August 31, 2012 - Iowa Medicaid Enterprise

More documents

Recommendations

Info

NDC Product Description Termination Date Quarter Covered 65597010790 BENICAR HCT TAB 40-25MG 12/31/9999 20121 49401010101 BENLYSTA INJ 120MG 12/31/9999 20121 49401010201 BENLYSTA INJ 400MG 12/31/9999 20121 63801010701 BENSAL HP OIN 12/31/9999 20121 63801010705 BENSAL HP OIN 12/31/9999 20121 63801010709 BENSAL HP OIN 12/31/9999 20121 63801010712 BENSAL HP OIN 12/31/9999 20121 51552013504 BENTONITE POW 12/31/9999 20121 51552013506 BENTONITE POW 12/31/9999 20121 58914001210 BENTYL CAP 10MG 12/31/9999 20121 58914008052 BENTYL INJ 10MG/ML 12/31/9999 20121 58914001516 BENTYL SYP 10MG/5ML 12/31/9999 20121 58914001310 BENTYL TAB 20MG 12/31/9999 20121 00299367008 BENZAC W LIQ 5% WASH 05/31/2012 20121 00066049425 BENZACLIN GEL 1-5% 12/31/9999 20121 00066049435 BENZACLIN GEL 1-5%PUMP 12/31/9999 20121 00066049455 BENZACLIN GEL 1-5%PUMP 12/31/9999 20121 51552024105 BENZALDEHYDE ELX 12/31/9999 20121 51552024106 BENZALDEHYDE ELX 12/31/9999 20121 51552064806 BENZALKONIUM SOL 17% 12/31/9999 20121 51552064808 BENZALKONIUM SOL 17% 12/31/9999 20121 38779026405 BENZALKONIUM SOL NF 12/31/9999 20121 38779026408 BENZALKONIUM SOL NF 12/31/9999 20121 38779026409 BENZALKONIUM SOL NF 12/31/9999 20121 00066051046 BENZAMYCIN GEL 12/31/9999 20121 00066057760 BENZAMYCIN GEL PAK 12/31/9999 20121 10337080641 BENZASHAVE CRE 10% 12/31/9999 20121 00225061023 BENZEDREX INH 12/31/9999 20121 16781019460 BENZEFOAM AER 5.3% 12/31/9999 20121 16781019496 BENZEFOAM AER 5.3% 12/31/9999 20121 16781020196 BENZEFOAM AER ULTRA 12/31/9999 20121 00168047440 BENZL PEROX LIQ 6.5-10% 12/31/9999 20121 00168047540 BENZL PEROX LIQ 8.5-10% 12/31/9999 20121 51552017701 BENZOIN TIN PLAIN 12/31/9999 20121 51552017703 BENZOIN TIN PLAIN 12/31/9999 20121 51552017704 BENZOIN TIN PLAIN 12/31/9999 20121 51552017706 BENZOIN TIN PLAIN 12/31/9999 20121 00574911902 BENZOIN CMPD TIN 12/31/9999 20121 51552022803 BENZOIN CMPD TIN 12/31/9999 20121 51552022804 BENZOIN CMPD TIN 12/31/9999 20121 51552022806 BENZOIN CMPD TIN 12/31/9999 20121 51552022808 BENZOIN CMPD TIN 12/31/9999 20121 00406224701 BENZONATATE CAP 100MG 12/31/9999 20121 00406224705 BENZONATATE CAP 100MG 12/31/9999 20121 00904590440 BENZONATATE CAP 100MG 12/31/9999 20121 00904590460 BENZONATATE CAP 100MG 12/31/9999 20121 50111085101 BENZONATATE CAP 100MG 12/31/9999 20121 50111085102 BENZONATATE CAP 100MG 12/31/9999 20121 57664013388 BENZONATATE CAP 100MG 12/31/9999 20121 65162053610 BENZONATATE CAP 100MG 12/31/9999 20121 65162053650 BENZONATATE CAP 100MG 12/31/9999 20121 67877010501 BENZONATATE CAP 100MG 12/31/9999 20121 67877010505 BENZONATATE CAP 100MG 12/31/9999 20121 68084021401 BENZONATATE CAP 100MG 12/31/9999 20121 68382024701 BENZONATATE CAP 100MG 12/31/9999 20121 68382024705 BENZONATATE CAP 100MG 12/31/9999 20121 00258367801 BENZONATATE CAP 200MG 10/31/2012 20121 00406224801 BENZONATATE CAP 200MG 12/31/9999 20121 00555188302 BENZONATATE CAP 200MG 12/31/9999 20121 00904590560 BENZONATATE CAP 200MG 12/31/9999 20121 00904625460 BENZONATATE CAP 200MG 12/31/9999 20121 57664013488 BENZONATATE CAP 200MG 12/31/9999 20121 65162053710 BENZONATATE CAP 200MG 12/31/9999 20121 67877010601 BENZONATATE CAP 200MG 12/31/9999 20121 67877010605 BENZONATATE CAP 200MG 12/31/9999 20121 68382024801 BENZONATATE CAP 200MG 12/31/9999 20121 45802091596 BENZOYL PER GEL 10% 02/01/2014 20121
NDC Product Description Termination Date Quarter Covered 45802090596 BENZOYL PER GEL 2.5% 02/02/2013 20121 00536408956 BENZOYL PER GEL 5% 12/31/9999 20121 45802091001 BENZOYL PER GEL 5% 12/31/9999 20121 45802091096 BENZOYL PER GEL 5% 12/31/9999 20121 59366278204 BENZOYL PER KIT 4% WASH 08/03/2012 20121 68462054838 BENZOYL PER KIT 4% WASH 12/31/9999 20121 68462054938 BENZOYL PER KIT 8% WASH 12/31/9999 20121 45802091801 BENZOYL PER LIQ 10% WASH 02/01/2013 20121 45802091834 BENZOYL PER LIQ 10% WASH 03/01/2013 20121 67405043005 BENZOYL PER LIQ 10% WASH 09/30/2012 20121 67405043008 BENZOYL PER LIQ 10% WASH 09/30/2012 20121 67405083005 BENZOYL PER LIQ 10% WASH 12/31/9999 20121 67405083008 BENZOYL PER LIQ 10% WASH 12/31/9999 20121 45802090734 BENZOYL PER LIQ 2.5%WASH 12/31/9999 20121 59366270401 BENZOYL PER LIQ 4% CREM 10/26/2012 20121 68462041438 BENZOYL PER LIQ 4% CREM 12/31/9999 20121 45802091301 BENZOYL PER LIQ 5% WASH 01/01/2013 20121 45802091326 BENZOYL PER LIQ 5% WASH 07/01/2012 20121 45802091334 BENZOYL PER LIQ 5% WASH 12/31/9999 20121 67405042505 BENZOYL PER LIQ 5% WASH 12/31/2012 20121 67405042508 BENZOYL PER LIQ 5% WASH 11/30/2012 20121 67405082505 BENZOYL PER LIQ 5% WASH 12/31/9999 20121 67405082508 BENZOYL PER LIQ 5% WASH 12/31/9999 20121 00168075847 BENZOYL PER LIQ 5.75-10% 12/31/9999 20121 68462041538 BENZOYL PER LIQ 8% CREM 12/31/9999 20121 00536081595 BENZOYL PER LOT 10% 12/31/9999 20121 00472046906 BENZOYL PER LOT 3% 12/31/9999 20121 00472046912 BENZOYL PER LOT 3% 12/31/9999 20121 68462041134 BENZOYL PER LOT 3% 12/31/9999 20121 68462041138 BENZOYL PER LOT 3% 12/31/9999 20121 00536081095 BENZOYL PER LOT 5% 12/31/9999 20121 00472047006 BENZOYL PER LOT 6% 12/31/9999 20121 00472047012 BENZOYL PER LOT 6% 12/31/9999 20121 67405043506 BENZOYL PER LOT 6% 09/30/2012 20121 67405043512 BENZOYL PER LOT 6% 09/30/2012 20121 67405083506 BENZOYL PER LOT 6% 12/31/9999 20121 67405083512 BENZOYL PER LOT 6% 12/31/9999 20121 68462041234 BENZOYL PER LOT 6% 12/31/9999 20121 68462041238 BENZOYL PER LOT 6% 12/31/9999 20121 00472047106 BENZOYL PER LOT 9% 12/31/9999 20121 00472047112 BENZOYL PER LOT 9% 12/31/9999 20121 68462041334 BENZOYL PER LOT 9% 12/31/9999 20121 68462041338 BENZOYL PER LOT 9% 12/31/9999 20121 00472046330 BENZOYL PER PAD 3% 12/31/9999 20121 00472046430 BENZOYL PER PAD 6% 12/31/9999 20121 00472046530 BENZOYL PER PAD 9% 12/31/9999 20121 51552052104 BENZOYL PER POW HYDROUS 12/31/9999 20121 51552052106 BENZOYL PER POW HYDROUS 12/31/9999 20121 51552052109 BENZOYL PER POW HYDROUS 12/31/9999 20121 00574011601 BENZPHETAMIN TAB 50MG 07/31/2012 20121 10702004001 BENZPHETAMIN TAB 50MG 12/31/9999 20121 10702004003 BENZPHETAMIN TAB 50MG 12/31/9999 20121 10702004050 BENZPHETAMIN TAB 50MG 12/31/9999 20121 64376065001 BENZPHETAMIN TAB 50MG 12/31/9999 20121 64376065005 BENZPHETAMIN TAB 50MG 12/31/9999 20121 64376065031 BENZPHETAMIN TAB 50MG 12/31/9999 20121 64376065090 BENZPHETAMIN TAB 50MG 12/31/9999 20121 00143972905 BENZTROPINE INJ 1MG/ML 12/31/9999 20121 00517078505 BENZTROPINE INJ 1MG/ML 12/31/9999 20121 00603243321 BENZTROPINE TAB 0.5MG 12/31/9999 20121 00603243332 BENZTROPINE TAB 0.5MG 12/31/9999 20121 00832108000 BENZTROPINE TAB 0.5MG 12/31/9999 20121 00904105560 BENZTROPINE TAB 0.5MG 12/31/9999 20121 00904105561 BENZTROPINE TAB 0.5MG 12/31/9999 20121 50111039301 BENZTROPINE TAB 0.5MG 12/31/9999 20121 51079040401 BENZTROPINE TAB 0.5MG 06/30/2012 20121 51079040420 BENZTROPINE TAB 0.5MG 06/30/2012 20121
Page 1 and 2: Rebatable Drug List for Iowa Medica
Page 3 and 4: NDC Product Description Termination
Page 51: NDC Product Description Termination
Page 103 and 104:
NDC Product Description Termination
Page 105 and 106:
Page 107 and 108:
Page 109 and 110:
Page 111 and 112:
Page 113 and 114:
Page 115 and 116:
Page 117 and 118:
Page 119 and 120:
Page 121 and 122:
Page 123 and 124:
Page 125 and 126:
Page 127 and 128:
Page 129 and 130:
Page 131 and 132:
Page 133 and 134:
Page 135 and 136:
Page 137 and 138:
Page 139 and 140:
Page 141 and 142:
Page 143 and 144:
Page 145 and 146:
Page 147 and 148:
Page 149 and 150:
Page 151 and 152:
Page 153 and 154:
Page 155 and 156:
Page 157 and 158:
Page 159 and 160:
Page 161 and 162:
Page 163 and 164:
Page 165 and 166:
Page 167 and 168:
Page 169 and 170:
Page 171 and 172:
Page 173 and 174:
Page 175 and 176:
Page 177 and 178:
Page 179 and 180:
Page 181 and 182:
Page 183 and 184:
Page 185 and 186:
Page 187 and 188:
Page 189 and 190:
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Page 201 and 202:
Page 203 and 204:
Page 205 and 206:
Page 207 and 208:
Page 209 and 210:
Page 211 and 212:
Page 213 and 214:
Page 215 and 216:
Page 217 and 218:
Page 219 and 220:
Page 221 and 222:
Page 223 and 224:
Page 225 and 226:
Page 227 and 228:
Page 229 and 230:
Page 231 and 232:
Page 233 and 234:
Page 235 and 236:
Page 237 and 238:
Page 239 and 240:
Page 241 and 242:
Page 243 and 244:
Page 245 and 246:
Page 247 and 248:
Page 249 and 250:
Page 251 and 252:
Page 253 and 254:
Page 255 and 256:
Page 257 and 258:
Page 259 and 260:
Page 261 and 262:
Page 263 and 264:
Page 265 and 266:
Page 267 and 268:
Page 269 and 270:
Page 271 and 272:
Page 273 and 274:
Page 275 and 276:
Page 277 and 278:
Page 279 and 280:
Page 281 and 282:
Page 283 and 284:
Page 285 and 286:
Page 287 and 288:
Page 289 and 290:
Page 291 and 292:
Page 293 and 294:
Page 295 and 296:
Page 297 and 298:
Page 299 and 300:
Page 301 and 302:
Page 303 and 304:
Page 305 and 306:
Page 307 and 308:
Page 309 and 310:
Page 311 and 312:
Page 313 and 314:
Page 315 and 316:
Page 317 and 318:
Page 319 and 320:
Page 321 and 322:
Page 323 and 324:
Page 325 and 326:
Page 327 and 328:
Page 329 and 330:
Page 331 and 332:
Page 333 and 334:
Page 335 and 336:
Page 337 and 338:
Page 339 and 340:
Page 341 and 342:
Page 343 and 344:
Page 345 and 346:
Page 347 and 348:
Page 349 and 350:
Page 351 and 352:
Page 353 and 354:
Page 355 and 356:
Page 357 and 358:
Page 359 and 360:
Page 361 and 362:
Page 363 and 364:
Page 365 and 366:
Page 367 and 368:
Page 369 and 370:
Page 371 and 372:
Page 373 and 374:
Page 375 and 376:
Page 377 and 378:
Page 379 and 380:
Page 381 and 382:
Page 383 and 384:
Page 385 and 386:
Page 387 and 388:
Page 389 and 390:
Page 391 and 392:
Page 393 and 394:
Page 395 and 396:
Page 397 and 398:
Page 399 and 400:
Page 401 and 402:
Page 403 and 404:
Page 405 and 406:
Page 407 and 408:
Page 409 and 410:
Page 411 and 412:
Page 413 and 414:
Page 415 and 416:
Page 417 and 418:
Page 419 and 420:
Page 421 and 422:
Page 423 and 424:
Page 425 and 426:
Page 427 and 428:
Page 429 and 430:
Page 431 and 432:
Page 433 and 434:
Page 435 and 436:
Page 437 and 438:
Page 439 and 440:
Page 441 and 442:
Page 443 and 444:
Page 445 and 446:
Page 447 and 448:
Page 449 and 450:
Page 451 and 452:
Page 453 and 454:
Page 455 and 456:
Page 457 and 458:
Page 459 and 460:
Page 461 and 462:
Page 463 and 464:
Page 465 and 466:
Page 467 and 468:
Page 469:
show all

August 31, 2012 - Iowa Medicaid Enterprise

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?