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Company IC Limited / / Currency USD / / Facility VON WILLEBRAND FACTOR COMPLEX / / Organization Medicare / Physical Health Services Unit / NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES / International Unit / NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICAID SERVICES / United Nations / / / Position qualifier / Medical Director / Governor / appropriate qualifier / / Product INJECTION 000J3262 TOCILIZUMAB INJECTION / NON-DEPOT 000J2355 OPRELVEKIN INJECTION 000J2357 OMALIZUMAB INJECTION / INJECTION 000J2010 LINCOMYCIN INJECTION / DECITABINE INJECTION / METHYLPREDNISOLONE / COLISTIMETHATE / INJECTION 000J3385 VELAGLUCERASE ALFA 000J3396 VERTEPORFIN INJECTION / TERRAMYCIN / ITRACONAZOLE / PROTAMINE SULFATE / DIMENHYDRINATE / DORIPENEM INJECTION 000J1270 DOXERCALCIFEROL INJECTION 000J1290 ECALLANTIDE INJECTION / DEMADEX / ACETYLCYSTEINE / INJECTION 000J3465 VORICONAZOLE INJECTION 000J3470 HYALURONIDASE INJECTION / PROMETHAZINE / HEXACETONL INJECTION / LINEZOLID / IBANDRONATE SODIUM INJECTION 000J1742 IBUTILIDE FUMARATE INJECTION / NALOXONE HCL / TRIPTORELIN PAMOATE 000J3350 UREA INJECTION 000J3355 UROFOLLITROPIN 000J3357 USTEKINUMAB INJECTION / INJECTION 000J0718 CERTOLIZUMAB PEGOL INJECTION / GLUCAGON / INJECTION 000J1756 IRON SUCROSE INJECTION 000J1786 IMUGLUCERASE INJECTION / MEDROXYPROGESTERONE ACETATE / KANAMYCIN SULFATE / SUMATRIPTAN SUCCINATE / MILRINONE LACTATE / CHORIONIC GONADOTROPIN / DEXTROSE / GENTAMICIN / INJECTION 000J1930 LANREOTIDE INJECTION 000J1931 LARONIDASE INJECTION / NALBUPHINE / NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES CODE MOD DESCRIPTION 000J0490 BELIMUMAB 000J0500 DICYCLOMINE INJECTION / DEFEROXAMINE MESYLATE / DEPOT 000J2354 OCTREOTIDE INJECTION / ALEFACEPT 000J0220 ALGLUCOSIDASE ALFA INJECTION / DIMECAPROL INJECTION / AMPICILLIN / TORSEMIDE / LONG-ACTING INJ 000J2360 ORPHENADRINE INJECTION / ESTRADIOL VALERATE / INJECTION 000J2770 QUINUPRISTIN/DALFOPRINTIN 000J2778 RANIBIZUMAB INJECTION / DEPO-ESTRADIOL / HYDROXYZINE / OXACILLIN SODIUM / IVIG PRIVIGEN INJECTION / PENICILLIN G POTASSIUM / LIPOSOME INJECTION / LEVORPHANOL TARTRATE / DOBUTAMINE HCL INJECTION 000J1260 DOLASETRON MESYLATE 000J1265 DOPAMINE INJECTION / DIAZOXIDE / DIAZEPAM / CEFAZOLIN SODIUM / HALOPERIDOL DECANOATE / DEXRAZOXANE / PIPERACILLIN / FENTANYL CITRATE / PENTAZOCINE INJECTION 000J3095 TELAVANCIN INJECTION 000J3101 TENECTEPLASE INJECTION / GARAMYCIN / BUPRENORPHINE HYDROCHLORIDE / THEOPHYLLINE / TESTOSTERONE ENANTHATE / BACLOFEN / DIGOXIN / AMIKACIN SULFATE / TESTOSTERONE PROPIONATE / HCL INJECTION 000J2783 RASBURICASE 000J2785 REGADENOSON INJECTION / DEPOT FORM 000J2323 NATALIZUMAB INJECTION 000J2325 NESIRITIDE INJECTION / MG 000J2950 PROMAZINE / EPINEPHRINE / HYDROXYPROGESTERONE CAPROATE / LIDOCAINE / INJECTION 000J1170 HYDROMORPHONE INJECTION / PHYTONADIONE / MAGNESIUM SULFATE / ECULIZUMAB INJECTION 000J1324 ENFUVIRTIDE 000J1325 EPOPROSTENOL INJECTION / NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES CODE MOD DESCRIPTION 000J1600 GOLD SODIUM THIOMALEATE INJECTION / LEVO-DROMORAN / BROMPHENIRAMINE MALEATE / PROCHLORPERAZINE / IRON DEXTRAN / LEVETIRACETAM INJECTION / OCTREOTIDE INJECTION / CORTROSYN / CIPROFLOXACIN / IDURSULFASE INJECTION 000J1744 ICATIBANT 000J1745 INFLIXIMAB INJECTION / DIHYDROERGOTAMINE MESYLT INJECTION / BUPRENEX / C1 ESTERASE INHIBITOR INJECTION 000J0600 EDETATE CALCIUM DISODIUM INJECTION / ANTIHEMOPHILIAC VIII/VWF COMP HUMATE-P INJECTION / DESMOPRESSIN ACETATE / CALCITRIOL / HYDROCORTISONE SODIUM PHOSPHATE / ZIDOVUDINE / VANCOMYCIN HCL / GRANISETRON / PAMIDRONATE DISODIUM / MINOCYCLINE HYDROCHLORIDE / ALPROSTADIL / METOCLOPRAMIDE HCL / BUSULFAN INJECTION / MORPHINE SULFATE / METHOCARBAMOL / HALOPERIDOL / ESTROGEN CONJUGATE INJECTION 000J1430 ETHANOLAMINE OLEATE 000J1438 ETANERCEPT INJECTION / THYPINONE / RANITIDINE / PENICILLIN / PREDNISOLONE ACETATE / LA ROPIVACAINE HCL INJECTION ROMIPLOSTIM INJECTION / DAPTOMYCIN INJECTION / ACYCLOVIR / PENTOBARBITAL SODIUM / CEFOTAXIME SODIUM / DROPERIDOL / MG 1MG / MG 000J0713 CEFTAZIDIME / FREE 000J2278 ZICONOTIDE INJECTION 000J2280 MOXIFLOXACIN INJECTION / TRIAMCINOLONE / DEXAMETHASONE SODIUM PHOSPHATE / RISPERIDONE / MG 10MG / BENZTROPINE MESYLATE / FLUPHENAZINE DECANOATE / INJECTION 000J1800 PROPRANOLOL INJECTION / CLONIDINE HCL 000J0740 CIDOFOVIR INJECTION / ATROPINE SULFATE / MANNITOL / BETASERON / OXYTOCIN / FLUCONAZOLE / LEVOCARNITINE / CEFUROXIME / BOVINE 000J2505 PEGFILGRASTIM INJECTION / CORTICOTROPIN / HCL INJECTION 000J2410 OXYMORPHONE HCL INJECTION 000J2425 PALIFERMIN INJECTION / POWDER 000J1568 OCTAGAM INJECTION / INJECTION 000J2820 SARGRAMOSTIM INJECTION / SPARINE / AMPICILLIN SODIUM / LEVOFLOXACIN / GAMMA GLOBULIN INJECTION 000J1561 GAMUNEX INJECTION / TRIAMCINOLONE DIACETATE / COSYNTROPIN / OLANZAPINE / FOMEPIZOLE / ESTRADIOL / TOBRAMYCIN SULFATE / COLCHICINE INJECTION / MG 000J0640 LEUCOVORIN / LEUPROLIDE ACETATE / CALCIUM GLUCONATE INJECTION / MG 3 / BETA / AMPHOTERICIN B / AMINOPHYLLIN / AZITHROMYCIN / FOSCARNET SODIUM / INJECTION 000J2175 MEPERIDINE HCL 000J2185 MEROPENEM 000J2210 METHYLERGONOVIN MALEATE INJECTION / HCL INJECTION 000J2560 PHENOBARBITAL SODIUM INJECTION 000J2562 PLERIXAFOR INJECTION / AMIFOSTINE / CHLOROTHIAZIDE / PROZINE-50 000J2993 RETEPLASE INJECTION / TESTOSTERONE / FOSAPREPITANT INJECTION / FILGRASTIM INJECTION 000J1441 FILGRASTIM INJECTION / LORAZEPAM / I.U. VWF / ProgrammingLanguage BETA / K / ML / / Technology DIALYSIS / ALPHA / / URL http / SocialTag 
REV. JULY 1, 2013 MANUAL LETTER #[removed]NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES