439 B
439 B
| 1 | Acct No | Product Name | Last Ship Date | Qty Dispensed | Primary Payer | Component |
|---|---|---|---|---|---|---|
| 2 | PT-1181 | Libre 3 | May 23, 2026 | 2 | Molina Healthcare | sensor |
| 3 | PT-1182 | fs libre 3 | May 26, 2026 | 2 | Molina Healthcare | sensor |
| 4 | PT-1183 | FSL3 | May 28, 2026 | 6 | Molina Healthcare | sensor |
| 5 | PT-1184 | FreeStyle Libre 3 | May 29, 2026 | 3 | Molina Healthcare | sensor |
| 6 | PT-1185 | fs libre 3 | May 20, 2026 | 9 | Molina Healthcare | sensor |
| 7 | PT-1186 | FSL3 | May 29, 2026 | 6 | Molina Healthcare | sensor |