August 31, 2012 - Iowa Medicaid Enterprise

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NDC Product Description Termination Date Quarter Covered 65649030141 XIFAXAN TAB 200MG 12/31/9999 20121 65649030302 XIFAXAN TAB 550MG 12/31/9999 20121 65649030303 XIFAXAN TAB 550MG 12/31/9999 20121 59630091110 XODOL TAB 10-300MG 12/31/9999 20121 68453091110 XODOL TAB 10-300MG 12/31/9999 20121 68453091210 XODOL TAB 5-300MG 12/31/9999 20121 59630091310 XODOL TAB 7.5-300 12/31/9999 20121 68453091310 XODOL TAB 7.5-300 12/31/9999 20121 50242004062 XOLAIR SOL 150MG 12/31/9999 20121 13478000305 XOLEGEL GEL 2% 06/29/2013 20121 66992031010 XOLOX TAB 10-500MG 04/19/2020 20121 63402051124 XOPENEX NEB 0.31MG 12/31/9999 20121 63402051224 XOPENEX NEB 0.63MG 12/31/9999 20121 63402051324 XOPENEX NEB 1.25/3ML 12/31/9999 20121 63402051530 XOPENEX CONC NEB 1.25/0.5 12/31/9999 20121 63402051001 XOPENEX HFA AER 12/31/9999 20121 58980062510 X-VIATE CRE 40% 12/31/9999 20121 58980062530 X-VIATE CRE 40% 12/31/9999 20121 58980062570 X-VIATE CRE 40% 12/31/9999 20121 58980062415 X-VIATE GEL 40% 12/31/9999 20121 58980062380 X-VIATE LOT 40% 12/31/9999 20121 63323048157 XYLO/EPI INJ 0.5% 12/31/9999 20121 63323048320 XYLO/EPI INJ 2% 11/30/2012 20121 63323048327 XYLO/EPI INJ 2% 12/31/9999 20121 63323048350 XYLO/EPI INJ 2% 05/30/2012 20121 63323048357 XYLO/EPI INJ 2% 12/31/9999 20121 63323048210 XYLO/EPI 1%- INJ 1:100000 06/30/2012 20121 63323048217 XYLO/EPI 1%- INJ 1:100000 12/31/9999 20121 63323048227 XYLO/EPI 1%- INJ 1:100000 12/31/9999 20121 63323048257 XYLO/EPI 1%- INJ 1:100000 12/31/9999 20121 00186033001 XYLOCAINE GEL 2% 05/31/2012 20121 00186033036 XYLOCAINE GEL 2% 12/31/9999 20121 63323047930 XYLOCAINE GEL 2% 06/30/2013 20121 00186013501 XYLOCAINE INJ 0.5% 12/31/2012 20121 63323048450 XYLOCAINE INJ 0.5% 05/30/2014 20121 63323048457 XYLOCAINE INJ 0.5% 12/31/9999 20121 00186011001 XYLOCAINE INJ 1% 05/31/2013 20121 00186014501 XYLOCAINE INJ 1% 05/31/2013 20121 00186027512 XYLOCAINE INJ 1% 09/30/2012 20121 63323048520 XYLOCAINE INJ 1% 10/30/2014 20121 63323048527 XYLOCAINE INJ 1% 12/31/9999 20121 63323048550 XYLOCAINE INJ 1% 03/30/2015 20121 63323048557 XYLOCAINE INJ 1% 12/31/9999 20121 00186012001 XYLOCAINE INJ 2% 10/31/2012 20121 00186015501 XYLOCAINE INJ 2% 05/31/2013 20121 00186023203 XYLOCAINE INJ 2% 10/31/2012 20121 00186024312 XYLOCAINE INJ 2% 10/31/2012 20121 63323048610 XYLOCAINE INJ 2% 05/30/2014 20121 63323048617 XYLOCAINE INJ 2% 12/31/9999 20121 63323048620 XYLOCAINE INJ 2% 12/30/2014 20121 63323048627 XYLOCAINE INJ 2% 12/31/9999 20121 63323048650 XYLOCAINE INJ 2% 03/30/2014 20121 63323048657 XYLOCAINE INJ 2% 12/31/9999 20121 63323049889 XYLOCAINE INJ 2% 12/31/9999 20121 00186013701 XYLOCAINE INJ MPF 0.5% 03/31/2013 20121 63323049150 XYLOCAINE INJ MPF 0.5% 11/30/2013 20121 63323049157 XYLOCAINE INJ MPF 0.5% 12/31/9999 20121 00186011201 XYLOCAINE INJ -MPF 1% 12/31/2012 20121 00186011291 XYLOCAINE INJ -MPF 1% 01/31/2013 20121 00186021003 XYLOCAINE INJ -MPF 1% 02/28/2013 20121 00186023003 XYLOCAINE INJ -MPF 1% 03/31/2013 20121 00186027613 XYLOCAINE INJ -MPF 1% 05/31/2013 20121 00186027713 XYLOCAINE INJ -MPF 1% 06/30/2013 20121 00186027844 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 63323049202 XYLOCAINE INJ -MPF 1% 04/30/2015 20121 63323049205 XYLOCAINE INJ -MPF 1% 03/30/2014 20121 63323049227 XYLOCAINE INJ -MPF 1% 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 63323049230 XYLOCAINE INJ -MPF 1% 06/30/2014 20121 63323049231 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 63323049237 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 63323049257 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 63323049280 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 63323049289 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 63323049297 XYLOCAINE INJ -MPF 1% 12/31/9999 20121 00186024444 XYLOCAINE INJ MPF 1.5% 12/31/9999 20121 00186024554 XYLOCAINE INJ MPF 1.5% 12/31/9999 20121 63323049391 XYLOCAINE INJ MPF 1.5% 12/31/9999 20121 63323049397 XYLOCAINE INJ MPF 1.5% 12/31/9999 20121 00186021503 XYLOCAINE INJ -MPF 2% 06/30/2012 20121 00186024044 XYLOCAINE INJ -MPF 2% 12/31/9999 20121 00186024113 XYLOCAINE INJ -MPF 2% 06/30/2013 20121 00186024213 XYLOCAINE INJ -MPF 2% 05/31/2013 20121 63323049502 XYLOCAINE INJ -MPF 2% 12/30/2014 20121 63323049505 XYLOCAINE INJ -MPF 2% 01/30/2015 20121 63323049507 XYLOCAINE INJ -MPF 2% 12/31/9999 20121 63323049527 XYLOCAINE INJ -MPF 2% 12/31/9999 20121 63323049680 XYLOCAINE INJ -MPF 2% 12/31/9999 20121 63323049697 XYLOCAINE INJ -MPF 2% 12/31/9999 20121 00186023503 XYLOCAINE INJ -MPF 4% 03/31/2013 20121 63323049089 XYLOCAINE INJ -MPF 4% 12/31/9999 20121 00186032001 XYLOCAINE SOL 4% 11/30/2012 20121 63323049750 XYLOCAINE SOL 4% 12/31/9999 20121 63323048710 XYLO-MPF/EPI INJ 1% 05/30/2012 20121 63323048717 XYLO-MPF/EPI INJ 1% 12/31/9999 20121 63323048731 XYLO-MPF/EPI INJ 1% 12/31/9999 20121 63323048737 XYLO-MPF/EPI INJ 1% 12/31/9999 20121 63323048792 XYLO-MPF/EPI INJ 1% 12/31/9999 20121 63323048817 XYLO-MPF/EPI INJ 1.5% 12/31/9999 20121 63323048830 XYLO-MPF/EPI INJ 1.5% 06/30/2012 20121 63323048831 XYLO-MPF/EPI INJ 1.5% 12/31/9999 20121 63323048837 XYLO-MPF/EPI INJ 1.5% 12/31/9999 20121 63323048889 XYLO-MPF/EPI INJ 1.5% 12/31/9999 20121 63323048892 XYLO-MPF/EPI INJ 1.5% 12/31/9999 20121 63323048910 XYLO-MPF/EPI INJ 2% 05/30/2012 20121 63323048917 XYLO-MPF/EPI INJ 2% 12/31/9999 20121 63323048921 XYLO-MPF/EPI INJ 2% 12/31/9999 20121 63323048927 XYLO-MPF/EPI INJ 2% 12/31/9999 20121 63323048991 XYLO-MPF/EPI INJ 2% 05/30/2012 20121 58394001401 XYNTHA INJ 1000UNIT 12/31/9999 20121 58394002403 XYNTHA INJ 1000UNIT 12/31/9999 20121 58394001501 XYNTHA INJ 2000UNIT 12/31/9999 20121 58394002503 XYNTHA INJ 2000UNIT 12/31/9999 20121 58394001201 XYNTHA INJ 250UNIT 12/31/9999 20121 58394001603 XYNTHA INJ 3000UNIT 12/31/9999 20121 58394001301 XYNTHA INJ 500UNIT 12/31/9999 20121 58394002303 XYNTHA SOLOF INJ 500UNIT 12/31/9999 20121 58394002203 XYNTHA SOLOF KIT 250UNIT 12/31/9999 20121 68727010001 XYREM SOL 500MG/ML 12/31/9999 20121 00024580120 XYZAL SOL 11/30/2013 20121 00024580121 XYZAL SOL 12/31/9999 20121 00024580032 XYZAL TAB 5MG 12/31/9999 20121 00024580090 XYZAL TAB 5MG 12/31/9999 20121 50419040203 YASMIN 28 TAB 3-0.03MG 12/31/9999 20121 50419040503 YAZ TAB 3-0.02MG 12/31/9999 20121 68047035016 Y-COF-DMX LIQ 12/31/9999 20121 00003232822 YERVOY INJ 200MG 12/31/9999 20121 00003232711 YERVOY INJ 50MG 12/31/9999 20121 51552050902 YOHIMBINE POW 12/31/9999 20121 51552050904 YOHIMBINE POW 12/31/9999 20121 00185099810 YOHIMBINE TAB 5.4MG 12/31/9999 20121 10267071501 YOHIMBINE TAB 5.4MG 12/31/9999 20121 46672011110 YOHIMBINE TAB 5.4MG 12/31/9999 20121 46672011111 YOHIMBINE TAB 5.4MG 12/31/9999 20121 46672011125 YOHIMBINE TAB 5.4MG 12/31/9999 20121
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August 31, 2012 - Iowa Medicaid Enterprise

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