209 B
209 B
| 1 | Acct No | Product Name | Last Ship Date | Qty Dispensed | Primary Payer | Component |
|---|---|---|---|---|---|---|
| 2 | PT-1181 | Omnipod | Jul 31, 2025 | 3 | Centene | pod |
| 3 | PT-1182 | op5 | May 06, 2025 | 1 | Centene | pod |
| 4 | PT-1183 | Omnipod | Sep 06, 2025 | 3 | Centene | pod |