276 B
276 B
| 1 | MRN | Product Name | Dispense Date | Qty Dispensed | Plan Name | Supply Type | Supplier | State |
|---|---|---|---|---|---|---|---|---|
| 2 | PT-1031 | Dexcom G6 | 02-May-2026 | 3 | Medicaid | sensor | Gaboro DME | PA |
| 3 | PT-1032 | Dexcom G6 | 30-Apr-2026 | 2 | Medicaid | sensor | Gaboro DME | PA |
| 4 | PT-1033 | Dexcom G6 Pro | 04-May-2026 | 2 | Medicaid | sensor | Gaboro DME | PA |