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05/01/02 Louisiana Medicaid Management APPENDIX C 05/01/02 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM PAGE 1 DEPT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES FINANCING LOUISIANA MEDICAID PHARMACY BENEFITS MANAGEMENT UNIT ONLY THESE COMPANIES PRODUCTS ARE COVERED AND ONLY THOSE DOSAGE FORMS LISTED IN APPENDIX A. MEDICAID DRUG FEDERAL REBATE PARTICIPATING PHARMACEUTICAL COMPANIES LABELER PHARMACEUTICAL COMPANY EFFECTIVE END DATE CODE DATE 00002 ELI LILLY & CO 04/01/91 00003 E.R.SQUIBB & SONS,INC 04/01/91 00004 HOFFMAN-LA ROCHE,INC 04/01/91 00005 LEDERLE LABORATORIES AMERICAN CYANAMID 04/01/91 00006 MERCK SHARP & DOHME 04/01/91 00007 SMITHKLINE BEECHAM CORPORATION 04/01/91 00008 WYETH LABORATORIES 04/01/91 00009 THE UPJOHN COMPANY 04/01/91 00011 BECTON DICKINSON MICROBIOLOGY SYSTEMS 10/01/91 07/01/98 00013 ADRIA LABORATORIES DIV.OF ERBAMONT,INC 04/01/91 00014 G.D.SEARLE & CO 04/01/91 01/01/01 00015 MEAD JOHNSON & COMPANY 04/01/91 00016 KABI PHARMACIA 04/01/91 00021 REED & CARNRICK 10/01/96 01/01/97 00023 ALLERGAN,INC 04/01/91 00024 WINTHROP PHARMACEUTICALS 04/01/91 00025 G.D.SEARLE & CO 04/01/91 00026 MILES INC.,PHARMACEUTICAL DIVISION 04/01/91 00028 GEIGY PHARMACEUTICALS 04/01/91 00029 SMITHKLINE BEECHAM CORPORATION 04/01/91 00031 ROBINS,A.H. 04/01/91 00032 SOLVAY PHARMACEUTICALS 04/01/91 00033 SYNTEX 04/01/91 00034 THE PURDUE FREDERICK COMPANY 04/01/91 00037 CARTER-WALLACE,INC 04/01/91 00038 STUART PHARMACEUTICALS,ICI AMERICAS INC 04/01/91 07/01/01 00039 HOECHST-ROUSSEL PHARMACEUTICALS INC 04/01/91 00043 SANDOZ CONSUMER CORPORATION 04/01/91 00044 KNOLL PHARMACEUTICALS 04/01/91 00045 MCNEIL PHARMACEUTICAL 04/01/91 00046 WYETH-AYERST 04/01/91 00047 WARNER-CHILCOTT 04/01/91 00048 BOOTS PHARMACEUTICALS,INC 04/01/91 00049 PFIZER,INC 04/01/91 00051 UNIMED PHARMACEUTICALS 10/01/97 00052 ORGANON,INC 04/01/91 00053 CENTEON 04/01/91 00054 ROXANE LABORATORIES,INC 04/01/91 00056 THE DUPONT MERCK PHARMACEUTICAL CO 04/01/91 00058 IOLAB CORPORATION 04/01/91 00060 DUPONT PHARMACEUTICALS 04/01/91 01/01/01 00062 ORTHO PHARMACEUTICAL CORPORATION 04/01/91 00064 HEALTHPOINT MEDICAL 07/01/95 00065 ALCON LABORATORIES,INC 04/01/91 00066 DERMIK LABORATORIES 04/01/91 00067 RHONE-POULENC RORER PHARMACEUTICALS,INC 04/01/91 00068 MARION MERRELL DOW,INC 04/01/91 00069 PFIZER LABORATORIES 04/01/91 00070 ARCOLA LABORATORIES 07/01/93 APPENDIX C 05/01/02 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM PAGE 2 DEPT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES FINANCING LOUISIANA MEDICAID PHARMACY BENEFITS MANAGEMENT UNIT ONLY THESE COMPANIES PRODUCTS ARE COVERED AND ONLY THOSE DOSAGE FORMS LISTED IN APPENDIX A. MEDICAID DRUG FEDERAL REBATE PARTICIPATING PHARMACEUTICAL COMPANIES LABELER PHARMACEUTICAL COMPANY EFFECTIVE END DATE CODE DATE 00071 PARKE-DAVIS 04/01/91 00072 WESTWOOD-SQUIBB PHARMACEUTICALS 04/01/91 00074 ABBOTT LABORATORIES 04/01/91 00075 RHONE-POULENC RORER PHARMACEUTICALS,INC 04/01/91 00076 STAR PHARMACEUTICALS,INC 04/01/91 00078 SANDOZ PHARMACEUTICAL CORPORATION 04/01/91 00081 BURROUGHS WELLCOME CO 04/01/91 00083 CIBA-PHARMACEUTICAL COMPANY 04/01/91 00084 AMERICAN PHARMACEUTICAL CO. 04/01/93 10/01/95 00085 SCHERING CORPORATION 04/01/91 00086 CARNRICK LABORATORIES,INC 04/01/91 00087 BRISTOL-MYERS SQUIBB COMPANY 04/01/91 00088 MARION MERRELL DOW,INC 04/01/91 00089 3M PHARMACEUTICALS 04/01/91 00091 SCHWARZ PHARMA KREMERS URBAN COMPANY 04/01/91 00093 LEMMON COMPANY (TEVA USA) 04/01/91 00094 THE DUPONT MERCK PHARMACEUTICAL COMPANY 04/01/91 01/01/01 00095 WILLIAM P. POYTHRESS,INC 10/01/91 00096 PERSON & COVEY INC. 04/01/99 00108 SMITHKLINE BEECHAM CORPORATION 04/01/91 00113 L.PERRIGO COMPANY 04/01/91 00115 RICHLYN LABORATORIES,INC 04/01/91 00116 XTTRIUM LABORATORIES, INC 01/01/02 00117 CORD LABORATORIES,INC 04/01/91 01/01/92 00118 HOLLISTER-STIER MILES,INC.PHARM.DIV. 04/01/91 00121 PHARMACEUTICAL ASSOCIATES,INC 04/01/91 00126 COLGATE HOYT LABORATORIES 04/01/91 00131 CENTRAL PHARMACEUTICAL COMPANY 04/01/91 00132 C B FLEET COMPANY INC 04/01/91 00135 SMITHKLINE BEECHAM 01/01/95 00143 WEST-WARD PHARMACEUTICAL CORPORATION 04/01/91 00144 SUPERIOR PHARMACEUTICAL COMPANY 04/01/95 04/01/02 00145 STIEFEL LABORATORIES INC 04/01/91 00147 CAMALL CO. 04/01/91 10/01/01 00148 MANUFACTURING CHEMISTS,INC 10/01/92 07/01/95 00149 NORWICH EATON PHARMACEUTICALS,INC NY 04/01/91 00152 THE GRAY PHARMACEUTICAL COMPANY 04/01/91 00161 CUTTER BIOLOGICAL MILES,INC.PHARM.DIV. 04/01/91 00165 BLAINE COMPANY, INCORPORATED 01/01/92 00168 E.FOUGERA & CO.,DIV.OF ALTANA INC 04/01/91 00169 NOVO NORDISK PHARMACEUTICALS,INC 04/01/91 00172 ZENITH LABORATORIES,INC 04/01/91 00173 GLAXO,ALLEN AND HANBURY 04/01/91 00178 MISSION PHARMACAL COMPANY 04/01/91 00182 GOLDLINE LABORATORIES,INC 04/01/91 00185 EON LABS 04/01/91 00186 ASTRA PHARMACEUTICAL PRODUCTS INC 04/01/91 00187 ICN PHARMACEUTICALS INC 04/01/91 00192 MILES,INC 10/01/94 APPENDIX C 05/01/02 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM PAGE 3 DEPT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES FINANCING LOUISIANA MEDICAID PHARMACY BENEFITS MANAGEMENT UNIT ONLY THESE COMPANIES PRODUCTS ARE COVERED AND ONLY THOSE DOSAGE FORMS LISTED IN APPENDIX A. MEDICAID DRUG FEDERAL REBATE PARTICIPATING PHARMACEUTICAL COMPANIES LABELER PHARMACEUTICAL COMPANY EFFECTIVE END DATE CODE DATE 00205 LEDERLE PARENTERALS,INC 04/01/91 00206 LEDERLE PIPERACILLIN,INC 04/01/91 00209 MARSAM PHARMACEUTICALS,INC 10/01/94 00214 GLAXOSMITHKLINE 04/01/02 00217 DUNHALL PHARMACEUTICALS INC 01/01/00 10/01/01 00224 KONSYL PHARMACEUTICALS/DIV OF LAFAYETTE 01/01/92 00225 B.F.ASCHER & COMPANY,INC 04/01/91 00228 PUREPAC PHARM CO.DIV.KALIPHARMA INC 04/01/91 00245 UPSHER-SMITH LABORATORIES,INC 04/01/91 00249 GERIATRIC PHARMACEUTICAL CORP 04/01/91 10/01/98 00254 VINTAGE PHARMACEUTICALS 04/01/93 00256 FLEMING AND COMPANY 10/01/91 00258 INWOOD LABORATORIES,INC 04/01/91 00259 MAYRAND PHARMACEUTICALS,INC 04/01/91 00263 RYSTAN COMPANY,INCORPORATED 10/01/94 04/01/02 00264 MC GAW,INC 04/01/91 00268 CENTER LABORATORIES 04/01/91 00274 SCHERER LABORATORIES INC 04/01/91 01/01/00 00277 LASER,INC 04/01/91 00281 SAVAGE LABORATORIES,DIV.OF ALTANA 04/01/91 00288 FLUORITAB CORPORATION 10/01/91 00299 GALDERMA, L.T. 04/01/91 00300 TAP PHARMACEUTICAL,INC 04/01/91 00302 GENETCO,INC 01/01/94 07/01/94 00303 BAUSCH & LOMB PHARMACEUTICALS,INC 04/01/91 01/01/98 00304 J.J.BALAN 04/01/91 00310 ICI PHARMA ICI AMERICAS,INC 04/01/91 00311 ALMAY,INC 04/01/93 01/01/95 00314 HYREX PHARMACEUTICALS 04/01/91 00327 GUARDIAN LABS DIV UNITED-GUARDIAN INC 04/01/91 00332 BIOCRAFT LABORATORIES,INC (TEVA USA) 04/01/91 00338 BAXTER HEALTHCARE CORPORATION 04/01/91 00349 PARMED PHARMACEUTICALS,INC 04/01/91 00353 AMERICAN PHARMACAL 01/01/95 01/01/00 00364 SCHEIN PHARMACEUTICAL,INC 04/01/91 00369 SCHERING CORPORATION 04/01/91 00372 SCOT-TUSSIN PHARMACAL COMPANY,INCORPORA 04/01/92 00378 MYLAN PHARMACEUTICALS,INC 04/01/91 00386 GEBAUER CO. 04/01/91 07/01/00 00392 CRANDALL ASSOCIATE,INC 04/01/91 07/01/99 00396 MILEX PRODUCTS INC 04/01/91 04/01/93 00398 C & M PHARMACAL, INC 04/01/91 04/01/93 00402 STERIS LABORATORIES,INC 04/01/91 00405 ALIGEN INDEPENDENT LABS.,INC 04/01/91 10/01/97 00406 MALLINCKRODT SPECIALTY CHEMICALS CO 10/01/91 00409 AP PHARMACEUTICALS,INC 10/01/95 01/01/01 00414 SUPPOSITORIA LABORATORIES 04/01/94 00417 HALL LABORATORIES, INC 10/01/92 04/01/98 00418 PASADENA RESEARCH LABORATORIES 10/01/96 10/01/97 APPENDIX C 05/01/02 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM PAGE 4 DEPT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES FINANCING LOUISIANA MEDICAID PHARMACY BENEFITS MANAGEMENT UNIT ONLY THESE COMPANIES PRODUCTS ARE COVERED AND ONLY THOSE DOSAGE FORMS LISTED IN APPENDIX A. MEDICAID DRUG FEDERAL REBATE PARTICIPATING PHARMACEUTICAL COMPANIES LABELER PHARMACEUTICAL COMPANY EFFECTIVE END DATE CODE DATE 00421 THE FIELDING PHARMACEUTICAL COMPANY 04/01/91 00426 PENNEX PHARMACEUTICALS 01/01/94 07/01/99 00430 WARNER CHILCOTT LABORATORIES 01/01/98 00451 MURO PHARMACEUTICAL,INC 04/01/91 00454 LPI HOLDINGS,INC.DBA LEXIS LABS 01/01/92 07/01/94 00456 FOREST PHARMACEUTICALS,INC 04/01/91 00462 PHARMADERM,DIV.OF ALTANA INC 04/01/91 01/01/99 00463 C.O. TRUXTON INC 04/01/91 01/01/96 00469 LYPHOMED DIVISION FUJISAWA USA 04/01/91 00472 ALPHARMA 04/01/91 00477 OBETROL PHARMACEUTICALS 01/01/92 04/01/96 00478 REXAR PHARMACEUTICALS CORPORATION 01/01/92 04/01/96 00482 KENWOOD LABORATORIES DIV.BRADLEY PHARM 04/01/91 00484 SMITHKLINE BEECHAM CORPORATION 04/01/91 00485 EDWARDS PHARMACEUTICALS,INC 04/01/91 00486 BEACH PRODUCTS INC 04/01/91 00487 NEPHRON PHARMACEUTICALS CORPORATION 04/01/92 00496 FERNDALE LABORATORIES INC 04/01/91 00501 WARNER-LAMBERT 04/01/95 00514 DOW B.HICKAM,INC 04/01/91 00516 GLENWOOD 07/01/97 10/01/98 00517 LUITPOLD PHARMACEUTICALS INC 10/01/91 00524 BOOTS PHARMACEUTICALS 04/01/91 04/01/02 00525 PAN AMERICAN LABORATORIES INC 04/01/91 00527 LANNETT COMPANY INC 07/01/94 00535 GILBERT LABORATORIES 07/01/02 00536 RUGBY LABORATORIES,INC 04/01/91 00538 LANDRY PHARMACEUTICALS,INCORPORATED 01/01/92 07/01/93 00539 AMERICAN UROLOGICALS INC 10/01/91 04/01/98 00548 INTERNATIONAL MEDICATIONS SYSTEMS LTD 04/01/91 00551 SEATRACE COMPANY 01/01/92 00555 BARR LABORATORIES,INC 04/01/91 00556 H R CENCI LABORATORIES 04/01/91 10/01/98 00563 BOCK PHARMACAL COMPANY 04/01/91 07/01/01 00573 WHITEHALL LABORATORIES,INC 04/01/91 00574 PADDOCK LABORATORIES,INC 04/01/91 00575 BAKER CUMMINS 04/01/91 00585 FISONS CORPORATION 04/01/91 00588 KEENE PHARMACEUTICALS,INC 10/01/95 04/01/00 00590 THE DUPONT MERCK PHARMACEUTICAL COMPANY 04/01/91 00591 DANBURY PHARMACAL,INC 07/01/01 00597 BOEHRINGER INGELHEIM PHARMACEUTICALS 04/01/91 00601 KABIVITRUM,INC 04/01/91 00603 QUALITEST PRODUCTS INC 04/01/91 00615 VANGARD LABS,INC 04/01/91 09/06/01 00641 ELKINS-SINN,INC 04/01/91 00642 EVERETT;ABPRATPROES.OMC/ 04/01/91 00662 PFIZER,INC 04/01/91 04/01/02 00663 PFIZER LABORATORIES 04/01/91 04/01/02 APPENDIX C 05/01/02 LOUISIANA MEDICAID MANAGEMENT INFORMATION SYSTEM PAGE 5 DEPT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES FINANCING LOUISIANA MEDICAID PHARMACY BENEFITS MANAGEMENT UNIT ONLY THESE COMPANIES PRODUCTS ARE COVERED AND ONLY THOSE DOSAGE FORMS LISTED IN APPENDIX A.
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