August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 00555092502 WARFARIN TAB 3MG 12/31/9999 20121 31722033001 WARFARIN TAB 3MG 12/31/9999 20121 31722033010 WARFARIN TAB 3MG 12/31/9999 20121 51672403001 WARFARIN TAB 3MG 12/31/9999 20121 51672403003 WARFARIN TAB 3MG 12/31/9999 20121 51672403007 WARFARIN TAB 3MG 12/31/9999 20121 68382005401 WARFARIN TAB 3MG 12/31/9999 20121 68382005410 WARFARIN TAB 3MG 12/31/9999 20121 00378880401 WARFARIN TAB 4MG 09/30/2012 20121 00378880410 WARFARIN TAB 4MG 09/30/2012 20121 00406205501 WARFARIN TAB 4MG 12/31/9999 20121 00406205510 WARFARIN TAB 4MG 12/31/9999 20121 00555087402 WARFARIN TAB 4MG 12/31/9999 20121 00555087405 WARFARIN TAB 4MG 12/31/9999 20121 31722033101 WARFARIN TAB 4MG 12/31/9999 20121 31722033110 WARFARIN TAB 4MG 12/31/9999 20121 51672403101 WARFARIN TAB 4MG 12/31/9999 20121 51672403103 WARFARIN TAB 4MG 12/31/9999 20121 51672403107 WARFARIN TAB 4MG 12/31/9999 20121 68382005501 WARFARIN TAB 4MG 12/31/9999 20121 68382005510 WARFARIN TAB 4MG 12/31/9999 20121 00378880501 WARFARIN TAB 5MG 09/30/2012 20121 00378880510 WARFARIN TAB 5MG 09/30/2012 20121 00406205601 WARFARIN TAB 5MG 12/31/9999 20121 00406205610 WARFARIN TAB 5MG 12/31/9999 20121 00555083302 WARFARIN TAB 5MG 12/31/9999 20121 00555083305 WARFARIN TAB 5MG 12/31/9999 20121 31722033201 WARFARIN TAB 5MG 12/31/9999 20121 31722033210 WARFARIN TAB 5MG 12/31/9999 20121 51672403201 WARFARIN TAB 5MG 12/31/9999 20121 51672403203 WARFARIN TAB 5MG 12/31/9999 20121 51672403207 WARFARIN TAB 5MG 12/31/9999 20121 62584099401 WARFARIN TAB 5MG 12/31/9999 20121 68382005601 WARFARIN TAB 5MG 12/31/9999 20121 68382005610 WARFARIN TAB 5MG 12/31/9999 20121 00378880601 WARFARIN TAB 6MG 10/31/2012 20121 00378880610 WARFARIN TAB 6MG 10/31/2012 20121 00406205701 WARFARIN TAB 6MG 12/31/9999 20121 00555092602 WARFARIN TAB 6MG 12/31/9999 20121 31722033301 WARFARIN TAB 6MG 12/31/9999 20121 51672403301 WARFARIN TAB 6MG 12/31/9999 20121 51672403303 WARFARIN TAB 6MG 12/31/9999 20121 68382005701 WARFARIN TAB 6MG 12/31/9999 20121 00378887501 WARFARIN TAB 7.5MG 10/31/2012 20121 00378887510 WARFARIN TAB 7.5MG 10/31/2012 20121 00406205801 WARFARIN TAB 7.5MG 12/31/9999 20121 00555083402 WARFARIN TAB 7.5MG 12/31/9999 20121 31722033401 WARFARIN TAB 7.5MG 12/31/9999 20121 51672403401 WARFARIN TAB 7.5MG 12/31/9999 20121 51672403403 WARFARIN TAB 7.5MG 12/31/9999 20121 68382005801 WARFARIN TAB 7.5MG 12/31/9999 20121 24385023663 WART REMOVER LIQ 17% 12/31/9999 20121 52747051501 WATCHHALER MIS 12/31/9999 20121 23359001204 WEE CARE SUS 15/1.25 12/31/9999 20121 65597090230 WELCHOL PAK 3.75GM 12/31/9999 20121 65597070118 WELCHOL TAB 625MG 12/31/9999 20121 00173017855 WELLBUTRIN TAB 100MG 12/31/9999 20121 00173094755 WELLBUTRIN TAB 100MG SR 12/31/9999 20121 00173013555 WELLBUTRIN TAB 150MG SR 12/31/9999 20121 00173072200 WELLBUTRIN TAB 200MG SR 12/31/9999 20121 00173017755 WELLBUTRIN TAB 75MG 12/31/9999 20121 64455073030 WELLBUTRIN TAB XL 150MG 12/31/9999 20121 64455073090 WELLBUTRIN TAB XL 150MG 12/31/9999 20121 64455073130 WELLBUTRIN TAB XL 300MG 12/31/9999 20121 10631010545 WESTCORT OIN 0.2% 12/31/9999 20121 10631010560 WESTCORT OIN 0.2% 12/31/9999 20121 51552072206 WHEAT GERM OIL 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00064219016 WIBI LOT 12/31/9999 20121 67467018101 WILATE INJ 12/31/9999 20121 67467018102 WILATE INJ 12/31/9999 20121 67467018201 WILATE INJ 12/31/9999 20121 67467018202 WILATE INJ 12/31/9999 20121 51552099807 WILLOW BARK POW 12/31/9999 20121 00944296709 WINRHO SDF INJ 15000UNT 10/31/2012 20121 53270300001 WINRHO SDF INJ 15000UNT 12/31/9999 20121 00944296703 WINRHO SDF INJ 1500UNIT 09/30/2012 20121 53270330001 WINRHO SDF INJ 1500UNIT 12/31/9999 20121 00944296707 WINRHO SDF INJ 2500UNIT 10/31/2012 20121 53270350001 WINRHO SDF INJ 2500UNIT 12/31/9999 20121 00944296705 WINRHO SDF INJ 5000UNIT 09/30/2012 20121 53270310001 WINRHO SDF INJ 5000UNIT 12/31/9999 20121 49348080538 WITCH HAZEL LIQ 12/31/9999 20121 63868092716 WITCH HAZEL LIQ USP 12/31/9999 20121 36800017465 WOMANS LAXAT TAB 5MG EC 12/31/9999 20121 63868049930 WOMANS LAXAT TAB 5MG EC 12/31/9999 20121 00113017465 WOMENS LAXAT TAB 5MG EC 12/31/9999 20121 11701016102 WOUN'DRES GEL 12/31/9999 20121 11701016116 WOUN'DRES GEL 12/31/9999 20121 68180089713 WYMZYA FE CHW 0.4MG-35 12/31/9999 20121 00013830301 XALATAN SOL 0.005% 12/31/9999 20121 00013830304 XALATAN SOL 0.005% 12/31/9999 20121 00069814120 XALKORI CAP 200MG 12/31/9999 20121 00069814020 XALKORI CAP 250MG 12/31/9999 20121 00009002901 XANAX TAB 0.25MG 12/31/9999 20121 00009002902 XANAX TAB 0.25MG 12/31/9999 20121 00009005501 XANAX TAB 0.5MG 12/31/9999 20121 00009005503 XANAX TAB 0.5MG 12/31/9999 20121 00009009001 XANAX TAB 1MG 12/31/9999 20121 00009009004 XANAX TAB 1MG 12/31/9999 20121 00009009401 XANAX TAB 2MG 12/31/9999 20121 00009005707 XANAX XR TAB 0.5MG 12/31/9999 20121 00009005907 XANAX XR TAB 1MG 12/31/9999 20121 00009006607 XANAX XR TAB 2MG 12/31/9999 20121 00009006807 XANAX XR TAB 3MG 12/31/9999 20121 51552010002 XANTHAN GUM POW 12/31/9999 20121 51552010005 XANTHAN GUM POW 12/31/9999 20121 51552010008 XANTHAN GUM POW 12/31/9999 20121 51552010009 XANTHAN GUM POW 12/31/9999 20121 50458058010 XARELTO TAB 10MG 12/31/9999 20121 50458058030 XARELTO TAB 10MG 12/31/9999 20121 50458057810 XARELTO TAB 15MG 12/31/9999 20121 50458057830 XARELTO TAB 15MG 12/31/9999 20121 50458057890 XARELTO TAB 15MG 12/31/9999 20121 50458057910 XARELTO TAB 20MG 12/31/9999 20121 50458057930 XARELTO TAB 20MG 12/31/9999 20121 50458057990 XARELTO TAB 20MG 12/31/9999 20121 00004110020 XELODA TAB 150MG 12/31/9999 20121 00004110150 XELODA TAB 500MG 12/31/9999 20121 00004110175 XELODA TAB 500MG 12/31/2013 20121 67386042101 XENAZINE TAB 12.5MG 12/31/9999 20121 67386042201 XENAZINE TAB 25MG 12/31/9999 20121 00004025652 XENICAL CAP 120MG 06/30/2013 20121 00004025752 XENICAL CAP 120MG 12/31/9999 20121 00259161001 XEOMIN INJ 100UNIT 12/31/9999 20121 00259160501 XEOMIN INJ 50 UNIT 12/31/9999 20121 00096070935 XERAC-AC SOL 6.25% 12/31/9999 20121 00096070960 XERAC-AC SOL 6.25% 12/31/9999 20121 00037050105 XERESE CRE 5-1% 12/31/9999 20121 55513073001 XGEVA INJ 12/31/9999 20121 66887000301 XIAFLEX INJ 0.9MG 12/31/9999 20121 67425000412 XIBROM SOL 0.09% 08/31/2012 20121 67425000450 XIBROM SOL 0.09% 08/31/2012 20121 65649030103 XIFAXAN TAB 200MG 12/31/9999 20121 65649030105 XIFAXAN TAB 200MG 12/31/2012 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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