August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00074707090 SYNTHROID TAB 175MCG 12/31/9999 20121 00074714811 SYNTHROID TAB 200MCG 12/31/9999 20121 00074714819 SYNTHROID TAB 200MCG 12/31/9999 20121 00074714890 SYNTHROID TAB 200MCG 12/31/9999 20121 00074434119 SYNTHROID TAB 25MCG 12/31/9999 20121 00074434190 SYNTHROID TAB 25MCG 12/31/9999 20121 00074714919 SYNTHROID TAB 300MCG 12/31/9999 20121 00074714990 SYNTHROID TAB 300MCG 12/31/9999 20121 00074455211 SYNTHROID TAB 50MCG 12/31/9999 20121 00074455219 SYNTHROID TAB 50MCG 12/31/9999 20121 00074455290 SYNTHROID TAB 50MCG 12/31/9999 20121 00074518211 SYNTHROID TAB 75MCG 12/31/9999 20121 00074518219 SYNTHROID TAB 75MCG 12/31/9999 20121 00074518290 SYNTHROID TAB 75MCG 12/31/9999 20121 00074659419 SYNTHROID TAB 88MCG 12/31/9999 20121 00074659490 SYNTHROID TAB 88MCG 12/31/9999 20121 25010071015 SYPRINE CAP 250MG 12/31/9999 20121 51552127402 SYRSPEND SF SUS 12/31/9999 20121 00065050935 SYSTANE OIN 12/31/9999 20121 00065042915 SYSTANE SOL 12/31/9999 20121 00065042921 SYSTANE SOL 12/31/9999 20121 00065042930 SYSTANE SOL 12/31/9999 20121 00065042967 SYSTANE SOL 12/31/9999 20121 00065143302 SYSTANE BAL SOL RESTOR 12/31/9999 20121 00065143307 SYSTANE BAL SOL RESTOR 12/31/9999 20121 00065045407 SYSTANE GEL DRO 0.4-0.3% 12/31/9999 20121 00065044801 SYSTANE LIQ DRO 0.4-0.3% 10/31/2012 20121 00065043132 SYSTANE PF SOL 12/31/9999 20121 00065143105 SYSTANE ULTR SOL 12/31/9999 20121 00065143201 SYSTANE ULTR SOL PF 12/31/9999 20121 46122005762 TAB TUSSIN TAB 400MG 12/31/9999 20121 46122005862 TAB TUSSIN TAB DM 12/31/9999 20121 00173088025 TABLOID TAB 40MG 12/31/9999 20121 00944870101 TACHOSIL PAD 12/31/9999 20121 00944870202 TACHOSIL PAD 12/31/9999 20121 50222022704 TACLONEX OIN 12/31/9999 20121 50222022781 TACLONEX OIN 12/31/9999 20121 50222050106 TACLONEX SUS SCALP 12/31/9999 20121 00378204501 TACROLIMUS CAP 0.5MG 12/31/9999 20121 00781210201 TACROLIMUS CAP 0.5MG 12/31/9999 20121 00781930201 TACROLIMUS CAP 0.5MG 12/31/9999 20121 16729004101 TACROLIMUS CAP 0.5MG 12/31/9999 20121 51079081701 TACROLIMUS CAP 0.5MG 12/31/9999 20121 51079081720 TACROLIMUS CAP 0.5MG 12/31/9999 20121 55111052501 TACROLIMUS CAP 0.5MG 12/31/9999 20121 68084044901 TACROLIMUS CAP 0.5MG 12/31/9999 20121 00378204601 TACROLIMUS CAP 1MG 12/31/9999 20121 00378204605 TACROLIMUS CAP 1MG 12/31/9999 20121 00781210301 TACROLIMUS CAP 1MG 12/31/9999 20121 00781930301 TACROLIMUS CAP 1MG 12/31/9999 20121 16729004201 TACROLIMUS CAP 1MG 12/31/9999 20121 51079081801 TACROLIMUS CAP 1MG 12/31/9999 20121 51079081820 TACROLIMUS CAP 1MG 12/31/9999 20121 55111052601 TACROLIMUS CAP 1MG 12/31/9999 20121 68084045001 TACROLIMUS CAP 1MG 12/31/9999 20121 00378204701 TACROLIMUS CAP 5MG 12/31/9999 20121 00591335901 TACROLIMUS CAP 5MG 05/31/2012 20121 00781210401 TACROLIMUS CAP 5MG 12/31/9999 20121 00781930401 TACROLIMUS CAP 5MG 12/31/9999 20121 16729004301 TACROLIMUS CAP 5MG 12/31/9999 20121 51079002801 TACROLIMUS CAP 5MG 12/31/9999 20121 51079002820 TACROLIMUS CAP 5MG 12/31/9999 20121 55111052701 TACROLIMUS CAP 5MG 12/31/9999 20121 68084045101 TACROLIMUS CAP 5MG 12/31/9999 20121 62107005330 TACTINAL CHW CHILDREN 12/31/9999 20121 62107005201 TACTINAL TAB 325MG 12/31/9999 20121 62107005210 TACTINAL TAB 325MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 62107005001 TACTINAL TAB 500MG 12/31/9999 20121 62107005010 TACTINAL TAB 500MG 12/31/9999 20121 62107005101 TACTINAL TAB 500MG 12/31/9999 20121 62107005110 TACTINAL TAB 500MG 12/31/9999 20121 00135014802 TAGAMET HB TAB 200MG 12/31/9999 20121 00135014805 TAGAMET HB TAB 200MG 12/31/9999 20121 38779051908 TALC POW 12/31/9999 20121 38779051909 TALC POW 12/31/9999 20121 51552021904 TALC POW 12/31/9999 20121 51552021906 TALC POW 12/31/9999 20121 51552021908 TALC POW 12/31/9999 20121 51552021909 TALC POW 12/31/9999 20121 00409194101 TALWIN INJ 30MG/ML 12/31/9999 20121 29336030710 TAMBOCOR TAB 100MG 04/30/2013 20121 99207018110 TAMBOCOR TAB 100MG 12/31/9999 20121 29336031410 TAMBOCOR TAB 150MG 04/30/2013 20121 99207018215 TAMBOCOR TAB 150MG 12/31/9999 20121 29336030510 TAMBOCOR TAB 50MG 04/30/2013 20121 99207018050 TAMBOCOR TAB 50MG 12/31/9999 20121 00004080285 TAMIFLU CAP 30MG 12/31/9999 20121 00004080185 TAMIFLU CAP 45MG 12/31/9999 20121 00004080085 TAMIFLU CAP 75MG 12/31/9999 20121 00004082009 TAMIFLU SUS 6MG/ML 12/31/9999 20121 00093078405 TAMOXIFEN TAB 10MG 12/31/9999 20121 00093078406 TAMOXIFEN TAB 10MG 12/31/9999 20121 00093078410 TAMOXIFEN TAB 10MG 12/31/9999 20121 00093078486 TAMOXIFEN TAB 10MG 12/31/9999 20121 00378014405 TAMOXIFEN TAB 10MG 12/31/9999 20121 00378014491 TAMOXIFEN TAB 10MG 12/31/9999 20121 00591223218 TAMOXIFEN TAB 10MG 11/30/2013 20121 00591223260 TAMOXIFEN TAB 10MG 12/31/9999 20121 00591247218 TAMOXIFEN TAB 10MG 12/31/9999 20121 63739026910 TAMOXIFEN TAB 10MG 12/31/9999 20121 00093078201 TAMOXIFEN TAB 20MG 12/31/9999 20121 00093078205 TAMOXIFEN TAB 20MG 12/31/9999 20121 00093078210 TAMOXIFEN TAB 20MG 12/31/9999 20121 00093078256 TAMOXIFEN TAB 20MG 12/31/9999 20121 00378027401 TAMOXIFEN TAB 20MG 12/31/9999 20121 00378027493 TAMOXIFEN TAB 20MG 12/31/9999 20121 00591223319 TAMOXIFEN TAB 20MG 01/31/2014 20121 00591223330 TAMOXIFEN TAB 20MG 01/31/2014 20121 00591247319 TAMOXIFEN TAB 20MG 12/31/9999 20121 00591247330 TAMOXIFEN TAB 20MG 12/31/9999 20121 00093733801 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00115821101 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00115821103 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00228299611 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00228299650 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00378250010 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00378250077 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00378250093 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00781207601 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 00904615661 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 51079029401 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 51079029417 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 51079029419 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 51079029420 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 51079029430 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 51079029456 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 62756016013 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 62756016088 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 64679051602 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 64679051603 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 68084040701 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 68382013201 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 68382013210 TAMSULOSIN CAP 0.4MG 12/31/9999 20121 61787086616 TANAFED DMX SUS 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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