 20121 00074706990 SYNTHROID TAB 150MCG 12/31/9999 20121 00074707019 SYNTHROID TAB 175MCG 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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