366 B
366 B
| 1 | Member ID | DME Description | DOS | QTY | Insurance | Item Type | Payer ID |
|---|---|---|---|---|---|---|---|
| 2 | PT-1191 | Omnipod 5 | 2026-05-02 | 3 | CMS | pod | 00019 |
| 3 | PT-1192 | op5 | 2026-05-01 | 3 | CMS | pod | 00019 |
| 4 | PT-1193 | OmniPod 5 | 2026-05-03 | 9 | CMS | pod | 00019 |
| 5 | PT-1194 | op5 | 2026-04-27 | 6 | CMS | pod | 00019 |
| 6 | PT-1195 | Omnipod | 2026-05-05 | 9 | CMS | pod | 00019 |
| 7 | PT-1196 | op5 | 2026-05-01 | 9 | CMS | pod | 00019 |
| 8 | PT-1197 | OmniPod 5 | 2026-04-27 | 2 | CMS | pod | 00019 |