264 B
264 B
| 1 | account_number | item_description | order_date | units_dispensed | plan_name | component | Facility |
|---|---|---|---|---|---|---|---|
| 2 | PT-1141 | Omnipod | 20/07/2025 | 3 | BCBS - FL | pod | Gaboro PA Main |
| 3 | PT-1142 | op5 | 05/06/2025 | 9 | BCBS - FL | pod | Gaboro PA Main |
| 4 | PT-1143 | Omnipod 5 | 11/08/2025 | 1 | BCBS - FL | pod | Gaboro PA Main |