August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00121067716 TRICITRATES SOL 12/31/9999 20121 00121077916 TRICITRATES SOL 12/31/9999 20121 63044063510 TRICON CAP 12/31/9999 20121 00074612390 TRICOR TAB 145MG 12/31/9999 20121 00074612290 TRICOR TAB 48MG 12/31/9999 20121 00065054301 TRIESENCE INJ 40MG/ML 12/31/9999 20121 13811004090 TRIFERA OB TAB 12/31/9999 20121 13811004590 TRIFEREX 150 CAP FORTE 12/31/9999 20121 00378241001 TRIFLUOPERAZ TAB 10MG 12/31/9999 20121 00781103601 TRIFLUOPERAZ TAB 10MG 12/31/9999 20121 51079057501 TRIFLUOPERAZ TAB 10MG 12/31/9999 20121 51079057520 TRIFLUOPERAZ TAB 10MG 12/31/9999 20121 00378240101 TRIFLUOPERAZ TAB 1MG 12/31/9999 20121 00781103001 TRIFLUOPERAZ TAB 1MG 12/31/9999 20121 51079057201 TRIFLUOPERAZ TAB 1MG 12/31/9999 20121 51079057220 TRIFLUOPERAZ TAB 1MG 12/31/9999 20121 00378240201 TRIFLUOPERAZ TAB 2MG 12/31/9999 20121 00781103201 TRIFLUOPERAZ TAB 2MG 12/31/9999 20121 51079057301 TRIFLUOPERAZ TAB 2MG 12/31/9999 20121 51079057320 TRIFLUOPERAZ TAB 2MG 12/31/9999 20121 00378240501 TRIFLUOPERAZ TAB 5MG 12/31/9999 20121 00781103401 TRIFLUOPERAZ TAB 5MG 12/31/9999 20121 51079057401 TRIFLUOPERAZ TAB 5MG 12/31/9999 20121 51079057420 TRIFLUOPERAZ TAB 5MG 12/31/9999 20121 61314004475 TRIFLURIDINE SOL 1% OP 12/31/9999 20121 13811051810 TRIGELS-F CAP FORTE 12/31/9999 20121 59630048530 TRIGLIDE TAB 160MG 12/31/9999 20121 59630048030 TRIGLIDE TAB 50MG 12/31/9999 20121 13811008130 TRIGOFEN DRO 1-2MG/ML 12/31/9999 20121 13811008230 TRIGOFEN DM DRO 12/31/9999 20121 00121065816 TRIHEXYPHEN ELX 0.4MG/ML 12/31/9999 20121 61748005416 TRIHEXYPHEN ELX 0.4MG/ML 12/31/9999 20121 00143176401 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 00143176410 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 00591533501 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 00591533510 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 00603624021 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 00603624032 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 16571016010 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 16571016011 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 62584088601 TRIHEXYPHEN TAB 2MG 12/31/9999 20121 00143176301 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 00143176310 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 00591533701 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 00591533710 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 00603624121 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 00603624132 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 16571016110 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 16571016111 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 62584088721 TRIHEXYPHEN TAB 5MG 12/31/9999 20121 00555903270 TRI-LEGEST TAB FE 12/31/9999 20121 00078035752 TRILEPTAL SUS 300MG/5M 12/31/9999 20121 00078045605 TRILEPTAL TAB 150MG 12/31/9999 20121 00078045635 TRILEPTAL TAB 150MG 12/31/9999 20121 00078045661 TRILEPTAL TAB 150MG 12/31/9999 20121 00078033705 TRILEPTAL TAB 300MG 12/31/9999 20121 00078033706 TRILEPTAL TAB 300MG 12/31/9999 20121 00078033761 TRILEPTAL TAB 300MG 12/31/9999 20121 00078045705 TRILEPTAL TAB 600MG 12/31/9999 20121 00078045735 TRILEPTAL TAB 600MG 12/31/9999 20121 00078045761 TRILEPTAL TAB 600MG 12/31/9999 20121 00074918990 TRILIPIX CAP 135MG 12/31/9999 20121 00074964290 TRILIPIX CAP 45MG 12/31/9999 20121 00299595030 TRI-LUMA CRE 12/31/9999 20121 00299595031 TRI-LUMA CRE 12/31/9999 20121 68220013104 TRILYTE SOL 12/31/9999 20121 13811004390 TRIMAGEN TAB 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 13811004490 TRIMAGEN TAB FORTE 12/31/9999 20121 13811004690 TRIMAGEN FA TAB 12/31/9999 20121 13811004730 TRIMESIS RX TAB 12/31/9999 20121 43386066024 TRIMETHOBENZ CAP 300MG 12/31/9999 20121 52152018502 TRIMETHOBENZ CAP 300MG 12/31/9999 20121 53489037601 TRIMETHOBENZ CAP 300MG 12/31/9999 20121 51552123202 TRIMETHOBENZ POW HCL 12/31/9999 20121 51552123204 TRIMETHOBENZ POW HCL 12/31/9999 20121 38779077004 TRIMETHOPRIM POW 12/31/9999 20121 38779077005 TRIMETHOPRIM POW 12/31/9999 20121 38779077008 TRIMETHOPRIM POW 12/31/9999 20121 17478070311 TRIMETHOPRIM SOL POLYMYXN 12/31/9999 20121 24208031510 TRIMETHOPRIM SOL POLYMYXN 12/31/9999 20121 00093215801 TRIMETHOPRIM TAB 100MG 12/31/9999 20121 00591557101 TRIMETHOPRIM TAB 100MG 12/31/9999 20121 43386033001 TRIMETHOPRIM TAB 100MG 12/31/9999 20121 45963029530 TRIMIPRAMINE CAP 100MG 12/31/9999 20121 45963029330 TRIMIPRAMINE CAP 25MG 12/31/9999 20121 52152029308 TRIMIPRAMINE CAP 25MG 12/31/9999 20121 52152029330 TRIMIPRAMINE CAP 25MG 12/31/9999 20121 45963029430 TRIMIPRAMINE CAP 50MG 12/31/9999 20121 52152029408 TRIMIPRAMINE CAP 50MG 12/31/9999 20121 52152029430 TRIMIPRAMINE CAP 50MG 12/31/9999 20121 13811061510 TRINATAL TAB ULTRA 12/31/9999 20121 13811061490 TRINATAL GT TAB 12/31/9999 20121 13811000710 TRINATAL RX TAB 1 12/31/9999 20121 60258019201 TRINATE TAB 05/31/2012 20121 52544024828 TRINESSA TAB 12/31/9999 20121 52544027428 TRI-NORINYL TAB 28 12/31/9999 20121 50474036422 TRINSICON CAP 12/31/9999 20121 50474036427 TRINSICON CAP 12/31/9999 20121 42023012006 TRIOSTAT INJ 10MCG/ML 12/31/9999 20121 68025004115 TRIOXIN SUS OTIC 12/31/9999 20121 13811052501 TRIPHROCAPS CAP 12/31/9999 20121 00113006764 TRIPLE ANTIB OIN 12/31/9999 20121 00472017909 TRIPLE ANTIB OIN 12/31/9999 20121 00472017916 TRIPLE ANTIB OIN 12/31/9999 20121 00472017934 TRIPLE ANTIB OIN 12/31/9999 20121 00472017956 TRIPLE ANTIB OIN 12/31/9999 20121 00536110095 TRIPLE ANTIB OIN 04/30/2013 20121 00603064450 TRIPLE ANTIB OIN 12/31/9999 20121 00713026831 TRIPLE ANTIB OIN 12/31/9999 20121 00904073431 TRIPLE ANTIB OIN 12/31/9999 20121 00904073436 TRIPLE ANTIB OIN 12/31/9999 20121 37205027310 TRIPLE ANTIB OIN 12/31/9999 20121 45802006101 TRIPLE ANTIB OIN 12/31/9999 20121 45802006103 TRIPLE ANTIB OIN 12/31/9999 20121 45802006170 TRIPLE ANTIB OIN 12/31/9999 20121 51672201601 TRIPLE ANTIB OIN 12/31/9999 20121 51672201602 TRIPLE ANTIB OIN 12/31/9999 20121 49348027569 TRIPLE ANTIB OIN MAX ST 12/31/9999 20121 49348060072 TRIPLE ANTIB OIN MAX ST 12/31/9999 20121 62011009901 TRIPLE ANTIB OIN MAX ST 12/31/9999 20121 00713062231 TRIPLE ANTIB OIN PLUS 12/31/9999 20121 24385014303 TRIPLE ANTIB OIN PLUS 12/31/9999 20121 37205026610 TRIPLE ANTIB OIN PLUS 12/31/9999 20121 51672202701 TRIPLE ANTIB OIN PLUS 12/31/9999 20121 51672202702 TRIPLE ANTIB OIN PLUS 12/31/9999 20121 00472070078 TRIPLE SULFA CRE VAG 12/31/9999 20121 44183020130 TRIP-PSE LIQ 12/31/9999 20121 00603766317 TRI-PREVIFEM TAB 12/31/9999 20121 63459060010 TRISENOX SOL 10MG/10M 12/31/9999 20121 00555901858 TRI-SPRINTEC TAB 12/31/9999 20121 50383080816 TRI-TANNATE SUS PED 12/31/9999 20121 13811056890 TRIVEEN-CF TAB NAC 12/31/9999 20121 13811059130 TRIVEEN-DUO PAK DHA 12/31/9999 20121 13811054630 TRIVEEN-ONE CAP 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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