August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 51672130200 TERCONAZOLE CRE 0.8% 12/31/9999 20121 45802071708 TERCONAZOLE SUP 80MG 12/31/9999 20121 00456069801 TESSALON CAP 200MG 03/31/2013 20121 00456068801 TESSALON PER CAP 100MG 03/31/2013 20121 00456068802 TESSALON PER CAP 100MG 03/31/2013 20121 66887000105 TESTIM GEL 1%(50MG) 12/31/9999 20121 43773100102 TESTOPEL MIS PELLETS 12/31/9999 20121 43773100103 TESTOPEL MIS PELLETS 12/31/9999 20121 00781307370 TESTOST CYP INJ 100MG/ML 12/31/9999 20121 00574082001 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00574082010 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00591322379 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00703612101 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00703612501 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00781307470 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00781307471 TESTOST CYP INJ 200MG/ML 12/31/9999 20121 00591322126 TESTOST ENAN INJ 200MG/ML 12/31/9999 20121 38779016303 TESTOSTERONE POW 12/31/9999 20121 38779016304 TESTOSTERONE POW 12/31/9999 20121 38779016305 TESTOSTERONE POW 12/31/9999 20121 38779016308 TESTOSTERONE POW 12/31/9999 20121 38779016309 TESTOSTERONE POW 12/31/9999 20121 00187090101 TESTRED CAP 10MG 12/31/9999 20121 00065074112 TETRACAINE SOL 0.5% OP 12/31/9999 20121 24208092064 TETRACAINE SOL 0.5% OP 12/31/9999 20121 00172241600 TETRACYCLINE CAP 250MG 12/31/9999 20121 00172241610 TETRACYCLINE CAP 250MG 12/31/9999 20121 00172241660 TETRACYCLINE CAP 250MG 12/31/9999 20121 00172241680 TETRACYCLINE CAP 250MG 12/31/9999 20121 00591223401 TETRACYCLINE CAP 250MG 12/31/9999 20121 00591223410 TETRACYCLINE CAP 250MG 12/31/9999 20121 00172240700 TETRACYCLINE CAP 500MG 12/31/9999 20121 00172240710 TETRACYCLINE CAP 500MG 12/31/9999 20121 00172240760 TETRACYCLINE CAP 500MG 12/31/9999 20121 00172240780 TETRACYCLINE CAP 500MG 12/31/9999 20121 00591223501 TETRACYCLINE CAP 500MG 12/31/9999 20121 00591223510 TETRACYCLINE CAP 500MG 12/31/9999 20121 00536094094 TETRAHYDROZ SOL 0.05% OP 12/31/9999 20121 00074302511 TEVETEN TAB 400MG 12/31/9999 20121 00074304011 TEVETEN TAB 600MG 12/31/9999 20121 00074301511 TEVETEN HCT TAB 600-12.5 12/31/9999 20121 00074302011 TEVETEN HCT TAB 600-25MG 12/31/9999 20121 57844071319 TEV-TROPIN INJ 5MG 12/31/9999 20121 00178045501 TEXACORT SOL 2.5% 12/31/9999 20121 61570002401 THALITONE TAB 15MG 12/31/2013 20121 59572021015 THALOMID CAP 100MG 12/31/9999 20121 59572021095 THALOMID CAP 100MG 12/31/9999 20121 59572021513 THALOMID CAP 150MG 12/31/9999 20121 59572021593 THALOMID CAP 150MG 12/31/9999 20121 59572022016 THALOMID CAP 200MG 12/31/9999 20121 59572022096 THALOMID CAP 200MG 12/31/9999 20121 59572020514 THALOMID CAP 50MG 12/31/9999 20121 59572020517 THALOMID CAP 50MG 12/31/9999 20121 59572020594 THALOMID CAP 50MG 12/31/9999 20121 59572020597 THALOMID CAP 50MG 12/31/9999 20121 00409159304 THAM INJ 30MEQ 12/31/9999 20121 50474010001 THEO-24 CAP 100MG CR 12/31/9999 20121 50474020001 THEO-24 CAP 200MG CR 12/31/9999 20121 50474020050 THEO-24 CAP 200MG CR 12/31/9999 20121 50474030001 THEO-24 CAP 300MG CR 12/31/9999 20121 50474030050 THEO-24 CAP 300MG CR 12/31/9999 20121 50474040001 THEO-24 CAP 400MG ER 12/31/9999 20121 00472154016 THEOLATE ELX 150-90 12/31/9999 20121 00264955410 THEOPHYL/D5W INJ 0.8MG/ML 12/31/9999 20121 00264955810 THEOPHYL/D5W INJ 1.6MG/ML 12/31/9999 20121 00121479415 THEOPHYLLINE ELX 80/15ML 12/31/9999 20121 00472144416 THEOPHYLLINE ELX 80/15ML 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 54838055680 THEOPHYLLINE SOL 80/15ML 12/31/9999 20121 50111048301 THEOPHYLLINE TAB 100MG CR 12/31/9999 20121 50111048302 THEOPHYLLINE TAB 100MG CR 12/31/9999 20121 00904588761 THEOPHYLLINE TAB 100MG ER 12/31/9999 20121 50111048201 THEOPHYLLINE TAB 200MG CR 12/31/9999 20121 50111048202 THEOPHYLLINE TAB 200MG CR 12/31/9999 20121 50111048203 THEOPHYLLINE TAB 200MG CR 12/31/9999 20121 00904588861 THEOPHYLLINE TAB 200MG ER 12/31/9999 20121 00615250339 THEOPHYLLINE TAB 200MG SR 12/31/9999 20121 00904588961 THEOPHYLLINE TAB 300MG ER 12/31/9999 20121 23155006201 THEOPHYLLINE TAB 300MG ER 12/31/9999 20121 50111045901 THEOPHYLLINE TAB 300MG ER 12/31/9999 20121 50111045902 THEOPHYLLINE TAB 300MG ER 12/31/9999 20121 50111045903 THEOPHYLLINE TAB 300MG ER 12/31/9999 20121 00615159039 THEOPHYLLINE TAB 300MG SR 12/31/9999 20121 16571001110 THEOPHYLLINE TAB 400MG ER 12/31/9999 20121 29033000101 THEOPHYLLINE TAB 400MG ER 12/31/9999 20121 42858070101 THEOPHYLLINE TAB 400MG ER 12/31/9999 20121 68462038001 THEOPHYLLINE TAB 400MG ER 12/31/9999 20121 23155006301 THEOPHYLLINE TAB 450MG ER 12/31/9999 20121 50111051801 THEOPHYLLINE TAB 450MG ER 12/31/9999 20121 29033000201 THEOPHYLLINE TAB 600MG ER 12/31/9999 20121 42858070201 THEOPHYLLINE TAB 600MG ER 12/31/9999 20121 68462035601 THEOPHYLLINE TAB 600MG ER 12/31/9999 20121 62107006601 THERA TAB 12/31/9999 20121 62107006605 THERA TAB 12/31/9999 20121 10267125301 THERA FORM/ TAB HEMATIN 12/31/9999 20121 10267125304 THERA FORM/ TAB HEMATIN 12/31/9999 20121 68405058026 THERABENZAPR PAK -60 12/31/9999 20121 68405805826 THERABENZAPR PAK -60 12/31/9999 20121 68405805836 THERABENZAPR PAK -90 12/31/9999 20121 68405815836 THERABENZAPR PAK -90-5 12/31/9999 20121 68405839836 THERACODEINE PAK -300 12/31/9999 20121 68405849836 THERACODOPHE PAK -750 12/31/9999 20121 68405809836 THERACODOPHN PAK -325 12/31/9999 20121 68405819836 THERACODOPHN PAK -650 12/31/9999 20121 68405829836 THERACODOPHN PAK -LOW-90 12/31/9999 20121 00904429909 THERA-DERM LOT 12/31/9999 20121 00904430309 THERA-DERM OIL BATH 12/31/9999 20121 00904430316 THERA-DERM OIL BATH 12/31/9999 20121 68405807826 THERAFELDAMI PAK 12/31/9999 20121 00067640708 THERAFLU LIQ WARM RLF 12/31/9999 20121 00067661606 THERAFLU PAK COLD/CGH 12/31/9999 20121 00067631906 THERAFLU POW 12/31/9999 20121 00067642706 THERAFLU POW MAX-D 12/31/9999 20121 00067671606 THERAFLU CLD PAK /SORE TH 12/31/9999 20121 00067711606 THERAFLU SEV PAK COLD NT 12/31/9999 20121 00067640312 THERAFLU SEV PAK COLD/CGH 12/31/9999 20121 00067622624 THERAFLU SEV TAB COLD DT 12/31/9999 20121 00067622424 THERAFLU SEV TAB COLD NT 12/31/9999 20121 00178032003 THERA-GESIC CRE 12/31/9999 20121 00178032005 THERA-GESIC CRE 12/31/9999 20121 00178035003 THERA-GESIC CRE PLUS 12/31/9999 20121 51645087510 THERA-M TAB 12/31/9999 20121 51645087513 THERA-M TAB 12/31/9999 20121 62107003805 THERA-M TAB 12/31/9999 20121 62107003813 THERA-M TAB 12/31/9999 20121 68405100802 THERAMINE CAP 12/31/9999 20121 68405100803 THERAMINE CAP 12/31/9999 20121 68405068026 THERAPENTIN PAK -60 12/31/9999 20121 68405806826 THERAPENTIN PAK -60 12/31/9999 20121 68405806836 THERAPENTIN PAK -90 12/31/9999 20121 24385022540 THERAPEUTIC GEL 2% 12/31/9999 20121 37205061634 THERAPEUTIC GEL 2% 12/31/9999 20121 00904525944 THERAPEUTIC SHA 12/31/9999 20121 00182451910 THERAPEUTIC TAB -M 05/31/2012 20121 50383068304 THERA-PLUS LIQ 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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