August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00113035934 TUSSIN DM SYP 100-10/5 12/31/9999 20121 37205097026 TUSSIN DM SYP 100-10/5 12/31/9999 20121 37205097034 TUSSIN DM SYP 100-10/5 12/31/9999 20121 63868085554 TUSSIN DM SYP 100-10/5 12/31/9999 20121 63868085556 TUSSIN DM SYP 100-10/5 12/31/9999 20121 68016085557 TUSSIN DM SYP 10-100/5 12/31/9999 20121 53014054801 TUSSIONEX SUS EXT-REL 12/31/9999 20121 53014054867 TUSSIONEX SUS EXT-REL 08/31/2012 20121 00406886701 TUSSIZONE-12 TAB 5-60MG 12/31/9999 20121 51552095703 TUTTI FRUTTI CON 12/31/9999 20121 59630080101 TWINJECT INJ 0.15MG 12/31/9999 20121 59630080102 TWINJECT INJ 0.15MG 12/31/9999 20121 59630080201 TWINJECT INJ 0.3MG 12/31/9999 20121 59630080202 TWINJECT INJ 0.3MG 12/31/9999 20121 00597012537 TWYNSTA TAB 40-10MG 12/31/9999 20121 00597012437 TWYNSTA TAB 40-5MG 12/31/9999 20121 00597012737 TWYNSTA TAB 80-10MG 12/31/9999 20121 00597012637 TWYNSTA TAB 80-5MG 12/31/9999 20121 00008499001 TYGACIL INJ 50MG 12/31/9999 20121 00008499002 TYGACIL INJ 50MG 12/31/9999 20121 00008499019 TYGACIL INJ 50MG 12/31/9999 20121 00008499020 TYGACIL INJ 50MG 12/31/9999 20121 00173075200 TYKERB TAB 250MG 12/31/9999 20121 50458051360 TYLENOL/COD TAB #3 12/31/9999 20121 50458051380 TYLENOL/COD TAB #3 12/31/9999 20121 50458051560 TYLENOL/COD TAB #4 12/31/9999 20121 50458051570 TYLENOL/COD TAB #4 12/31/9999 20121 00045052660 TYLOX CAP 5-500MG 08/30/2012 20121 00045052679 TYLOX CAP 5-500MG 08/31/2012 20121 50458052660 TYLOX CAP 5-500MG 12/31/9999 20121 50458052679 TYLOX CAP 5-500MG 12/31/9999 20121 59075073015 TYSABRI INJ 12/31/9999 20121 66302020603 TYVASO SOL 0.6MG/ML 12/31/9999 20121 66302020602 TYVASO REFIL SOL 0.6MG/ML 12/31/9999 20121 66302020601 TYVASO START SOL 0.6MG/ML 12/31/9999 20121 00078053815 TYZEKA TAB 600MG 12/31/9999 20121 00482476015 TYZINE SOL 0.1% 12/31/9999 20121 00482476030 TYZINE SOL 0.1% 12/31/9999 20121 00482477015 TYZINE PED DRO 0.05% 12/31/9999 20121 10337047715 TYZINE PED DRO 0.05% 12/31/9999 20121 51672300902 U-CORT CRE 1% 12/31/9999 20121 66869022010 UDAMIN TAB 12/31/9999 20121 66869082010 UDAMIN SP TAB 12/31/9999 20121 51672132902 U-KERA E CRE 40% 12/31/9999 20121 51672132907 U-KERA E CRE 40% 12/31/9999 20121 51672132908 U-KERA E CRE 40% 12/31/9999 20121 59630078008 ULESFIA LOT 5% 12/31/9999 20121 64764091830 ULORIC TAB 40MG 12/31/9999 20121 64764067730 ULORIC TAB 80MG 12/31/9999 20121 00074445604 ULTANE SOL 12/31/9999 20121 00074445651 ULTANE SOL 12/31/9999 20121 13811004930 ULTIMATECARE CAP ONE 12/31/9999 20121 13811005030 ULTIMATECARE CAP ONE NF 12/31/9999 20121 13811006260 ULTIMATECARE MIS ADVANTAG 12/31/9999 20121 13811006360 ULTIMATECARE MIS COMBO 12/31/9999 20121 67457019803 ULTIVA INJ 1MG 12/31/9999 20121 67457019805 ULTIVA INJ 2MG 12/31/9999 20121 67457019810 ULTIVA INJ 5MG 12/31/9999 20121 10267004301 ULTRA NATAL TAB 12/31/9999 20121 00941042451 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941042452 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941042453 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941042455 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043051 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043052 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043053 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043055 ULTRABAG/ SOL DIANEAL 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00941043351 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043352 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043353 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941043355 ULTRABAG/ SOL DIANEAL 12/31/9999 20121 00941042652 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042653 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042655 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042752 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042753 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042755 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042952 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042953 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 00941042955 ULTRABAG/PD2 SOL DIANEAL 12/31/9999 20121 50458065010 ULTRACET TAB 37.5-325 12/31/9999 20121 50458065060 ULTRACET TAB 37.5-325 12/31/9999 20121 50458065960 ULTRAM TAB 50MG 12/31/9999 20121 50458065330 ULTRAM ER TAB 100MG 12/31/9999 20121 50458065530 ULTRAM ER TAB 200MG 12/31/9999 20121 50458065730 ULTRAM ER TAB 300MG 12/31/9999 20121 10631010350 ULTRAVATE CRE 0.05% 12/31/9999 20121 10631011001 ULTRAVATE KIT 12/31/9999 20121 10631011301 ULTRAVATE KIT PAC 12/31/9999 20121 10631010250 ULTRAVATE OIN 0.05% 12/31/9999 20121 50419034005 ULTRAVIST INJ 150MG/ML 12/31/9999 20121 50419034210 ULTRAVIST INJ 240MG/ML 12/31/9999 20121 50419034221 ULTRAVIST INJ 240MG/ML 12/31/9999 20121 50419034405 ULTRAVIST INJ 300MG/ML 12/31/9999 20121 50419034410 ULTRAVIST INJ 300MG/ML 12/31/9999 20121 50419034412 ULTRAVIST INJ 300MG/ML 12/31/9999 20121 50419034415 ULTRAVIST INJ 300MG/ML 12/31/9999 20121 50419034421 ULTRAVIST INJ 300MG/ML 12/31/9999 20121 50419034458 ULTRAVIST INJ 300MG/ML 12/31/9999 20121 50419034605 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 50419034610 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 50419034612 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 50419034615 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 50419034620 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 50419034625 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 50419034658 ULTRAVIST INJ 370MG/ML 12/31/9999 20121 68712000401 UMECTA EMU 12/31/9999 20121 68712000403 UMECTA EMU 12/31/9999 20121 68712000501 UMECTA SUS 40% 12/31/9999 20121 68712002001 UMECTA MOUSS AER 40% 12/31/9999 20121 68712001001 UMECTA NAIL SUS FILM 12/31/9999 20121 68712001003 UMECTA NAIL SUS FILM 12/31/9999 20121 68712001702 UMECTA PD EMU 40-0.3% 12/31/9999 20121 68712001802 UMECTA PD SUS 40-0.3% 12/31/9999 20121 00049001383 UNASYN INJ 1.5GM 12/31/9999 20121 00049003183 UNASYN INJ 1.5GM 06/30/2013 20121 00049002283 UNASYN INJ 1.5GM PB 12/31/9999 20121 00049002428 UNASYN INJ 15GM 12/31/9999 20121 00049001483 UNASYN INJ 3GM 12/31/9999 20121 00049003283 UNASYN INJ 3GM 12/31/9999 20121 00049002383 UNASYN INJ 3GM PB 12/31/2013 20121 51552036606 UNDECYLENIC LIQ ACID 12/31/9999 20121 51552036616 UNDECYLENIC LIQ ACID USP 12/31/9999 20121 51552126806 UNIBASE CRE 12/31/9999 20121 00536475011 UNICOMPLEX-M TAB 12/31/9999 20121 00091372001 UNIRETIC TAB 15-12.5 12/31/9999 20121 00091372501 UNIRETIC TAB 15-25MG 12/31/9999 20121 00091371201 UNIRETIC TAB 7.5-12.5 12/31/9999 20121 00527137401 UNITHROID TAB 100MCG 12/31/9999 20121 00527137501 UNITHROID TAB 112MCG 12/31/9999 20121 00527137601 UNITHROID TAB 125MCG 12/31/9999 20121 00527137701 UNITHROID TAB 150MCG 12/31/9999 20121 00527137801 UNITHROID TAB 175MCG 12/31/9999 20121 00527137901 UNITHROID TAB 200MCG 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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