470 B
470 B
| 1 | External Patient Ref | Item Description | Dispense Date | Quantity | Plan Name | Supply Type |
|---|---|---|---|---|---|---|
| 2 | PT-1221 | dexcom g6 | 05/01/2025 00:00:00 | 6 | Humana | sensor |
| 3 | PT-1222 | Dexcom G6 Pro | 04/23/2025 00:00:00 | 6 | Humana | sensor |
| 4 | PT-1223 | G6 | 08/09/2025 00:00:00 | 6 | Humana | sensor |
| 5 | PT-1224 | dexcom g6 | 06/17/2025 00:00:00 | 6 | Humana | sensor |
| 6 | PT-1225 | Dexcom G6 Pro | 04/30/2025 00:00:00 | 6 | Humana | sensor |
| 7 | PT-1226 | dexcom g6 | 06/07/2025 00:00:00 | 2 | Humana | sensor |
| 8 | PT-1227 | dexcom g6 | 09/03/2025 00:00:00 | 9 | Humana | sensor |