August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 51285059402 VIVACTIL TAB 10MG 12/31/9999 20121 51285059502 VIVACTIL TAB 5MG 12/31/9999 20121 00053759601 VIVAGLOBIN SOL 160MG/ML 09/07/2013 20121 00053759610 VIVAGLOBIN SOL 160MG/ML 05/06/2013 20121 00053759620 VIVAGLOBIN SOL 160MG/ML 06/08/2013 20121 00135007707 VIVARIN TAB 200MG 12/31/9999 20121 00135007713 VIVARIN TAB 200MG 12/31/9999 20121 00135007717 VIVARIN TAB 200MG 12/31/9999 20121 00135007809 VIVARIN TAB 200MG 12/31/9999 20121 00078036542 VIVELLE-DOT DIS 0.025MG 12/31/9999 20121 00078036545 VIVELLE-DOT DIS 0.025MG 12/31/9999 20121 00078034342 VIVELLE-DOT DIS 0.0375MG 12/31/9999 20121 00078034345 VIVELLE-DOT DIS 0.0375MG 12/31/9999 20121 00078034362 VIVELLE-DOT DIS 0.0375MG 12/31/9999 20121 00078034442 VIVELLE-DOT DIS 0.05MG 12/31/9999 20121 00078034445 VIVELLE-DOT DIS 0.05MG 12/31/9999 20121 00078034462 VIVELLE-DOT DIS 0.05MG 12/31/9999 20121 00078034542 VIVELLE-DOT DIS 0.075MG 12/31/9999 20121 00078034545 VIVELLE-DOT DIS 0.075MG 12/31/9999 20121 00078034562 VIVELLE-DOT DIS 0.075MG 12/31/9999 20121 00078034642 VIVELLE-DOT DIS 0.1MG 12/31/9999 20121 00078034645 VIVELLE-DOT DIS 0.1MG 12/31/9999 20121 00078034662 VIVELLE-DOT DIS 0.1MG 12/31/9999 20121 65757030001 VIVITROL INJ 380MG 12/31/9999 20121 13811051510 VOL-CARE RX TAB 12/31/9999 20121 13811051410 VOL-NATE TAB 12/31/9999 20121 13811051910 VOL-PLUS TAB 12/31/9999 20121 13811051950 VOL-PLUS TAB 12/31/9999 20121 13811051690 VOL-TAB RX TAB 12/31/9999 20121 63481068403 VOLTAREN GEL 1% 12/31/9999 20121 63481068405 VOLTAREN GEL 1% 12/31/9999 20121 63481068447 VOLTAREN GEL 1% 12/31/9999 20121 00078047861 VOLTAREN SOL 0.1% OP 06/30/2012 20121 00078044605 VOLTAREN-XR TAB 100MG 12/31/9999 20121 00409102901 VOLUVEN INJ 6%/NACL 12/31/9999 20121 00409102902 VOLUVEN INJ 6%/NACL 12/31/9999 20121 00378164093 VORICONAZOLE TAB 200MG 12/31/9999 20121 00781566831 VORICONAZOLE TAB 200MG 12/31/9999 20121 51079016501 VORICONAZOLE TAB 200MG 12/31/9999 20121 51079016503 VORICONAZOLE TAB 200MG 12/31/9999 20121 51079016520 VORICONAZOLE TAB 200MG 11/30/2012 20121 59762093002 VORICONAZOLE TAB 200MG 12/31/9999 20121 00378162693 VORICONAZOLE TAB 50MG 12/31/9999 20121 00781566731 VORICONAZOLE TAB 50MG 12/31/9999 20121 51079016401 VORICONAZOLE TAB 50MG 12/31/9999 20121 51079016403 VORICONAZOLE TAB 50MG 12/31/9999 20121 51079016420 VORICONAZOLE TAB 50MG 11/30/2012 20121 59762092501 VORICONAZOLE TAB 50MG 12/31/9999 20121 00095020110 VOSOL HC SOL OTIC 12/31/9999 20121 68774060001 VOSPIRE ER TAB 4MG 12/31/9999 20121 68774060101 VOSPIRE ER TAB 8MG 12/31/9999 20121 00173080409 VOTRIENT TAB 200MG 12/31/9999 20121 54092070104 VPRIV INJ 400UNIT 12/31/9999 20121 76439022160 VP-ZEL TAB 12/31/9999 20121 49348031212 V-R WOMENS TAB HEALTH 12/31/9999 20121 00015307519 VUMON INJ 50MG/5ML 12/31/9999 20121 00145000204 VUSION OIN 12/31/9999 20121 66582031128 VYTORIN TAB 10-10MG 12/31/9999 20121 66582031131 VYTORIN TAB 10-10MG 12/31/9999 20121 66582031154 VYTORIN TAB 10-10MG 12/31/9999 20121 66582031182 VYTORIN TAB 10-10MG 12/31/9999 20121 66582031228 VYTORIN TAB 10-20MG 12/31/9999 20121 66582031231 VYTORIN TAB 10-20MG 12/31/9999 20121 66582031254 VYTORIN TAB 10-20MG 12/31/9999 20121 66582031282 VYTORIN TAB 10-20MG 12/31/9999 20121 66582031287 VYTORIN TAB 10-20MG 12/31/9999 20121 66582031331 VYTORIN TAB 10-40MG 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 66582031352 VYTORIN TAB 10-40MG 12/31/9999 20121 66582031354 VYTORIN TAB 10-40MG 12/31/9999 20121 66582031374 VYTORIN TAB 10-40MG 12/31/9999 20121 66582031386 VYTORIN TAB 10-40MG 12/31/9999 20121 66582031531 VYTORIN TAB 10-80MG 12/31/9999 20121 66582031552 VYTORIN TAB 10-80MG 12/31/9999 20121 66582031554 VYTORIN TAB 10-80MG 12/31/9999 20121 66582031566 VYTORIN TAB 10-80MG 12/31/9999 20121 66582031574 VYTORIN TAB 10-80MG 12/31/9999 20121 59417010210 VYVANSE CAP 20MG 12/31/9999 20121 59417010310 VYVANSE CAP 30MG 12/31/9999 20121 59417010410 VYVANSE CAP 40MG 12/31/9999 20121 59417010510 VYVANSE CAP 50MG 12/31/9999 20121 59417010610 VYVANSE CAP 60MG 12/31/9999 20121 59417010710 VYVANSE CAP 70MG 12/31/9999 20121 00378881001 WARFARIN TAB 10MG 10/31/2012 20121 00406205901 WARFARIN TAB 10MG 12/31/9999 20121 00555083502 WARFARIN TAB 10MG 12/31/9999 20121 31722033501 WARFARIN TAB 10MG 12/31/9999 20121 51672403501 WARFARIN TAB 10MG 12/31/9999 20121 51672403503 WARFARIN TAB 10MG 12/31/9999 20121 68382005901 WARFARIN TAB 10MG 12/31/9999 20121 00378880101 WARFARIN TAB 1MG 08/31/2012 20121 00378880110 WARFARIN TAB 1MG 08/31/2012 20121 00406205201 WARFARIN TAB 1MG 12/31/9999 20121 00406205210 WARFARIN TAB 1MG 12/31/9999 20121 00555083102 WARFARIN TAB 1MG 12/31/9999 20121 00555083105 WARFARIN TAB 1MG 12/31/9999 20121 31722032701 WARFARIN TAB 1MG 12/31/9999 20121 31722032710 WARFARIN TAB 1MG 12/31/9999 20121 51672402701 WARFARIN TAB 1MG 12/31/9999 20121 51672402703 WARFARIN TAB 1MG 12/31/9999 20121 51672402707 WARFARIN TAB 1MG 12/31/9999 20121 68382005201 WARFARIN TAB 1MG 12/31/9999 20121 68382005210 WARFARIN TAB 1MG 12/31/9999 20121 00378882501 WARFARIN TAB 2.5MG 09/30/2012 20121 00378882510 WARFARIN TAB 2.5MG 09/30/2012 20121 00406206401 WARFARIN TAB 2.5MG 12/31/9999 20121 00406206410 WARFARIN TAB 2.5MG 12/31/9999 20121 00555083202 WARFARIN TAB 2.5MG 12/31/9999 20121 00555083205 WARFARIN TAB 2.5MG 12/31/9999 20121 31722032901 WARFARIN TAB 2.5MG 12/31/9999 20121 31722032910 WARFARIN TAB 2.5MG 12/31/9999 20121 51672402901 WARFARIN TAB 2.5MG 12/31/9999 20121 51672402903 WARFARIN TAB 2.5MG 12/31/9999 20121 51672402907 WARFARIN TAB 2.5MG 12/31/9999 20121 68084002701 WARFARIN TAB 2.5MG 12/31/9999 20121 68382006401 WARFARIN TAB 2.5MG 12/31/9999 20121 68382006410 WARFARIN TAB 2.5MG 12/31/9999 20121 00378880201 WARFARIN TAB 2MG 08/31/2012 20121 00378880210 WARFARIN TAB 2MG 08/31/2012 20121 00406205301 WARFARIN TAB 2MG 12/31/9999 20121 00406205310 WARFARIN TAB 2MG 12/31/9999 20121 00555086902 WARFARIN TAB 2MG 12/31/9999 20121 00555086905 WARFARIN TAB 2MG 12/31/9999 20121 31722032801 WARFARIN TAB 2MG 12/31/9999 20121 31722032810 WARFARIN TAB 2MG 12/31/9999 20121 51672402801 WARFARIN TAB 2MG 12/31/9999 20121 51672402803 WARFARIN TAB 2MG 12/31/9999 20121 51672402807 WARFARIN TAB 2MG 12/31/9999 20121 62584098401 WARFARIN TAB 2MG 12/31/9999 20121 68382005301 WARFARIN TAB 2MG 12/31/9999 20121 68382005310 WARFARIN TAB 2MG 12/31/9999 20121 00378880301 WARFARIN TAB 3MG 09/30/2012 20121 00378880310 WARFARIN TAB 3MG 09/30/2012 20121 00406205401 WARFARIN TAB 3MG 12/31/9999 20121 00406205410 WARFARIN TAB 3MG 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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