August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00597004646 VIRAMUNE TAB 200MG 12/31/9999 20121 00597004660 VIRAMUNE TAB 200MG 12/31/9999 20121 00597012330 VIRAMUNE XR TAB 12/31/9999 20121 00187000714 VIRAZOLE INH 6GM 12/31/9999 20121 76439031930 VIRDEC DRO 12/31/9999 20121 76439032030 VIRDEC DM DRO 3.5-1-3 12/31/9999 20121 61958040301 VIREAD POW 40MG/GM 12/31/9999 20121 61958040401 VIREAD TAB 150MG 12/31/9999 20121 61958040501 VIREAD TAB 200MG 12/31/9999 20121 61958040601 VIREAD TAB 250MG 12/31/9999 20121 61958040101 VIREAD TAB 300MG 12/31/9999 20121 61570003775 VIROPTIC SOL 1% OP 12/31/9999 20121 00407222201 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222202 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222203 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222216 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222217 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222219 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222221 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222252 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222253 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222254 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222255 VISIPAQUE INJ 270MG/ML 12/31/9999 20121 00407222301 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222302 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222303 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222304 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222306 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222316 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222317 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222319 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222321 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222323 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222350 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222351 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222353 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222354 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222355 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222356 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222357 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222358 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222360 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222361 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222362 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222363 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222364 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222365 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222366 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00407222367 VISIPAQUE INJ 320MG/ML 12/31/9999 20121 00069541066 VISTARIL CAP 25MG 12/31/9999 20121 00069542066 VISTARIL CAP 50MG 12/31/9999 20121 61958010101 VISTIDE INJ 75MG/ML 12/31/9999 20121 00536475308 VI-STRESS TAB 12/31/9999 20121 50236000115 VISUDYNE INJ 15MG 12/31/9999 20121 00536544001 VIT E D-ALPH CAP 400UNIT 12/31/9999 20121 52152007805 VITA CON CAP 12/31/9999 20121 52152007802 VITA CON CAP FORTE 12/31/9999 20121 52152007804 VITA CON CAP FORTE 12/31/9999 20121 64980010201 VITA S FORTE TAB 12/31/9999 20121 00536476301 VITABEE W/C TAB 12/31/9999 20121 00642007212 VITAFOL TAB 12/31/9999 20121 00642007630 VITAFOL-OB PAK +DHA 12/31/9999 20121 00642007912 VITAFOL-OB TAB 65-1MG 12/31/9999 20121 00642007030 VITAFOL-ONE CAP 12/31/9999 20121 00642007812 VITAFOL-PN TAB 12/31/9999 20121 59528198801 VITAL-D RX TAB 12/31/9999 20121 00168003501 VITAMIN A&D OIN 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00168003502 VITAMIN A&D OIN 12/31/9999 20121 00168003504 VITAMIN A&D OIN 12/31/9999 20121 00168003516 VITAMIN A&D OIN 12/31/9999 20121 00168003545 VITAMIN A&D OIN 12/31/9999 20121 00904584327 VITAMIN A&D OIN 12/31/9999 20121 45802039504 VITAMIN A&D OIN 12/31/9999 20121 53329006704 VITAMIN A&D OIN 12/31/9999 20121 00536478701 VITAMIN B CO CAP 12/31/9999 20121 00182004701 VITAMIN B-1 TAB 100MG 09/30/2012 20121 62107005901 VITAMIN B-1 TAB 100MG 12/31/9999 20121 00536467801 VITAMIN B-1 TAB 50MG 12/31/9999 20121 62107006001 VITAMIN B-1 TAB 50MG 12/31/9999 20121 00182101701 VITAMIN B-12 TAB 1000MCG 12/31/9999 20121 00536355601 VITAMIN B-12 TAB 1000MCG 12/31/9999 20121 51645091401 VITAMIN B-12 TAB 1000MCG 12/31/9999 20121 00536354201 VITAMIN B-12 TAB 100MCG 12/31/9999 20121 00536355101 VITAMIN B-12 TAB 500MCG 12/31/9999 20121 51645091301 VITAMIN B-12 TAB 500MCG 12/31/9999 20121 51645091001 VITAMIN B-6 TAB 100MG 12/31/9999 20121 62107006101 VITAMIN B-6 TAB 100MG 12/31/9999 20121 00182008601 VITAMIN B-6 TAB 50MG 08/31/2012 20121 51645090901 VITAMIN B-6 TAB 50MG 12/31/9999 20121 00536329101 VITAMIN C CHW 500MG 12/31/9999 20121 00536016085 VITAMIN C SYP 500/5ML 12/31/9999 20121 00536016097 VITAMIN C SYP 500/5ML 12/31/9999 20121 50383016716 VITAMIN C SYP 500/5ML 12/31/9999 20121 00536329201 VITAMIN C TAB 500MG 12/31/9999 20121 00536329210 VITAMIN C TAB 500MG 12/31/9999 20121 51645092001 VITAMIN C TAB 500MG 12/31/9999 20121 51645092010 VITAMIN C TAB 500MG 12/31/9999 20121 60258014101 VITAMIN C TAB 500MG 12/31/9999 20121 62107004601 VITAMIN C TAB 500MG 12/31/9999 20121 62107004610 VITAMIN C TAB 500MG 12/31/9999 20121 00574019401 VITAMIN D CAP 50000UNT 07/31/2013 20121 00574019450 VITAMIN D CAP 50000UNT 09/30/2012 20121 50111099001 VITAMIN D CAP 50000UNT 12/31/9999 20121 51991060401 VITAMIN D CAP 50000UNT 12/31/9999 20121 64980015701 VITAMIN D CAP 50000UNT 12/31/9999 20121 68084046301 VITAMIN D CAP 50000UNT 12/31/9999 20121 00536480101 VITAMIN E CAP 1000UNIT 06/30/2012 20121 00536479301 VITAMIN E CAP 100UNIT 12/31/9999 20121 00182008201 VITAMIN E CAP 400UNIT 08/31/2012 20121 00536479901 VITAMIN E CAP 400UNIT 12/31/9999 20121 62107006401 VITAMIN E CAP 400UNIT 12/31/9999 20121 00182079943 VITAMIN E CRE 3000UNIT 12/31/2012 20121 51552072604 VITAMIN E LIQ ACETATE 12/31/9999 20121 51552072605 VITAMIN E LIQ ACETATE 12/31/9999 20121 51552072606 VITAMIN E LIQ ACETATE 12/31/9999 20121 00536853396 VITAMIN E OIL 06/14/2015 20121 00182108134 VITAMIN E OIL 28000UNT 07/31/2012 20121 51552079304 VITAMIN E POW SUCCINAT 12/31/9999 20121 00409915801 VITAMIN K1 INJ 10MG/ML 12/31/9999 20121 00409915701 VITAMIN K1 INJ 1MG/0.5 12/31/9999 20121 51552112905 VITAMIN K-1 POW 12/31/9999 20121 00603041054 VITAMINS A&D OIN 03/31/2013 20121 10267073701 VITAMN FORTE CAP 12/31/9999 20121 52152007602 VITAPLEX TAB 12/31/9999 20121 52152007604 VITAPLEX TAB 12/31/9999 20121 52152007702 VITAPLEX TAB PLUS 12/31/9999 20121 52152007704 VITAPLEX TAB PLUS 12/31/9999 20121 60575091390 VITA-RESPA TAB 12/31/9999 20121 13811001190 VITASPIRE TAB 12/31/9999 20121 49908010060 VITAZOL CRE 0.75% 12/31/9999 20121 00536344901 VITE/IRON CHW CHILDREN 12/31/9999 20121 67425000210 VITRASE INJ 200/ML 12/31/9999 20121 24208041201 VITRASERT IMP 4.5MG 12/31/9999 20121 64661008030 VIVA DHA CAP 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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