August 31, 2012 - Iowa Medicaid Enterprise

More documents

Recommendations

Info

NDC Product Description Termination Date Quarter Covered 64764045125 ACTOS TAB 45MG 12/31/9999 20121 64764045126 ACTOS TAB 45MG 12/31/9999 20121 68025000410 ACUFLEX TAB 12/31/9999 20121 00023218105 ACULAR SOL 0.5% OP 12/31/9999 20121 00023927705 ACULAR LS SOL 0.4% 12/31/9999 20121 61480013705 ACUNOL TAB 600MG 12/31/9999 20121 00023350730 ACUVAIL SOL 0.45% 12/31/9999 20121 00093894001 ACYCLOVIR CAP 200MG 12/31/9999 20121 00093894005 ACYCLOVIR CAP 200MG 12/31/9999 20121 00093894019 ACYCLOVIR CAP 200MG 12/31/9999 20121 00093894093 ACYCLOVIR CAP 200MG 12/31/9999 20121 00378220001 ACYCLOVIR CAP 200MG 12/31/9999 20121 00378220005 ACYCLOVIR CAP 200MG 02/28/2013 20121 00591269201 ACYCLOVIR CAP 200MG 05/31/2012 20121 23155014601 ACYCLOVIR CAP 200MG 12/31/9999 20121 51079044701 ACYCLOVIR CAP 200MG 12/31/9999 20121 51079044720 ACYCLOVIR CAP 200MG 12/31/9999 20121 60505004206 ACYCLOVIR CAP 200MG 12/31/9999 20121 61442011101 ACYCLOVIR CAP 200MG 12/31/9999 20121 63304065201 ACYCLOVIR CAP 200MG 12/31/9999 20121 63304065205 ACYCLOVIR CAP 200MG 12/31/9999 20121 67253010010 ACYCLOVIR CAP 200MG 12/31/9999 20121 67253010011 ACYCLOVIR CAP 200MG 12/31/9999 20121 00472008216 ACYCLOVIR SUS 200/5ML 12/31/9999 20121 50383081016 ACYCLOVIR SUS 200/5ML 12/31/9999 20121 00093894301 ACYCLOVIR TAB 400MG 12/31/9999 20121 00093894305 ACYCLOVIR TAB 400MG 12/31/9999 20121 00093894319 ACYCLOVIR TAB 400MG 12/31/9999 20121 00093894393 ACYCLOVIR TAB 400MG 12/31/9999 20121 00378025301 ACYCLOVIR TAB 400MG 12/31/9999 20121 00378025305 ACYCLOVIR TAB 400MG 07/31/2013 20121 00591033501 ACYCLOVIR TAB 400MG 10/31/2012 20121 00904612161 ACYCLOVIR TAB 400MG 12/31/9999 20121 50268006115 ACYCLOVIR TAB 400MG 12/31/9999 20121 60505530601 ACYCLOVIR TAB 400MG 12/31/9999 20121 60505530608 ACYCLOVIR TAB 400MG 12/31/9999 20121 61442011201 ACYCLOVIR TAB 400MG 12/31/9999 20121 61442011205 ACYCLOVIR TAB 400MG 12/31/9999 20121 63304050401 ACYCLOVIR TAB 400MG 12/31/9999 20121 67253010110 ACYCLOVIR TAB 400MG 12/31/9999 20121 67253010111 ACYCLOVIR TAB 400MG 12/31/9999 20121 00093894701 ACYCLOVIR TAB 800MG 12/31/9999 20121 00093894705 ACYCLOVIR TAB 800MG 12/31/9999 20121 00093894719 ACYCLOVIR TAB 800MG 12/31/9999 20121 00093894793 ACYCLOVIR TAB 800MG 12/31/9999 20121 00378030201 ACYCLOVIR TAB 800MG 12/31/9999 20121 00591033601 ACYCLOVIR TAB 800MG 10/31/2012 20121 60505530701 ACYCLOVIR TAB 800MG 12/31/9999 20121 60505530705 ACYCLOVIR TAB 800MG 12/31/9999 20121 61442011301 ACYCLOVIR TAB 800MG 12/31/9999 20121 61442011305 ACYCLOVIR TAB 800MG 12/31/9999 20121 63304050501 ACYCLOVIR TAB 800MG 12/31/9999 20121 55390061320 ACYCLOVIR NA INJ 1000MG 12/31/9999 20121 55390061210 ACYCLOVIR NA INJ 500MG 12/31/9999 20121 63323010510 ACYCLOVIR NA INJ 500MG 12/31/9999 20121 63323032510 ACYCLOVIR NA INJ 50MG/ML 12/31/9999 20121 63323032520 ACYCLOVIR NA INJ 50MG/ML 12/31/9999 20121 00023367030 ACZONE GEL 5% 12/31/9999 20121 00023367060 ACZONE GEL 5% 12/31/9999 20121 57665000101 ADAGEN INJ 250/ML 12/31/9999 20121 00085170101 ADALAT CC TAB 30MG ER 12/31/9999 20121 00085170102 ADALAT CC TAB 30MG ER 12/31/9999 20121 00085170103 ADALAT CC TAB 30MG ER 12/31/9999 20121 50419070105 ADALAT CC TAB 30MG ER 12/31/9999 20121 50419070110 ADALAT CC TAB 30MG ER 12/31/9999 20121 00085171601 ADALAT CC TAB 60MG ER 12/31/9999 20121 00085171602 ADALAT CC TAB 60MG ER 12/31/9999 20121
NDC Product Description Termination Date Quarter Covered 00085171603 ADALAT CC TAB 60MG ER 12/31/9999 20121 50419070205 ADALAT CC TAB 60MG ER 12/31/9999 20121 50419070210 ADALAT CC TAB 60MG ER 12/31/9999 20121 00085172201 ADALAT CC TAB 90MG ER 12/31/9999 20121 00085172202 ADALAT CC TAB 90MG ER 12/31/9999 20121 50419070305 ADALAT CC TAB 90MG ER 12/31/9999 20121 00168042446 ADAPALENE CRE 0.1% 12/31/9999 20121 45802045384 ADAPALENE CRE 0.1% 12/31/9999 20121 00093630195 ADAPALENE GEL 0.1% 12/31/9999 20121 51672415506 ADAPALENE GEL 0.1% 12/31/9999 20121 68462040355 ADAPALENE GEL 0.1% 12/31/9999 20121 51144005001 ADCETRIS INJ 50MG 12/31/9999 20121 66302046760 ADCIRCA TAB 20MG 12/31/9999 20121 00555076402 ADDERALL TAB 10MG 12/31/9999 20121 00555076502 ADDERALL TAB 12.5MG 12/31/9999 20121 00555076602 ADDERALL TAB 15MG 12/31/9999 20121 00555076702 ADDERALL TAB 20MG 12/31/9999 20121 00555076802 ADDERALL TAB 30MG 12/31/9999 20121 00555076202 ADDERALL TAB 5MG 12/31/9999 20121 00555076302 ADDERALL TAB 7.5MG 12/31/9999 20121 54092038301 ADDERALL XR CAP 10MG 12/31/9999 20121 54092038501 ADDERALL XR CAP 15MG 12/31/9999 20121 54092038701 ADDERALL XR CAP 20MG 12/31/9999 20121 54092038901 ADDERALL XR CAP 25MG 12/31/9999 20121 54092039101 ADDERALL XR CAP 30MG 12/31/9999 20121 54092038101 ADDERALL XR CAP 5MG 12/31/9999 20121 00469823414 ADENOCARD INJ 12MG/4ML 12/31/9999 20121 00469823412 ADENOCARD INJ 6MG/2ML 12/31/9999 20121 00469087120 ADENOSCAN INJ 3MG/ML 12/31/9999 20121 00469087130 ADENOSCAN INJ 3MG/ML 12/31/9999 20121 25021030104 ADENOSINE INJ 12MG/4ML 12/31/9999 20121 25021030176 ADENOSINE INJ 12MG/4ML 12/31/9999 20121 55390006801 ADENOSINE INJ 12MG/4ML 12/31/9999 20121 63323065104 ADENOSINE INJ 12MG/4ML 12/31/9999 20121 64679063002 ADENOSINE INJ 12MG/4ML 12/31/9999 20121 64679063008 ADENOSINE INJ 12MG/4ML 12/31/9999 20121 10019006302 ADENOSINE INJ 3MG/ML 12/31/9999 20121 10019006303 ADENOSINE INJ 3MG/ML 12/31/9999 20121 17478054202 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 25021030102 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 25021030172 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 55390006710 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 63323065102 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 64679063001 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 64679063007 ADENOSINE INJ 6MG/2ML 12/31/9999 20121 57844001901 ADIPEX-P CAP 37.5MG 12/31/9999 20121 57844000901 ADIPEX-P TAB 37.5MG 12/31/9999 20121 10337081506 ADOXA CAP 150MG 12/31/9999 20121 10337080205 ADOXA TAB 100MG 12/31/9999 20121 10337080225 ADOXA TAB 100MG 12/31/9999 20121 10337080150 ADOXA TAB 75MG 12/31/9999 20121 59630080301 ADRENACLICK INJ 0.15MG 12/31/9999 20121 59630080302 ADRENACLICK INJ 0.15MG 12/31/9999 20121 59630080401 ADRENACLICK INJ 0.3MG 12/31/9999 20121 59630080402 ADRENACLICK INJ 0.3MG 12/31/9999 20121 42023010101 ADRENALIN INJ 1MG/ML 12/31/9999 20121 42023010110 ADRENALIN INJ 1MG/ML 12/31/9999 20121 42023012225 ADRENALIN INJ 1MG/ML 12/31/9999 20121 42023010301 ADRENALIN SOL 1:1000 12/31/9999 20121 55390023301 ADRIAMYC INJ 50MG 12/31/9999 20121 55390023110 ADRIAMYCIN INJ 10MG 12/31/9999 20121 55390023210 ADRIAMYCIN INJ 20MG 12/31/9999 20121 55390023510 ADRIAMYCIN INJ 2MG/ML 12/31/9999 20121 55390023610 ADRIAMYCIN INJ 2MG/ML 12/31/9999 20121 55390023701 ADRIAMYCIN INJ 2MG/ML 12/31/9999 20121 55390023801 ADRIAMYCIN INJ 2MG/ML 12/31/9999 20121 00703301513 ADRUCIL INJ 50MG/ML 12/31/9999 20121
Page 1 and 2: Rebatable Drug List for Iowa Medica
Page 3 and 4: NDC Product Description Termination
Page 5: NDC Product Description Termination
Page 57 and 58:
NDC Product Description Termination
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104:
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?