TX ($12K)
| Code | Description | Total Paid |
|---|---|---|
| J7507 | Tacrolimus, immediate release, oral, 1 mg | $5K |
| J7517 | Mycophenolate mofetil, oral, 250 mg | $4K |
| Q0512 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for a subsequent prescription in a 30-day period | $2K |
| Q0511 | Pharmacy supply fee for oral anti-cancer, oral anti-emetic or immunosuppressive drug(s); for the first prescription in a 30-day period | $1K |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | $195.30 |
| # | Provider | Location | Claims | Total Paid |
|---|---|---|---|---|
| 1 | HEALTHCO PHARMACY CORP | HOUSTON, TX | 11,177 | $12K |