394 B
394 B
| 1 | acct_no | product | fill date | units | insurance name | type | Branch Code |
|---|---|---|---|---|---|---|---|
| 2 | PT-1211 | Libre 3 | 2026-05-03 | 3 | UHC | sensor | GA-02 |
| 3 | PT-1212 | FSL3 | 2026-04-28 | 2 | UHC | sensor | GA-02 |
| 4 | PT-1213 | FSL3 | 2026-04-29 | 9 | UHC | sensor | GA-02 |
| 5 | PT-1214 | Libre 3 | 2026-04-26 | 2 | UHC | sensor | GA-02 |
| 6 | PT-1215 | Libre 3 | 2026-05-03 | 2 | UHC | sensor | GA-02 |
| 7 | PT-1216 | fs libre 3 | 2026-04-28 | 3 | UHC | sensor | GA-02 |
| 8 | PT-1217 | fs libre 3 | 2026-05-02 | 1 | UHC | sensor | GA-02 |