474 B
474 B
| 1 | Account Number | Product | Fill Date | Count | Primary Payer | component |
|---|---|---|---|---|---|---|
| 2 | PT-1041 | Dexcom G7 CGM | 05/05/26 | 3 | Medicaid - GA | sensor |
| 3 | PT-1042 | dexcom g7 | 04/27/26 | 2 | Medicaid - GA | sensor |
| 4 | PT-1043 | Dexcom G7 CGM | 04/28/26 | 9 | Medicaid - GA | sensor |
| 5 | PT-1044 | Dexcom G7 | 04/30/26 | 3 | Medicaid - GA | sensor |
| 6 | PT-1045 | G7 | 05/04/26 | 2 | Medicaid - GA | sensor |
| 7 | PT-1046 | G7 | 05/03/26 | 9 | Medicaid - GA | sensor |
| 8 | PT-1047 | Dexcom G7 CGM | 04/29/26 | 6 | Medicaid - GA | sensor |
| 9 | PT-1048 | Dexcom G7 CGM | 04/25/26 | 3 | Medicaid - GA | sensor |